Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders' perspectives

The development of effective and inclusive health financing reforms is crucial for the progressive realisation of universal health coverage in low-income and middle-income countries. Tanzania has been reforming health financing policies to expand health insurance coverage and achieve better access to quality healthcare for all. Recent reforms have included improved community health funds (iCHFs), and others are underway to implement a mandatory national health insurance scheme in order to expand access to services and improve financial risk protection. Governance is a crucial structural determinant for the successful implementation of health financing reforms, however there is little understanding of the governance elements that hinder the implementation of health financing reforms such as the iCHF in Tanzania. Therefore, this study used the perspectives of health sector stakeholders to explore governance factors that influence the implementation of health financing reforms in Tanzania. We interviewed 36 stakeholders including implementers of health financing reforms, policymakers and health insurance beneficiaries in the regions of Dodoma, Dar es Salaam and Kilimanjaro. Normalisation process theory and governance elements guided the structure of the in-depth interviews and analysis. Governance factors that emerged from participants as facilitators included a shared strategic vision for a single mandatory health insurance, community engagement and collaboration with diverse stakeholders in the implementation of health financing policies and enhanced monitoring of iCHF enrolment due to digitisation of registration process. Governance factors that emerged as barriers to the implementation were a lack of transparency, limited involvement of the private sector in service delivery, weak accountability for revenues generated from community level and limited resources due to iCHF design. If stakeholders do not address the governance factors that hinder the implementation of health financing reforms, then current efforts to expand health insurance coverage are unlikely to succeed on their own

Comparative study of three community seed supply strategies in Tanzania

Community seed production projects are being implemented throughout Africa. This case study compares three such projects in central Tanzania. All three programs seek to encourage small-scale farmers to produce and sell sorghum and pearl millet varieties, but use different approaches to solve the common problems of seed multiplication and distribution. Three projects were relatively successful in promoting seed production. Training was provided in seed quality control, and growers generally understood the differences between seed and grain. However, questions remain about the practicality of producing certified seed, quality declared seed, or common grade seed. External investments remain necessary for the production and delivery of source seed. The biggest threat to the viability of these programs is the problem of seed marketing. While farmers are expected to sell seed to their neighbors, most sought marketing assistance from external buyers. Further investments are still needed in testing alternative marketing strategies. The study highlights a number of policy issues. None of the three programs is likely to continue without external technical support and funding. The appropriate, long-term levels of public investment need to be defined. In addition, the relationship between public and private sector investments in seed production and distribution needs to be explicitly define

The psychosocial determinants of the intention to test for HIV among young men in KwaZulu-Natal province, South Africa

: Voluntary counselling and testing is one of the effective prevention strategies against the HIV/AIDS epidemic. This study investigated the psychosocial determinants of the intention to be tested for HIV among young men in South Africa’s KwaZulu-Natal province using the theory of planned behaviour as the guiding framework. A facilitator-administered questionnaire was used to collect data among 350 isiZulu-speaking men between the ages of 18 and 35. Results show that 24% reported ever having tested. Intention to test showed strong positive correlations with subjective norm to test (r = 0.67), intention to use condoms (r = 0.65), intention to reduce alcohol use (r = 0.60), subjective norm to reduce alcohol use (r = 0.54), and subjective norm to use condoms (r = 0.51). For multiple regression, attitude, subjective norm and perceived behavioural control explained 43% of the variance in intention to test, with subjective norm and perceived behavioural control making significant unique contributions. An additional 12% of the variance was explained by intention to reduce alcohol and drug use, and use condoms

Preliminary Evaluation of Slaughter Value and Carcass Composition of Indigenous Sheep and Goats from Traditional Production System in Tanzania

The aim of the pilot study was to evaluate slaughter characteristics and carcass composition of indigenous long fat tailed sheep and Small East African goats purchased from the auction markets slaughtered at 1.5 to 2 yrs of age and 20 kg to 25 kg live weight. The animals were slaughtered according to halal standard procedures. The left half carcasses were jointed into eight wholesale joints, and dissected into muscles, fat and bone, which were weighed separately. Sheep had greater (p<0.05) slaughter BW (22.29 kg vs 20.50 kg) and empty BW (20.17 kg vs 18.67 kg) than goats (p<0.05). Dressing percentages were lower (p<0.001) in sheep than goats when carcass weight was expressed as percentage of slaughter BW (42.31% and 47.15%) and empty BW (46.75% and 51.79%). Sheep carcasses had lower (p<0.001) proportion (66.18% vs 71.64%) of muscles and higher (p<0.001) proportion of fat (7.41% vs 3.44%) than goat carcasses. Sheep had proportionally lighter (p<0.001) shoulder (18.89% vs 22.68%) and heavier (p<0.05) proportion of chump (7.916% vs 6.76%) and main rib (8.12% vs 7.07%). Sheep had more (p<0.001) muscles in the leg (28.83% vs 27.08%) and main rib (7.62% vs 6.36%) than goats. Sheep had less (p<0.001) muscles (20.28% vs 23.56%) in shoulder joints when expressed as percentage of total muscle of carcasses. It is concluded that there are differences in sheep and goat both in terms of carcass and joint yields and composition. The present study also implies that there is need to consider setting different meat cuts and prices for these cuts when one takes into account the differences in muscle distribution within joints in sheep and goats

Prevalence and correlates of partner violence among adolescent girls and young women: Evidence from baseline data of a cluster randomised trial in Tanzania.

BACKGROUND: Little has been documented about partner violence among adolescent girls and young women (AGYW) who are out of school, a factor associated with HIV acquisition. To understand areas for prioritising HIV prevention intervention efforts, we explored the prevalence and correlates of partner violence among out of school AGYW in Shinyanga, Tanzania. METHODS: A cross-sectional analysis of data from AGYW aged 15-23 years recruited in a cluster randomised trial conducted between October and December 2017 was used to examine correlates of partner violence. Data were collected through an Audio Computer-Assisted Self-interview. Multivariate logistic regression analysis was used to evaluate the association. RESULTS: 2276 (75.5%) AGYW were sexually active. Of these, 816 (35.9%) reported having experienced violence from partners in the last six months. After adjusting for other covariates, being formerly married (AOR = 1.55, 95% CI:1.02, 2.37), having children (AOR = 1.79, 95% CI:1.47, 2.16), anxiety and depression symptoms (AOR = 3.27, 95%CI: 2.15, 4.96), having engaged in sex work in the past six months (AOR = 1.92, 95% CI: 1.45, 2.53) and economic deprivation (AOR = 1.61, 95% CI: 1.34,1.92) were significantly associated with partner violence. CONCLUSIONS: Almost one in three sexually active AGYW had experienced partner violence in the 6 months preceding the survey. The findings underscore the need for future research to focus on understanding the reasons and dynamics underlying high level of partner violence among AGYW. Furthermore, there is a need for implementing intervention programs that aim to reduce economic deprivation among AGYWs and address social norms and structures perpetuating violence against AGYW. TRIAL REGISTRATION: ClinicalTrials.gov-ID NCT03597243

Data resource profile: network for analysing longitudinal population-based HIV/AIDS data on Africa (ALPHA Network)

The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network, http://alpha.lshtm.ac.uk/) brings together ten population-based HIV surveillance sites in eastern and southern Africa, and is coordinated by the London School of Hygiene and Tropical Medicine (LSHTM). It was established in 2005 and aims to (i) broaden the evidence base on HIV epidemiology for informing policy, (ii) strengthen the analytical capacity for HIV research, and (iii) foster collaboration between network members. All study sites, some starting in the late 1980s and early 1990s, conduct demographic surveillance in populations that range from approximately 20 to 220 thousand individuals. In addition, they conduct population-based surveys with HIV testing, and verbal autopsy interviews with relatives of deceased residents. ALPHA Network datasets have been used for studying HIV incidence, sexual behaviour and the effects of HIV on mortality, fertility, and household composition. One of the network’s substantive focus areas is the monitoring of AIDS mortality and HIV services coverage in the era of antiretroviral therapy. Service use data are retrospectively recorded in interviews and supplemented by information from record linkage with medical facilities in the surveillance areas. Data access is at the discretion of each of the participating sites, but can be coordinated by the network

Impact of the COVID-19 pandemic on type 2 diabetes care and factors associated with care disruption in Kenya and Tanzania

Background: The COVID-19 pandemic affected healthcare delivery globally, impacting care access and delivery of essential services. Objectives: We investigated the pandemic’s impact on care for patients with type 2 diabetes and factors associated with care disruption in Kenya and Tanzania. Methods: A cross-sectional study was conducted among adults diagnosed with diabetes pre-COVID-19. Data were collected in February–April 2022 reflecting experiences at two time-points, three months before and the three months most affected by the COVID-19 pandemic. A questionnaire captured data on blood glucose testing, changes in medication prescription and access, and healthcare provider access. Results: We recruited 1000 participants (500/country). Diabetes care was disrupted in both countries, with 34.8% and 32.8% of the participants reporting change in place and frequency of testing in Kenya, respectively. In Tanzania, 12.4% and 17.8% reported changes in location and frequency of glucose testing, respectively. The number of health facility visits declined, 14.4% (p &lt; 0.001) in Kenya and 5.6% (p = 0.001) in Tanzania. In Kenya, there was a higher likelihood of severe care disruption among insured patients (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI][1.05–2.34]; p = 0.029) and a lower likelihood among patients residing in rural areas (aOR, 0.35[95%CI, 0.22–0.58]; p &lt; 0.001). Tanzania had a lower likelihood of severe disruption among insured patients (aOR, 0.51[95%CI, 0.33–0.79]; p = 0.003) but higher likelihood among patients with low economic status (aOR, 1.81[95%CI, 1.14–2.88]; p = 0.011). Conclusions: COVID-19 disrupted diabetes care more in Kenya than Tanzania. Health systems and emergency preparedness should be strengthened to ensure continuity of service provision for patients with diabetes