Experimental Validation of Specialised Questioning Techniques in Conservation

Conservation increasingly relies on social science tools to understand human behavior. Specialized questioning techniques (SQTs) are a suite of methods designed to reduce bias in social surveys and are widely used to collect data on sensitive topics, including compliance with conservation rules. Most SQTs have been developed in Western, industrialized, educated, rich, and democratic countries, meaning their suitability in other contexts may be limited. Whether these techniques perform better than conventional direct questioning is important for those considering their use. We designed an experiment to validate the performance of four SQTs (unmatched count technique, randomized response technique, crosswise model, and bean method) against direct questions when asking about a commonly researched sensitive behavior in conservation, wildlife hunting. We developed fictional characters, and for each method asked respondents to report the answers that each fictional character should give when asked if they hunt wildlife. We collected data from 609 individuals living close to protected areas in two different cultural and socioeconomic contexts (Indonesia and Tanzania) to quantify the extent to which respondents understood and followed SQT instructions and to explore the sociodemographic factors that influenced a correct response. Data were modeled using binomial general linear mixed models. Participants were more likely to refuse to answer questions asked using SQTs compared with direct questions. Model results suggested that SQTs were harder for participants to understand. Demographic factors (e.g., age and education level) significantly influenced response accuracy. When sensitive responses to sensitive questions were required, all SQTs (excluding the bean method) outperformed direct questions, demonstrating that SQTs can successfully reduce sensitivity bias. However, when reviewing each method, most respondents (59–89%) reported they would feel uncomfortable using them to provide information on their own hunting behavior, highlighting the considerable challenge of encouraging truthful reporting on sensitive topics. Our results demonstrate the importance of assessing the suitability of social science methods prior to their implementation in conservation contexts

The costs of introducing artemisinin-based combination therapy: evidence from district-wide implementation in rural Tanzania

BACKGROUND\ud \ud The development of antimalarial drug resistance has led to increasing calls for the introduction of artemisinin-based combination therapy (ACT). However, little evidence is available on the full costs associated with changing national malaria treatment policy. This paper presents findings on the actual drug and non-drug costs associated with deploying ACT in one district in Tanzania, and uses these data to estimate the nationwide costs of implementation in a setting where identification of malaria cases is primarily dependant on clinical diagnosis.\ud \ud METHODS\ud \ud Detailed data were collected over a three year period on the financial costs of providing ACT in Rufiji District as part of a large scale effectiveness evaluation, including costs of drugs, distribution, training, treatment guidelines and other information, education and communication (IEC) materials and publicity. The district-level costs were scaled up to estimate the costs of nationwide implementation, using four scenarios to extrapolate variable costs.\ud \ud RESULTS\ud \ud The total district costs of implementing ACT over the three year period were slightly over one million USD, with drug purchases accounting for 72.8% of this total. The composite (best) estimate of nationwide costs for the first three years of ACT implementation was 48.3 million USD (1.29 USD per capita), which varied between 21 and 67.1 million USD in the sensitivity analysis (2003 USD). In all estimates drug costs constituted the majority of total costs. However, non-drug costs such as IEC materials, drug distribution, communication, and health worker training were also substantial, accounting for 31.4% of overall ACT implementation costs in the best estimate scenario. Annual implementation costs are equivalent to 9.5% of Tanzania's recurrent health sector budget, and 28.7% of annual expenditure on medical supplies, implying a 6-fold increase in the national budget for malaria treatment.\ud \ud CONCLUSION\ud \ud The costs of implementing ACT are substantial. Although drug purchases constituted a majority of total costs, non-drug costs were also considerable. It is clear that substantial external resources will be required to facilitate and sustain effective ACT delivery across Tanzania and other malaria-endemic countries

Why do health workers in rural Tanzania prefer public sector employment?

Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts. The study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs) and 29 in-depth interviews (IDIs) with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. The study found a clear preference for public sector employment. This was associated with health worker rights and access to various benefits offered to health workers in government service, particularly the favourable pension schemes providing economic security in old age. Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace. The preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health facilities is a challenge in a resource constrained health system where church-run health facilities are vital in the provision of health care in rural areas and where patients tend to prefer these services. In order to ensure equity in distribution of qualified health workers in Tanzania, a national regulation and legislation of the pension schemes is required