Sources of financial assistance for households suffering an adult death in Kagera, Tanzania

The AIDS crisis in Africa and elsewhere compels us to design appropriate assistance policies for households experience a death. Policies should take into account and strengthen existing household coping strategies, rather than duplicate or undermine them. The authors investigate the nature of coping mechanisms among a sample of households in Kagera, Tanzania in 1991-1994. They estimate the magnitude and timing of receipts of private transfers, credits, and public assistance by households with different characteristics. Their empirical strategy addresses three common methodological difficulties in estimating the impact of adult death: selection bias, endogeneity, and unobserved heterogeneity. The authors find that less-poor households (those with more physical and human capital) benefit from larger receipts of private assistance than poor households. Resource-abundant households are wealthy in social assets as well as physical assets. Poor households, on the other hand, rely relatively more on loans than private transfers, for up to a year after a death. This suggests that credit acts as insurance for households where informal interhousehold assistance contracts are not enforceable. A donor in Kagera can be sure that assistance to a wealthy household may not be able to return the favor. Assistance to the poor is more likely to come with more formal arrangements for repayment. Formal-sector assistance is targeted toward the poor immediately following the death. The impact of adult deaths on households may be mitigated either ex ante, through programs that minimize poverty and vulnerability, or ex post, by assistance targeted to the poorest and most vulnerable households. In addition, to the extent to which micro-credit programs improve access and lower the total costs of borrowing, they may not only stimulate growth and investment but also help resource-poor households overcome the impact of an adult death in the areas hard-hit by the AIDS epidemic.Rural Poverty Reduction,Safety Nets and Transfers,Services&Transfers to Poor,VN-Acb Mis -- IFC-00535908,Housing&Human Habitats

"Practical Knowledge" and Perceptions of Antibiotics and Antibiotic Resistance Among Drugsellers in Tanzanian Private Drugstores.

Studies indicate that antibiotics are sold against regulation and without prescription in private drugstores in rural Tanzania. The objective of the study was to explore and describe antibiotics sale and dispensing practices and link it to drugseller knowledge and perceptions of antibiotics and antibiotic resistance. Exit customers of private drugstores in eight districts were interviewed about the drugstore encounter and drugs bought. Drugsellers filled in a questionnaire with closed- and open-ended questions about antibiotics and resistance. Data were analyzed using mixed quantitative and qualitative methods. Of 350 interviewed exit customers, 24% had bought antibiotics. Thirty percent had seen a health worker before coming and almost all of these had a prescription. Antibiotics were dispensed mainly for cough, stomachache, genital complaints and diarrhea but not for malaria or headache. Dispensed drugs were assessed as relevant for the symptoms or disease presented in 83% of all cases and 51% for antibiotics specifically. Non-prescribed drugs were assessed as more relevant than the prescribed. The knowledge level of the drugseller was ranked as high or very high by 75% of the respondents. Seventy-five drugsellers from three districts participated. Seventy-nine percent stated that diseases caused by bacteria can be treated with antibiotics but 24% of these also said that antibiotics can be used for treating viral disease. Most (85%) said that STI can be treated with antibiotics while 1% said the same about headache, 4% general weakness and 3% 'all diseases'. Seventy-two percent had heard of antibiotic resistance. When describing what an antibiotic is, the respondents used six different kinds of keywords. Descriptions of what antibiotic resistance is and how it occurs were quite rational from a biomedical point of view with some exceptions. They gave rise to five categories and one theme: Perceiving antibiotic resistance based on practical experience. The drugsellers have considerable "practical knowledge" of antibiotics and a perception of antibiotic resistance based on practical experience. In the process of upgrading private drugstores and formalizing the sale of antibiotics from these outlets in resource-constrained settings, their "practical knowledge" as well as their perceptions must be taken into account in order to attain rational dispensing practices

EXPLORING DETERMINANTS OF CONSUMER PREFERENCES AND WILLINGNESS-TO-PAY FOR INSECTICIDES TREATED BEDNETS BEFORE INTERVENTION IN A POOR RURAL TANZANIA

Objective: To explore commodity and human factors associated with willingness to pay (WTP) and consumer preferences for insecticides treated bed nets (ITNs) prior an intervention Design: A two-week-interval test re-test cross-sectional contingent valuation study Setting: The study was conducted in Kisarawe District between September and November 2001 Results:Multivariate analyses showed nuisance of mosquito bites, age of the respondent, knowledge of malaria transmission, self rated health status, prior possession of a bed net, and self rated ability to pay to be significantly associated with maximum open-ended WTP (p<0.005). While, a recent experience with a malaria episode, nuisance of mosquito bites, and the price of an ITN were associated with the probability of giving an affirmative response for the discrete choice question (p<0.005). ITNs characteristics have different relative importance in determining consumer's preferences of and procurement decisions for an ITN. Respondents were willing to pay lower average prices compared to prices presented to them suggesting inability to pay for the market ITN prices. Conclusion: WTP studies conducted in communities before the interventions are implemented, could be useful in providing local information for understanding the local market structure, designing behavioural change messages and establishing affordable local prices and levels of subsidies for promoting potential demand for ITNS

Can mothers afford maternal health care costs? User costs of maternity services in rural Tanzania

Following the difficult economic situation various countries introduced health sector reforms, including user charges to finance the system. The assessment of user costs for maternity services in Tanzania was part of a larger study, which covered inputs, outputs and efficiency of services. The study was carried out from October 1997 to January 1998 in Mtwara urban and rural district in South Tanzania. One hundred and seven women attending a quarter of government health facilities were randomly selected and interviewed. Twenty one key informants were also interviewed and service procedures observed. Users of maternity services pay mainly for admission, drugs, other supplies and travel costs. Travel costs represent about half of these financial costs. The average total costs vary between US$11.60 for antenatal consultation and US$135.40 for caesarean section at the hospital. Unofficial payments are not included in the calculation. The amounts vary and payment is irregular. We therefore conclude that time costs are constantly higher than financial costs. High direct payments and the fear of unofficial costs are acute barriers to the use of maternity services. User costs can substantially be reduced by the re-organisation of service delivery especially at antenatal consultation. (Afr J Reprod Health 2002; 6[1]: 65-73