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

Acute adenolymphangitis due to bancroftian filariasis in Rufiji district, south east Tanzania

A longitudinal prospective surveillance for acute adenolymphagitis (ADL) was carried out in three villages in Rufiji district. A sample population of 3000 individuals aged 10 years and above was monitored fortnightly for a period of 12 months. The annual incidence of ADL was found to be 33 per 1000 population and was significantly higher in males than females (52.7/1000 and 18.7/1000 respectively). ADL episodes were more frequent in the age group of 40 years and above. Individuals with chronic manifestations seemed to be more vulnerable to ADL attacks with 62.2% of the total episodes occurring in this group. Furthermore, individuals with lymphoedema experienced more frequent acute episodes compared to those with hydrocele and \u27normal exposed\u27. ADL episodes ranged from one to five per annum and the majority of the affected (60.4%) experienced a single episode. The average duration of an ADL episode was 8.6 days and in 72.5% of the episodes the affected individuals were incapacitated and unable to do their normal activities for an average duration of 3.7 days. The physical incapacitation associated with ADL episodes emphasizes the significance of lymphatic filariasis as a major public health problem of substantial socio-economic consequences. (C) 2000 Elsevier Science B.V

Can NGOs regulate medicines markets? Social enterprise in wholesaling, and access to essential medicines

Citizens of high income countries rely on highly regulated medicines markets. However low income countries' impoverished populations generally struggle for access to essential medicines through out-of-pocket purchase on poorly regulated markets; results include ill health, drug resistance and further impoverishment. While the role of health facilities owned by non-governmental organisations (NGOs) in low income countries is well documented, national and international wholesaling of essential medicines by NGOs is largely unstudied. This article describes and assesses the activity of NGOs and social enterprise in essential medicines wholesaling. The article is based on a set of interviews conducted in 2006-8 with trading NGOs and social enterprises operating in Europe, India and Tanzania. The analysis applies socio-legal and economic perspectives on social enterprise and market regulation. Trading NGOs can resist the perverse incentives inherent in medicines wholesaling and improve access to essential medicines; they can also, in definable circumstances, exercise a broader regulatory influence over their markets by influencing the behaviour of competitors. We explore reasons for success and failure of social enterprise in essential medicines wholesaling, including commercial manufacturers' market response; social enterprise traders' own market strategies; and patterns of market advantage, market segmentation and subsidy generated by donors. We conclude that, in the absence of effective governmental activity and regulation, social enterprise wholesaling can improve access to good quality essential medicines. This role should be valued and where appropriate supported in international health policy design. NGO regulatory impact can complement but should not replace state action

Equity implications of coverage and use of insecticide treated nets distributed for free or with co-payment in two districts in Tanzania: A cross-sectional comparative household survey

<p>Abstract</p> <p>Background</p> <p>In Tanzania, the distribution and coverage of insecticide-treated nets (ITNs) is inequitable. Arguments about the most effective and equitable approach to distributing ITNs centre around whether to provide ITNs free of charge or continue with existing social marketing strategies. The Government has decided to provide free ITNs to all children under five in the country. It is still uncertain whether this strategy will achieve equitable coverage and use. This study examined the equity implications of ownership and use of ITNs in households from different socioeconomic quintiles in a district with free ITNs and a district without free ITN distribution.</p> <p>Methods</p> <p>A cross-sectional comparative household survey was conducted in two districts: Mpanda in Rukwa Region (with free ITN roll out) and Kisarawe in Coast region (without free ITNs). Heads of 314 households were interviewed in Mpanda and Kisarawe. The concentration index was estimated and regression analysis was performed to compare socioeconomic inequalities in ownership and use of ITNs.</p> <p>Results</p> <p>Ownership of ITNs increased from 29% in the 2007/08 national survey to 90% after the roll out of free ITNs in Mpanda, and use increased from 13% to 77%. Inequality was considerably lower in Mpanda, with nearly perfect equality in use (concentration index 0.009) and ownership (concentration index 0.010). In Kisarawe, ownership of ITNs increased from 48% in the 2007/08 national survey to 53%, with a marked inequality concentration index 0.132. ITN use in Kisarawe district was 42% with a pro rich concentration index of 0.027.</p> <p>Conclusions</p> <p>The results shed some light on the possibilities of reducing inequality in ownership and use of ITNs and attaining Roll Back Malaria and Millennium Development Goals through the provision of free ITNs to all. This has the potential to decrease the burden of disease and reduce disparity in disease outcome.</p

Perceptions of caretakers with different socioeconomic status about the harmful outcomes of fever in under-five children in Dodoma region, central Tanzania: A cross-sectional study

Background: Socioeconomic status can affect health in childhood through many different pathways. Evidence on how households differ with regard to socioeconomic status and the degree to which this difference is associated with investment in child health is essential to the design of appropriate intervention strategies.Aim: This study examines the impact of caretakers’ socio-economic characteristics on perceptions about the harmful outcomes of fever among under-five children.Material and methods: The study used a three-stage cluster sample of households with under-five children in Dodoma region, central Tanzania. Multilevel modelling approach was used to model the relationship between the outcome measure and caretakers’ socioeconomic characteristics while controlling for other variables.Results: A total of 329 under-five children with fever were studied of which 74.8% were perceived by their caretakers to have some chances for harmful effects of fever to occur when they experienced fever. Secondary school education or above of caretakers was significantly associated with decreased beliefs about the occurrence of harmful effects of fever.Conclusion: Many caretakers are concerned about the occurrence of harmful effects of fever for their under-five children. Study findings suggest that promoting enrolment in secondary education or above and participation in the labour market particularly in non-farm activities of women would be valuable to the health of under-five children in central Tanzania.Keywords: Beliefs, Childhood fever, Health effects, Perception, Socioeconomic statu

Local Production of Pharmaceuticals in Africa and Access to Essential Medicines: 'Urban bias' in Access to Imported Medicines in Tanzania and its Policy Implications.

\ud International policy towards access to essential medicines in Africa has focused until recently on international procurement of large volumes of medicines, mainly from Indian manufacturers, and their import and distribution. This emphasis is now being challenged by renewed policy interest in the potential benefits of local pharmaceutical production and supply. However, there is a shortage of evidence on the role of locally produced medicines in African markets, and on potential benefits of local production for access to medicines. This article contributes to filling that gap. This article uses WHO/HAI data from Tanzania for 2006 and 2009 on prices and sources of a set of tracer essential medicines. It employs innovative graphical methods of analysis alongside conventional statistical testing. Medicines produced in Tanzania were equally likely to be found in rural and in urban areas. Imported medicines, especially those imported from countries other than Kenya (mainly from India) displayed 'urban bias': that is, they were significantly more likely to be available in urban than in rural areas. This finding holds across the range of sample medicines studied, and cannot be explained by price differences alone. While different private distribution networks for essential medicines may provide part of the explanation, this cannot explain why the urban bias in availability of imported medicines is also found in the public sector. The findings suggest that enhanced local production may improve rural access to medicines. The potential benefits of local production and scope for their improvement are an important field for further research, and indicate a key policy area in which economic development and health care objectives may reinforce each other.\u

Health care seeking behaviour and utilisation in a multiple health insurance system: does insurance affiliation matter?

BACKGROUND: Many countries striving to achieve universal health insurance coverage have done so by means of multiple health insurance funds covering different population groups. However, existence of multiple health insurance funds may also cause variation in access to health care, due to the differential revenue raising capacities and benefit packages offered by the various funds resulting in inequity and inefficiency within the health system. This paper examines how the existence of multiple health insurance funds affects health care seeking behaviour and utilisation among members of the Community Health Fund, the National Health Insurance Fund and non-members in two districts in Tanzania. METHODS: Using household survey data collected in 2011 with a sample of 3290 individuals, the study uses a multinomial logit model to examine the influence of predisposing, enabling and need characteristics on the probability of seeking care and choice of provider. RESULTS: Generally, health insurance is found to increase the probability of seeking care and reduce delays. However, the probability, timing of seeking care and choice of provider varies across the CHF and NHIF members. CONCLUSIONS: Reducing fragmentation is necessary to provide opportunities for redistribution and to promote equity in utilisation of health services. Improvement in the delivery of services is crucial for achievement of improved access and financial protection and for increased enrolment into the CHF, which is essential for broadening redistribution and cross-subsidisation to promote equity

"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

Household perceptions towards a redistributive policy across health insurance funds in Tanzania.

BACKGROUND: The Tanzanian health insurance system comprises multiple health insurance funds targeting different population groups but which operate in parallel, with no mechanisms for redistribution across the funds. Establishing such redistributive mechanisms requires public support, which is grounded on the level of solidarity within the country. The aim of this paper is to analyse the perceptions of CHF, NHIF and non-member households towards cross-subsidisation of the poor as an indication of the level of solidarity and acceptance of redistributive mechanisms. METHODS: This study analyses data collected from a survey of 695 households relating to perceptions of household heads towards cross-subsidisation of the poor to enable them to access health services. Kruskal-Wallis test is used to compare perceptions by membership status. Generalized ordinal logistic regression models are used to identify factors associated with support for cross-subsidisation of the poor. RESULTS: Compared to CHF and NHIF households, non-member households expressed the highest support for subsidised CHF membership for the poor. The odds of expressing support for subsidised CHF membership are higher for NHIF households and non-member households, households that are wealthier, whose household heads have lower education levels, and have sick members. The majority of households support a partial rather than fully subsidised CHF membership for the poor and there were no significant differences by membership status. The odds of expressing willingness to contribute towards subsidised CHF membership are higher for households that are wealthier, with young household heads and have confidence in scheme management. CONCLUSION: The majority may support a redistributive policy, but there are indications that this support and willingness to contribute to its achievement are influenced by the perceived benefits, amount of subsidy considered, and trust in scheme management. These present important issues for consideration when designing redistributive policies