Implementation of an insecticide-treated net subsidy scheme under a public-private partnership for malaria control in Tanzania – challenges in implementation

BACKGROUND: In the past decade there has been increasing visibility of malaria control efforts at the national and international levels. The factors that have enhanced this scenario are the availability of proven interventions such as artemisinin-based combination therapy, the wide scale use of insecticide-treated nets (ITNs) and a renewed emphasis in indoor residual house-spraying. Concurrently, there has been a window of opportunity of financial commitments from organizations such as the Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM), the President's Malaria Initiative and the World Bank Booster programme. METHODS: The case study uses the health policy analysis framework to analyse the implementation of a public-private partnership approach embarked upon by the government of Tanzania in malaria control - 'The Tanzania National Voucher Scheme'- and in this synthesis, emphasis is on the challenges faced by the scheme during the pre-implementation (2001 - 2004) and implementation phases (2004 - 2005). Qualitative research tools used include: document review, interview with key informants, stakeholder's analysis, force-field analysis, time line of events, policy characteristic analysis and focus group discussions. The study is also complemented by a cross-sectional survey, which was conducted at the Rufiji Health Demographic Surveillance Site, where a cohort of women of child-bearing age were followed up regarding access and use of ITNs. RESULTS: The major challenges observed include: the re-introduction of taxes on mosquito nets and related products, procurement and tendering procedures in the implementation of the GFATM, and organizational arrangements and free delivery of mosquito nets through a Presidential initiative. CONCLUSION: The lessons gleaned from this synthesis include: (a) the consistency of the stakeholders with a common vision, was an important strength in overcoming obstacles, (b) senior politicians often steered the policy agenda when the policy in question was a 'crisis event', the stakes and the visibility were high, (c) national stakeholders in policy making have an advantage in strengthening alliances with international organizations, where the latter can become extremely influential in solving bottlenecks as the need arises, and (d) conflict can be turned into an opportunity, for example the Presidential initiative has inadvertently provided Tanzania with important lessons in the organization of 'catch-up' campaigns

Would a commodity-based trade approach improve market access for Africa? A case study of the potential of beef exports from communal areas of Namibia

They would like to acknowledge the help of the following key informants: Paul Strydom, Willie Shutz, Gizaw Negussie, Susanne Thalwitzer and Goliath Tujendapi of the Meat Board of Namibia; Cyprianus Khaiseb, Berndt Muller, Brian Perkins, Marco Duvel, Obed Kaatura, Berry Manda, Diederick Rupping, Hellmut von Seydlitz and Rosa Katjivena of the Meat Corporation of Namibia; Alexander Toto and Frank Chitate of the Directorate of Namibian Veterinary Service; Bertus Kruger of GTZ; and Andre Mouton. They also wish to thank Gavin Thomson for guidance in reviewing preliminary drafts of this article which is an output of a research project funded by the UK Department for International Development. The views expressed are those of the authors and do not necessarily reflect the views or policies of DFID