Aggregate cost implications of selected Cost-Drivers \ud in the Tanzanian Health Sector\ud

\ud Health is an important aspect of life of which one of its determinants is healthcare which is consumed in order to restore back deteriorated health to optimal pre-illness levels. The consumption of healthcare however has cost implications and accounts for a large share of resources directed towards the health sector. In health sector financing, it is vital to identify major cost components and create awareness about the costs of decisions. It is thus vital to identify factors that can cause changes in the cost of identified activities. A number of costly programs have been initiated and some others are on the horizon. In order to create awareness about the financial consequences of these decisions and to draw attention to the financing needs of the health sector, it is considered necessary to analyze the major health sector programs and initiatives with regard to the changes in costs brought about by new strategies, guidelines and interventions (including the adoption of new technologies), and aggregate these costs. The main objective of this study was to identify cost-driving decisions in the health sector. The study methodology comprised of three independent but complementary methodologies and activities: (a) Desk review of literature and documents; (b) Interviews with officials from MOHSW, programs and agencies involved in setting and promoting standards at international level; (c) collection of primary data/information and subsequent analysis of the same. The study reviewed 11 plans, including summary plans like the Health Sector Strategic Plan III and the Primary Health Services Development Program 2007 -2017 and national disease control programme plans/strategies. However, not all of cost-driving decisions in these plans could be integrated into the analysis because the plans are undergoing reprogramming, as the previous cost estimates are regarded not to be realistic relative to achieving plan objectives. In addition the costs of some decisions in some plans/strategies HRH, infrastructure, health care financing strategy, mhealth, etc. are not established or are in the process of being costed or reviewed. It should also be noted that the consultants did not assess all plans/strategies and their associated costs as to their plausibility. This was neither task of the consultants, nor would the time allocated to the study have allowed such an in-depth review. The study reviewed a total of 11 multi-year plans/strategies and found four plans to be affected by costs of decisions. Such decisions are: the adaption of WHO recommendations on Anti-retroviral Treatment eligibility criteria; re-treatment of conventional nets; indoor residual spraying; sustaining availability of long lasting insecticide treated nets (LLINs); provision of delivery kits to pregnant women in public health facilities, and the potential future introduction of a malaria vaccine, human papilloma virus and pneumococcal vaccines, which affect the Health Sector HIV and AIDS Strategic Plan II (HSHSP II) 2008 – 2012, the Malaria Mid-Term Strategic Plan 2008 – 2013 (NMCP), the National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania 2008 – 2015 (the Road Map), and the Expanded Program on Immunization 2010 - 2015 Comprehensive Multi Year Plan (EPI), respectively. The study found that these decisions have a significant cost implication to a tune of US$706,688,405 over a five year period 2011- 2015. The initially estimated costs of programs that are currently being updated (HSHSP II, EPI, NMCP and the Road Map) is US$ 2,297,009,378 exclusive of the identified cost drivers. The estimated cost of decisions is about 8 % of the total costs for health sector in Tanzania (HSSP III estimate) and about 3.3% of the 2009 GDP and added nominal per capita health spending/cost of US$17.3 (2009 population estimate) for five year period (annual per capita cost of US$ 3.46). This expenditure will definitely boost per capita health spending (US$13.45 in 2008/9). However, concerted revenue effort is needed if we are to hit HSSP III target of US$ 26.6 in 2014/15. The National Strategy for Non-communicable Diseases 2009 – 2015 did not include estimates, while most parts of the National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania 2008 – 2015 are undergoing reprogramming, as the previous cost estimates are regarded not to be realistic relative to achieving plan objectives. The rest of the programs are not significantly affected by cost of decisions. However, the estimated cost is likely to be higher owing to the fact that costs of some decisions in MMAM components such as HRH, infrastructure, health care financing strategy, mhealth, etc. are not established or are in the process of being costed or reviewed. Prevention and treatment of illness are the major strategies used to maintain or improve the health status of a population. Allocation of health resources are usually skewed towards treatment probably because addressing existing illnesses seem a present and clear danger than addressing potential illnesses which is what prevention is all about. Prevention and health promotion however lead to greater benefits than treatment in the long run in the sense that it reduces future demand for treatment than treatment alone does and has stronger merit good characteristics than treatment of illness. Health planning should thus intensify focus on prevention through promoting lifestyle and behaviour changes as well as intensifying prevention and health promotion at community level. Most health sector multi-year plans are characterized by heavy resource dependence on development partners. Such levels of dependence tend to compromise control over some decisions especially those supported by financiers. That is, recipients may be tempted to accept a full funded activity even if there is an ongoing similar activity which ends up creating parallel rather than complementary activities with cost implications. Thus, the financiers and recipients should undertake thorough analysis of potential decisions based on their cost implications (direct and indirect) as well as the time parameters, while avoiding decisions that spin off similar activities rather than complementing the existing ones. This can be facilitated by coordinated analysis from the MOHSW by keeping and monitoring comprehensive cost driver table enriched by inputs from all health sector programs and plans. Continuous reviews of the plans enhance the capacity of programs to adequately identify cost drivers and therefore enhance the planning process. However, reviews are not always undertaken on time and as regular as possible due to lack of resources or transfer of resources set aside for review process to implement other pressing components of the plan. MOHSW should make costing part of the plan a compulsory exercise for approval by the management and should not endorse plans which have not been adequately costed. MOHSW should also consider making reviews of multi-year plans a prerequisite for release of fund for subsequent implementation. Moreover, the reviews should integrate all stakeholders and involve technical people who are knowledgeable in costing and planning. The fact that most of the multi-year plans had indicative budgets, while others are not costed at all, warrants the conclusion that the basic knowledge in costing such as collaboration, parameter assumptions, time, manpower, and resources is lacking. Emphasis should thus be placed on developing and improving costing capacity in the programs as well as the MOHSW in terms of acquiring costing tools and exposure. The MOHSW should ensure that the priority activities of the strategies/plans are funded. This could be done through lobbying the government and other stakeholders for more resources. Protocols such as Abuja Declaration 2001, in which African governments committed themselves to scale up health budget to 15% of the annual budget, could be useful in this end. Also the government and local authorities through laws/bylaws could establish and commit specific sources of resources for the health sector. This should be pursued by keeping a close eye on the ratio of available resources to required resources which can indicate opportunities which development partners can be of help as well as providing an indication of the realism of planning. A review of the plans found the ratio of available resources to required resources to be 76 and 84 percent, respectively, for the Health Sector Strategic Plan III and the Expanded Program on Immunization 2010 – 2015 Comprehensive Multi Year Plan. The Malaria Medium Term Strategic Plan 2008-2013 on the other hand had the lowest ratio of available resources to required resources of 35 percent.\u

Recent advances in pretreatment of lignocellulosic wastes and production of value added products

This study highlights the recent advances in the treatment and value addition of lignocellulosic wastes (LCW) with main focus on domestic and agro-industrial residues. Mechanical, physical and biologicaltreatment systems are brought into perspective. The main value-added products from lignocellulosic wastes are summarized in a manner that pinpoints the most recent trends and the future directions. Physicochemical and biological treatment systems seem to be the most favored options while biofuels, biodegradable composites and biosorbents production paints a bright picture of the current and futurebio-based products. Engineered microbes seem to tackle the problem of bioconversion of substrates that are otherwise non convertible by conventional wild strains. Although the main challenge facing LCW utilization is the high costs involved in treatment and production processes, some recent affordable processes with promising results have been proposed. Future trends are being directed to nanobiotechnology and genetic engineering for improved processes and products. The paper presents state of the art review of the dual advantage of handling LCW for cleaner environment and productionof renewable bio-products

Trends in industrial and environmental biotechnology research in Tanzania

This paper reviews the trends in industrial and environmental biotechnology research in Tanzania for the past 20 years. Researches on production of bio-energy, enzymes and organic acids are reviewed.Furthermore, researches related to wastewater treatment systems including water stabilization ponds and constructed wetlands are covered. Brief highlights are made on researches related tobioprospecting and molecular biology techniques used in identification of organisms. In critically reviewing the research done so far, an attempt is made to pinpoint significant research gaps in areassuch as single cell protein, biomining, biocomposting and bioengineering. This paper, therefore, provides an overview of the renewable raw materials available in the developing countries and outlines the researches that have been done to convert them to bio-products, while reducing bio-wastes. The identified gaps will serve as guidance to scientists who are interested in doing research in untapped areas of biotechnology

Characteristics and dyes biodegradation potential of crude lignolytic enzymes from white-rot fungus crepidotus variabilis isolated in coastal Tanzania

Lignocellulosic enzymes from Crepidotus variabilis collected from mangrove forests of coastal Tanzania were investigated by using standard methods, and their ability to degrade aromatic compounds were elucidated. The fungal crude enzyme filtrates had maximum laccase (Lac), lignin peroxidase (LiP) and manganese peroxidase (MnP) activities of 70 U/mL, 16 U/mL and 8, U/mL respectively. The crude enzyme extracts were able to oxidize rhemazol brilliant blue-R (RBB-R) dye, phenol, "-naphthol and pyrogallol. Also, they could remove up to 58% and 92% color fromraw textile effluent and aromatic dyes, respectively, after 14 days of incubation at 30ºC and pH 4.5. Desalted and size-separated enzyme filtrates, resolved by sodium docecyl sulphatepolyacrylamide gel electrophoresis (SDS-PAGE) and isoelectric focusing (IEF), showed laccasesand peroxidases from C. variabilis to have molecular weights of 67 kDa and 47 kDa, respectively, while the isoelectric points (pI) of laccases and peroxidases were found to lie in a range of 3.0 to 4.1. The study provided basic information on the characteristics of crude lignolytic enzymes fromC. variabilis and confirmed it to be one of the potential biodegraders of aromatic compounds that could be applied in bioremediation of polluted ecosystem

Biosafety systems in Eastern and Central Africa

This review examines the biosafety systems of selected countries in the Eastern and Central Africa. The biosafety systems are meant to safeguard human health, animal health and the environment against any possible risks posed by development and application of modern biotechnology. Though the focus is in the Eastern and Central African region, the study gives an overview of worldwide biosafety frameworks as guided by the Cartagena protocol on biosafety. The Eastern and Central African countries covered in this study are Tanzania, Kenya, Uganda, Rwanda, Burundi, Ethiopia and the Democratic Republic of Congo (DRC). An attempt is made to assess the current status on the countries’ compliance to biosafety international conventions, institutional arrangements and regulatory regimes. A critical look is given to the existing biosafety frameworks, pinpointing their weaknesses and giving suggestions on what could be done to address the shortfalls. The study shows that Kenya is leading the group by having all the requirements in place, followed by Uganda. Tanzania has cleared the legal frameworks hurdles, but it is rather slow in processing applications of genetically modified organisms (GMOs) for containment and confined trials. Ethiopia, Rwanda, Burundi and DRC are still in the process of formulating their biosafety laws. The challenges facing the operationalization of the biosafety systems are financial constraints, insufficient trained human resources, poor facilities, low awareness and insufficient political will by some governments. It is argued that while biosafety frameworks stand to safeguard safe application of modern biotechnology, they should not have too stringent regulations, lest they impede the development of modern biotechnology in the Eastern and Central African region.Key words: Biosafety, Cartagena Protocol, genetically modified organisms, regulatory regimes, institutional framework, liability and redress

The Level of Trust Between International Election Observers and Incumbents in Unconsolidated Democracies

A great deal of research focuses on the question of why incumbents invite IEOs but do not explicitly explored the root cause of why cheating in elections occurs despite the presence of IEOs. The occurrence when incumbents in young democracies invite international election observers (IEOs) and nevertheless cheat in elections has not been fully explored. This research advances the following expectation: incumbents seeking international benefits and whose electoral institutions are not fully mature are more likely to invite IEOs and cheat in an election. This is due to the ability of the incumbents who are seeking for the reelection to change electoral rules so as to be reelected, be able to influence the national electoral board to act in a partisan way, ability to manipulate voter registration , and lastly, the ability of the incumbents to maneuver with the IEOs activities .The findings of this research has open a door for researchers to look at the problem of election manipulation from a different angle. Furthermore, it will help IEOs and NGOs trying to promote democracy have a better understanding of the context in young-democracies

Adaptation technologies and legal instruments to address climate change impacts to coastal and marine resources in Tanzania

The increase in greenhouse gases in the atmosphere and the consequent pressures related to climate change are having significant impacts on the coastal and marine resources on which much of Tanzania’s coastal population depends for its livelihood. A decline in mangrove cover, coral bleaching and mortality and the destruction of seagrass beds are some of these impacts. Coastal erosion also poses threats to the country’s coastal tourism infrastructure. This study examines various approaches that integrate protection and conservation of coastal and marine resources. It briefly highlights the global and regional issues while emphasis is put on Tanzanian perspective. Guidelines and reports for management interventions and adaptive technologies are discussed. Environmental protection remains the most preferred approach with variety of options. An overview is given on soft and hard adaptation technologies. Furthermore, Tanzania’s relevant policies and legislation that address climate change impacts to coastal and marine resources are reviewed.Key words: Climate change, coastal and marine resources, adaptation technologies, legal instruments

Influence of sampling depth and post-sampling analysis time on the occurrence of coliforms and vibrio in water and shellfish

The bacteriological quality was examined at the water surface, 3 m depth and in the shellfish flesh, and the results were compared to other potential pathogenic indicator organisms. The study was conducted at Long Harbour (mussel farm), St. John's and Outer Cove sites of Newfoundland, Canada. Bacteriological analysis was carried out for samples taken at water depth and at 1, 6, 12 and 24 hours post-sampling. It was observed that the total and faecal coliform bacteria were significantly higher in the 3 m water depth samples than in the surface water samples (ANOVA, F = 59.41, 26.751, 9.82 (T.C); 46.41, 26.81, 10.72 (F.C);

Lignocellulosic enzymes from Flavodon flavus, a fungus isolated from Western Indian Ocean off the coast of Dar es Salaam, Tanzania

Marine basidiomycetes fungus Flavodon flavus (Klotzsch) Ryvarden was isolated from sea grass at Mjimwema in the Western Indian Ocean off the Coast of Dar es Salaam, Tanzania, and cultured in thelaboratory. Protein content and lignocellulosic enzyme activities were measured by photometric methods. Desalted and size-separated enzyme filtrates were resolved by sodium docecyl  sulphatepolyacrylamide gel electrophoresis (SDS-PAGE) and isoelectric focusing (IEF). The fungal filtrate had maximum lignin peroxidase (LiP), manganese peroxidase (MnP) and Laccase (Lac) activities of 42, 25 and 15 U/mL, respectively. At low carbon medium, F. flavus showed effective (92 - 100%) decolorization of raw textile wastewater and synthetic dyes such as rhemazol brilliant blue-R (RBB-R), Brilliant green, Congo red, Reactive black and Reactive yellow. SDS-PAGE analysis showed major bands of sizeseparatedenzymes from F. flavus at relative molecular weights between 45 and 70 kDa. The LiP of F. flavus, purified by ion exchange chromatography, revealed that it has a molecular weight of 46 kDa and isoelectric point (pI) of 3.8. The study confirmed extracellular enzymes from F. flavus to be potential degraders of organic pollutants and showed that facultative marine fungi that live under harsh seawater conditions are suitable for bioremediation of recalcitrant environmental pollutants

The Relationship between Economic Growth and Service Sector in Tanzania: An Empirical Investigation

The study uses Autoregressive Distributed Lag Model (ARDL) to examine the relationship between economic growth and service sector in Tanzania for the period 1970 to 2015. Further, bounds test of cointegration is used to test for existence of long-run relationship among the variables. Results show that the real economic growth is positively related to the growth rate of the services sector, and the latter’s effect is statistically significant in the long-run as postulated in theory. The error correction term has the envisaged negative sign and is statistically significant, implying convergence towards the long-run equilibrium. The results also show there is a bi-directional causality between GDP growth and growth of services sector. However, the growth in services sector has no effect on the economic growth in the short-run. This calls for friendly cum enabling business environment for investment and business operations in trade, tourism, financial sector, etc. in order to enhance value addition in the services industry.  Promotion of technological innovations in the services sector is very crucial so as to improve efficiency, quality and productivity in delivery of services and thus enhance competition. The services sector should be considered as equally important as industrial sector due to cross-fertilization between the two