Integrating reproductive and child health and HIV services in Tanzania: Implication to policy, systems and services

In Tanzania, reproductive health and HIV services are coordinated by the Ministry of Health and Social Welfare in two separate units namely Reproductive and Child Health Section and the National AIDS Control Programme. The importance of integrating the two services that are vertically run is expected to improve access to and uptake of key essential services and extend coverage to underserved and vulnerable populations and thus minimizing missed opportunities. Experts around the world recognize the central role of Sexual and Reproductive Health (SRH) services in preventing HIV infection. Evidence suggests that improving access to contraception for women to prevent pregnancy is an important and cost-effective way to prevent HIV-positive births. Integrating SRH and HIV services therefore verifies its importance for improving maternal and child health as well as leading to prevention of HIV infection.  The primary objective of this review was to gain an understanding of the current linkages between SRH and HIV within Tanzania’s policies, programmes, systems and services. Policy documents, guidelines, national laws, and published reports on SRH and HIV were reviewed.  The majority of the reviewed documents mentioned fundamentals of integration between SRH and HIV. Majority of policies and guidelines both in family planning (FP) and HIV documents mandate bi-directional linkages. This review suggests that there are linkages between the two services and can be operationalised together. However, policies and guidelines only specify services to be integrated without due consideration of resources and structural orientation for linked services

Acceptability of malaria rapid diagnostic tests administered by village health workers in Pangani District, North eastern Tanzania.

BACKGROUND: Malaria continues to top the list of the ten most threatening diseases to child survival in Tanzania. The country has a functional policy for appropriate case management of malaria with rapid diagnostic tests (RDTs) from hospital level all the way to dispensaries, which are the first points of healthcare services in the national referral system. However, access to these health services in Tanzania is limited, especially in rural areas. Formalization of trained village health workers (VHWs) can strengthen and extend the scope of public health services, including diagnosis and management of uncomplicated malaria in resource-constrained settings. Despite long experience with VHWs in various health interventions, Tanzania has not yet formalized its involvement in malaria case management. This study presents evidence on acceptability of RDTs used by VHWs in rural northeastern Tanzania. METHODS: A cross-sectional study using quantitative and qualitative approaches was conducted between March and May 2012 in Pangani district, northeastern Tanzania, on community perceptions, practices and acceptance of RDTs used by VHWs. RESULTS: Among 346 caregivers of children under 5 years old, no evidence was found of differences in awareness of HIV rapid diagnostic tests and RDTs (54 vs. 46 %, p = 0.134). Of all respondents, 92 % expressed trust in RDT results, 96 % reported readiness to accept RDTs by VHWs, while 92 % expressed willingness to contribute towards the cost of RDTs used by VHWs. Qualitative results matched positive perceptions, attitudes and acceptance of mothers towards the use of RDTs by VHWs reported in the household surveys. Appropriate training, reliable supplies, affordability and close supervision emerged as important recommendations for implementation of RDTs by VHWs. CONCLUSION: RDTs implemented by VHWs are acceptable to rural communities in northeastern Tanzania. While families are willing to contribute towards costs of sustaining these services, policy decisions for scaling-up will need to consider the available and innovative lessons for successful universally accessible and acceptable services in keeping with national health policy and sustainable development goals

Changing Customary Land Tenure Regimes in Tanzania : The case of women's land rights in matrilineal and patrilineal communities

Customary land tenure is a dominant system in agrarian societies and in Africa generally,which is evolving from communal to individual regimes in response to socio-economicissues. Various studies have paid attention to economic incentives of shifting communaltenure into private property, while ignoring social implication of such changes. In Tanzania,while progress has been made to strengthen property rights through legislation, somecommunity members, particularly women, have lost their land rights. The objectives of thisstudy are to examine the changing customary land tenure regimes from communal toprivate, with a focus on the existing policies and laws protecting property rights, changesin social relations that determine customary land tenure in matrilineal and patrilinealcommunities. A cross-sectional study was carried out, whereby documentary reviewinterviews and focus group discussions were used to collect data. The study’s findings indicated that cultural mix has influenced land transfer practices,whereby social relations in matrilineal and patrilineal communities and women'sattachment to land have been affected. Intermarriage contributes to the loss of propertyrights in the case of divorce or death of a husband, particularly in a matrilineal society. Lowlevels of education and income constrain women from competing in the land market. Jointtitles allow women to be involved in making decisions about land use in households, andto claim property rights if they are widows. On the other hand, there is a perception that ajoint title does not ensure a positive outcome for some women, due to continuing subtleviolation of women’s land rights. The study revealed that although land laws exist, the main challenge was knowing abouttheir applicability. Land disputes persisted among those using the land, mainly as a resultof the violation of land rights. Although dispute resolution machinery allowing people topresent their land-related claims were in place, the resolutions reached largely depended onthe parties’ knowledge of the existence of the adjudication of land cases. The studyrecommends a review of policies and programmes, collaboration with non-governmentalorganizations (NGOs), women’s empowerment and a programme aimed at changingcommunity attitudes.Traditionell sedvanerätt till mark är ett dominerande system i agrara samhällen och i Afrikai allmänhet, som utvecklas från kollektiva till individuella system som svar påsocioekonomiska frågor. Olika studier har uppmärksammat ekonomiska incitament för attskifta från traditionell sedvanerätt till privat äganderätt samtidigt som man ignorerar desociala konsekvenserna av sådana förändringar. I Tanzania, medan framsteg har gjorts föratt stärka äganderätten till mark genom lagstiftning, har vissa medlemmar av samhället,särskilt kvinnor, förlorat sina markrättigheter. Syftet med denna studie är att undersöka deförändrade systemen för traditionell sedvanerätt till mark från kollektiva till privata medfokus på befintliga riktlinjer och lagar som skyddar äganderätt till mark, förändringar isociala relationer som bestämmer traditionell sedvanerätt till mark i matrilinjära ochpatrilinjära samhällen. En tvärsnittsstudie genomfördes, där dokumentstudier, intervjueroch fokusgruppsdiskussioner användes för att samla in data. Studiens resultat indikerade att kulturell blandning har påverkat formerna förmarköverlåtelser, där sociala relationer i matrilinjära och patrilinjära samhällen ochkvinnors anknytning till mark har påverkats. Blandäktenskap bidrar till förlust aväganderätt till mark vid skilsmässa eller makes dödsfall, särskilt i ett matrilinjärt samhälle.Låga utbildnings- och inkomstnivåer hindrar kvinnor från att konkurrera påfastighetsmarknaden. Gemensam äganderätt gör det möjligt för kvinnor att vara delaktigai att fatta beslut om markanvändning i hushållen och att göra anspråk på markrättigheterom de är änkor. Å andra sidan finns det en uppfattning om att ett gemensamt ägande integaranterar ett positivt resultat för vissa kvinnor, på grund av fortsatt intrång i kvinnorsmarkrättigheter. Studien visade att även om det finns fastighetsrättslig lagstiftning var den störstautmaningen att känna till deras tillämplighet. Marktvister kvarstod bland dem som användemarken, främst till följd av intrång i markrättigheter. Trots att mekanismer för tvistlösningsom tillåter personer att framföra sina markrelaterade anspråk fanns, berodde de uppnåddalösningarna i stor utsträckning på parternas kunskap om förekomsten av prövning avmarkrelaterade ärenden. Studien rekommenderar en översyn av riktlinjer och program,samarbete med icke-statliga organisationer (NGO), kvinnors egenmakt och ett programsom syftar till att förändra samhällsattityder.QC 20220919</p

Gender Gaps in Property Rights in Rural Communities of Tanzania: Challenges towards Achieving Sustainable Development Goals

Gender gaps in property rights have remained a concern in both developed and developing world. Gender equality in property rights has been given attention by the international community as one of the pillars of the sustainable development goals (SDGs). Despite the efforts made in achieving gender equality, Tanzania gender gaps emanating from the societal norms in rural communities still persist.This paper explores the existing gender gaps in property rights in rural areas of Kyela district and the associated challenges in achieving the sustainable development goals. Data collection involved documentary review, interviews and focus group discussions. Purposive sampling was used to select  study participants. The findings show that socio-cultural norms contradict the legal provisions aimed to brige gender gaps in property rights. Nonetheless, some progress towards attaining gender equity were observed in context of land co-occupancy. An illustrative example was the case of women whose name appeared in certificate of customary right of occupancy who the study noted were involved in decision making related to distribution of family land. Socio-cultural traditions do not offer equality in inheriting, controlling and transferring land. Gender inequality in opportunities for example education, limit women's knowledge about legal provisions which protect their property rights. The sustainable development targets in eliminating discriminatory practices against women will not be achieved if rigid societal norms remain undressed. In order to ensure that no one is left behind, there is a need to implement societal attitude change programmes.

Changing Customary Land Tenure Regimes in Tanzania : The case of women's land rights in matrilineal and patrilineal communities

Customary land tenure is a dominant system in agrarian societies and in Africa generally,which is evolving from communal to individual regimes in response to socio-economicissues. Various studies have paid attention to economic incentives of shifting communaltenure into private property, while ignoring social implication of such changes. In Tanzania,while progress has been made to strengthen property rights through legislation, somecommunity members, particularly women, have lost their land rights. The objectives of thisstudy are to examine the changing customary land tenure regimes from communal toprivate, with a focus on the existing policies and laws protecting property rights, changesin social relations that determine customary land tenure in matrilineal and patrilinealcommunities. A cross-sectional study was carried out, whereby documentary reviewinterviews and focus group discussions were used to collect data. The study’s findings indicated that cultural mix has influenced land transfer practices,whereby social relations in matrilineal and patrilineal communities and women'sattachment to land have been affected. Intermarriage contributes to the loss of propertyrights in the case of divorce or death of a husband, particularly in a matrilineal society. Lowlevels of education and income constrain women from competing in the land market. Jointtitles allow women to be involved in making decisions about land use in households, andto claim property rights if they are widows. On the other hand, there is a perception that ajoint title does not ensure a positive outcome for some women, due to continuing subtleviolation of women’s land rights. The study revealed that although land laws exist, the main challenge was knowing abouttheir applicability. Land disputes persisted among those using the land, mainly as a resultof the violation of land rights. Although dispute resolution machinery allowing people topresent their land-related claims were in place, the resolutions reached largely depended onthe parties’ knowledge of the existence of the adjudication of land cases. The studyrecommends a review of policies and programmes, collaboration with non-governmentalorganizations (NGOs), women’s empowerment and a programme aimed at changingcommunity attitudes.Traditionell sedvanerätt till mark är ett dominerande system i agrara samhällen och i Afrikai allmänhet, som utvecklas från kollektiva till individuella system som svar påsocioekonomiska frågor. Olika studier har uppmärksammat ekonomiska incitament för attskifta från traditionell sedvanerätt till privat äganderätt samtidigt som man ignorerar desociala konsekvenserna av sådana förändringar. I Tanzania, medan framsteg har gjorts föratt stärka äganderätten till mark genom lagstiftning, har vissa medlemmar av samhället,särskilt kvinnor, förlorat sina markrättigheter. Syftet med denna studie är att undersöka deförändrade systemen för traditionell sedvanerätt till mark från kollektiva till privata medfokus på befintliga riktlinjer och lagar som skyddar äganderätt till mark, förändringar isociala relationer som bestämmer traditionell sedvanerätt till mark i matrilinjära ochpatrilinjära samhällen. En tvärsnittsstudie genomfördes, där dokumentstudier, intervjueroch fokusgruppsdiskussioner användes för att samla in data. Studiens resultat indikerade att kulturell blandning har påverkat formerna förmarköverlåtelser, där sociala relationer i matrilinjära och patrilinjära samhällen ochkvinnors anknytning till mark har påverkats. Blandäktenskap bidrar till förlust aväganderätt till mark vid skilsmässa eller makes dödsfall, särskilt i ett matrilinjärt samhälle.Låga utbildnings- och inkomstnivåer hindrar kvinnor från att konkurrera påfastighetsmarknaden. Gemensam äganderätt gör det möjligt för kvinnor att vara delaktigai att fatta beslut om markanvändning i hushållen och att göra anspråk på markrättigheterom de är änkor. Å andra sidan finns det en uppfattning om att ett gemensamt ägande integaranterar ett positivt resultat för vissa kvinnor, på grund av fortsatt intrång i kvinnorsmarkrättigheter. Studien visade att även om det finns fastighetsrättslig lagstiftning var den störstautmaningen att känna till deras tillämplighet. Marktvister kvarstod bland dem som användemarken, främst till följd av intrång i markrättigheter. Trots att mekanismer för tvistlösningsom tillåter personer att framföra sina markrelaterade anspråk fanns, berodde de uppnåddalösningarna i stor utsträckning på parternas kunskap om förekomsten av prövning avmarkrelaterade ärenden. Studien rekommenderar en översyn av riktlinjer och program,samarbete med icke-statliga organisationer (NGO), kvinnors egenmakt och ett programsom syftar till att förändra samhällsattityder.QC 20220919</p