Suchergebnisse

Tanzania is currently developing a Health Financing Strategy to provide a medium to long-term road map for a sustainable and integrated health financing system. This book is designed to inform this discussion by providing an analytical basis for the discussion of options, a series of policy options which could be considered in moving forward, and the economic and financial implications of these options. In doing so, it is hoped that this book will help stimulate the discussion of options and help Tanzania develop a health financing strategy which meets its long-term needs.Health financing in Tanzania is currently highly fragmented, with many different sources of funds and programs directed at specific population groups. Despite this, many people still do not access health services because of financial barriers, and this burden falls disproportionately on the poor. This book looks at the current situation with respect to health financing as well as the experience in other countries to address health financing for the poor and the population generally, using a common analytical framework. The book then explores a number of options in the areas of revenue generation, pooling of funds, purchasing and service provision, and also looks at the regulatory and political environment, making specific recommendations which can be considered in each of these areas. The focus of these recommendations is particularly on improving financial health protection for the poor. The economic, financial and service delivery implications are then examined, using several different scenarios for extending pre-paid health insurance coverage to the population.Making Health Financing Work for the Poor in Tanzania will be of interest to readers working in the areas of health care and public health, social protection, and social analysis and policy, in Tanzania and in other

Abstract Background Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts. Methods The study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs) and 29 in-depth interviews (IDIs) with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. Results The study found a clear preference for public sector employment. This was associated with health worker rights and access to various benefits offered to health workers in government service, particularly the favourable pension schemes providing economic security in old age. Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace. Conclusions The preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health facilities is a challenge in a resource constrained health system where church-run health facilities are vital in the provision of health care in rural areas and where patients tend to prefer these services. In order to ensure equity in distribution of qualified health workers in Tanzania, a national regulation and legislation of the pension schemes is required.

The Service Delivery Indicators (SDIs) provides a set of key indicators serving as a benchmark for service delivery performance in the health and education sectors in Sub-Saharan Africa. The overarching objective of the SDIs is to ascertain the quality of service delivery in primary education and basic health services. This would in turn enable governments and service providers alike to identify gaps and bottlenecks, as well as track progress over time, and across countries. The SDI survey interviewed 403 heath providers across Tanzania between May 2014 and July 2014. This technical report presents the findings from the implementation of the SDI in the health sector in Tanzania in 2014. Survey implementation activities took place following extensive consultations with the government and key stakeholders on survey design, sampling, and adaptation of survey instruments. A major challenge for Tanzania's health sector is the shortage of skilled human resources for health (HRH). This survey found that provider knowledge and abilities were not adequate to deliver quality services. Caseload per provider and absenteeism are relatively low, so the issue is not over burdened providers. There seems to be ample room for a significant increase in the caseload of Tanzanian providers, i.e. the level of productivity in health service delivery, without jeopardizing quality. In addition to increasing the volume of skilled HRH to address the shortage of providers, improvements in management, supervision and training is important to improving service delivery. Health for all in Tanzania will mean the simultaneous availability of widely accessible inputs and skilled providers.

Background: Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts. Methods: The study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs) and 29 in-depth interviews (IDIs) with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. Results: The study found a clear preference for public sector employment. This was associated with health worker rights and access to various benefits offered to health workers in government service, particularly the favourable pension schemes providing economic security in old age. Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace. Conclusions: The preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health facilities is a challenge in a resource constrained health system where church-run health facilities are vital in the provision of health care in rural areas and where patients tend to prefer these services. In order to ensure equity in distribution of qualified health workers in Tanzania, a national regulation and legislation of the pension schemes is required. ; publishedVersion

Population policies have rarely been linked to economic policy, although the promoters of economic liberalization also support the embrace of population policy as important to the economic well-being of African states. Using a case study from Tanzania, I argue that population policies with a limited focus on fertility reduction may continue to be successful in the context of post-adjustment African health care systems, but policies that aim for the larger goals of improving women's reproductive health will be severely limited. Tanzania's donors & lenders promoted Neo-Malthusian types of population policies aimed primarily at reducing childbearing as a partial solution to the country's economic crisis. However, in the mid-1990s, the international discourse on population shifted toward a new dependent variable of 'women's reproductive' health. The notion of reproductive health reunites population & development issues in the context of basic health care provision. Improvements in the reproductive health of Tanzanian women will require more than simply the effective provision of contraceptives. This article argues that the challenges of improving reproductive health are unlikely to be met without a revitalization of public health care provision in African countries. 3 Tables, 61 References. Adapted from the source document.

This dissertation explores U.S. commercial marketing's influence on HIV prevention programming in Tanzania, particularly the practice of social marketing. Social marketing NGOs in Tanzania uphold the goal of creating commercial markets in condoms and promoting HIV prevention behaviors among the public through commercial advertising. Their aim is to address health inequalities among urban low income communities through application of new theories regarding "the social" nature of markets to make privatized access to health goods equitable and sustainable. This dissertation analyzes and historicizes social marketing naturalizations of interventions in human decision-making and economies based on the idea that humans are driven to pursue pleasures which undermine their ability to make rational choices in the interest of health. By drawing on the accounts of individuals - including members of Islamic-based health NGOs, Tanzanian entrepreneurs, and individuals in impoverished neighborhoods targeted by health programs - this work describes the politics and stakes of social marketing interventions, including unanticipated economic and health marginalization. Each of these groups drew from moral understandings of the imbrication of economic, political, and social life to critique the privatization of public health. This dissertation maps these controversies not only as debates about public health and political economy grounded in terms of a critique of private property, but as entailing epistemological and ethical claims about health, markets, and human nature.

Abstract Background The focus on the determinants of the quality of health services in low-income countries is increasing. Health workers' motivation has emerged as a topic of substantial interest in this context. The main objective of this article is to explore health workers' experience of working conditions, linked to motivation to work. Working conditions have been pointed out as a key factor in ensuring a motivated and well performing staff. The empirical focus is on rural public health services in Tanzania. The study aims to situate the results in a broader historical context in order to enhance our understanding of the health worker discourse on working conditions. Methods The study has a qualitative study design to elicit detailed information on health workers' experience of their working conditions. The data comprise focus group discussions (FGDs) and in-depth interviews (IDIs) with administrators, clinicians and nursing staff in the public health services in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in the same part of Tanzania. Results The article provides insights into health workers' understanding and assessment of their working conditions. An experience of unsatisfactory working conditions as well as a perceived lack of fundamental fairness dominated the FGDs and IDIs. Informants reported unfairness with reference to factors such as salary, promotion, recognition of work experience, allocation of allowances and access to training as well as to human resource management. The study also revealed that many health workers lack information or knowledge about factors that influence their working conditions. Conclusions The article calls for attention to the importance of locating the discourse of unfairness related to working conditions in a broader historical/political context. Tanzanian history has been characterised by an ambiguous and shifting landscape of state regulation, economic reforms, decentralisation and emerging democratic sentiments. Such a historic contextualisation enhances our understanding of the strong sentiments of unfairness revealed in this study and assists us in considering potential ways forward.

Background: The focus on the determinants of the quality of health services in low-income countries is increasing. Health workers' motivation has emerged as a topic of substantial interest in this context. The main objective of this article is to explore health workers' experience of working conditions, linked to motivation to work. Working conditions have been pointed out as a key factor in ensuring a motivated and well performing staff. The empirical focus is on rural public health services in Tanzania. The study aims to situate the results in a broader historical context in order to enhance our understanding of the health worker discourse on working conditions. Methods: The study has a qualitative study design to elicit detailed information on health workers' experience of their working conditions. The data comprise focus group discussions (FGDs) and in-depth interviews (IDIs) with administrators, clinicians and nursing staff in the public health services in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in the same part of Tanzania. Results: The article provides insights into health workers' understanding and assessment of their working conditions. An experience of unsatisfactory working conditions as well as a perceived lack of fundamental fairness dominated the FGDs and IDIs. Informants reported unfairness with reference to factors such as salary, promotion, recognition of work experience, allocation of allowances and access to training as well as to human resource management. The study also revealed that many health workers lack information or knowledge about factors that influence their working conditions. Conclusions: The article calls for attention to the importance of locating the discourse of unfairness related to working conditions in a broader historical/political context. Tanzanian history has been characterised by an ambiguous and shifting landscape of state regulation, economic reforms, decentralisation and emerging democratic sentiments. Such a historic contextualisation enhances our understanding of the strong sentiments of unfairness revealed in this study and assists us in considering potential ways forward. ; publishedVersion

Population policies have rarely been linked to economic policy, although the promoters of economic liberalisation also support the embrace of population policy as important to the economic wellbeing of African states. Using a case study from Tanzania, I argue that population policies with a limited focus on fertility reduction may continue to be successful in the context of post-adjustment African health care systems, but policies that aim for the larger goals of improving women's reproductive health will be severely limited. Tanzania's donors and lenders promoted Neo-Malthusian types of population policies aimed primarily at reducing childbearing as a partial solution to the country's economic crisis. However, in the mid-1990s, the international discourse on population shifted toward a new dependent variable of 'women's reproductive' health. The notion of reproductive health reunites population and development issues in the context of basic health care provision. Improvements in the reproductive health of Tanzanian women will require more than simply the effective provision of contraceptives. This article argues that the challenges of improving reproductive health are unlikely to be met without a revitalisation of public health care provision in African countries.