Case Study Of Tanzania Research Articles

Exploring the Readiness for Electronic Voting (E-Voting) in Emerging Economies: Evidence from Dodoma, Tanzania

There has been a lot of research on e-voting recently. Most studies assume that the implementation of e-voting is not merely about technology but also relates to several critical factors, such as the readiness of human resources and infrastructure, public trust, and others. This study explored the readiness for e-voting in developing countries, a case study of Tanzania. Specifically, the study aimed to examine the challenges of the current voting system, establish the e-voting readiness status in Tanzania, and find out factors for establishment of e-voting system in Tanzania. This study was quantitative in nature and obtained data from 196 respondents selected from Independent National Electoral Commission (INEC) officers and voters in Dodoma using purposive and convenient sampling techniques. Data was obtained from questionnaires distributed to officers and voters. The obtained data were analysed through descriptive statistics by the help of MS excel. The results show that the current voting system is faced with several challenges including limited safety, lack of trust, threat and insecurity vulnerability to mention but a few. It was further revealed that respondents were ready to adopt and use e-voting because it improves voters’ trust, ease voting procedures, reduces transportation costs on election materials/equipment and saves time. The study recommends the Independent National Election Commission of Tanzania, through various stakeholders see the possibility of establishing e-voting to achieve free and fair elections.

Examining the interdependencies of e-government challenges using PESTELMO, DEMATEL and ANP: A case study of Tanzania

E-government transformation requires a deeper understanding of contextual factors, including prevailing challenges. Significantly, few studies have raised that e-government challenges are not independent and that their interdependencies warrant further investigations. This study aims to analyse the interdependencies of e-government challenges using qualitative and quantitative methods – PESTELMO (Political, Economic, Socio-cultural, Technological, Environmental, Legal, Managerial and Organisational) analysis method and DEMATEL (Decision-Making Trial and Evaluation Laboratory) and ANP (Analytic Network Process) respectively. PESTELMO analysis method categorised 27 e-government challenges in Tanzania, which were then subjected to DEMATEL. DEMATEL results show that net causes are political, economic and legal challenges, while net receivers are sociocultural, technological, environmental, managerial and organisational challenges. The ANP results reveal that economic challenges are the most significant among the net causes. Hence, e-government policy and strategy makers may want to prioritise economic challenges to propagate beneficial results. This is the first study that analyses, visualises and attempts to measure the interdependencies among e-government challenges in Tanzania. The contributions of this paper lie in the empirical analysis of e-government challenges. The results provide insights to practitioners and researchers of e-government in Tanzania on the most critical challenges/hurdles to focus on for successful e-government transformation.

Factors Influencing Foreign Direct Investments Inflow in Africa: A Case Study of Tanzania

Africa has emerged as an attractive destination for foreign direct investment (FDI) due to its rich natural resources, growing economies, and increasing political stability. The doors of Tanzania, one of the largest countries in Africa, have been opened to international companies in search of growing markets. Nevertheless, Tanzania has seen a low level of foreign direct investment (FDI) inflows, primarily because of its stringent policies restricting the ownership of businesses by foreign nationals. The aim of this study is to identify and explain the factors that influence FDI inflows in Tanzania, which is the country that will be the focus of the study. This study will concentrate on the independent factors of political stability, availability of natural resources, size of the economy, and transport infrastructure, as well as the dependent variable of foreign direct investment (FDI). To collect the appropriate information, five survey questions were developed for each variable. A total of 125 respondents were collected using purposive sampling. The findings of this study will inform policymakers, investors, and other stakeholders in the region about the factors that influence foreign direct investment inflows into Tanzania. The study examined the impact of transport and infrastructure, political stability, the scale of the economy, and the availability of natural resources on foreign direct investment (FDI) in Tanzania.

Assessment of the Influence of Contextual Issues in Evaluating eHealth Systems Usability in Tanzania

The adoption of eHealth systems in healthcare facilities has rapidly increased in many countries. However, the main challenge has been the quality and level of usability of those adopted systems, and the complexity of the challenge varies from one country to another based on contextual issues. Usability is also linked to contextual issues, which have a direct impact on deciding the methods for providing services on similar systems. This research focuses on assessing the influence of contextual issues on metrics that are applicable for evaluating the usability of eHealth systems through a case study of Tanzania. The findings of this research were obtained through the quantitative method, and the analysis was performed through structural equation modelling (SEM) using AMOS and SPSS applications. It is evident from this research that contextual factors, such as user characteristics, goals and tasks, technical environment, physical environment, and resources and technology, significantly impact the usability metrics that are important to the evaluation of eHealth systems. The usability metrics for eHealth systems identified in this research include navigation visibility, accessibility, perceived ease of use, error correction, internal collaboration, information quality, external collaboration, technical quality, guide and support, and perceived benefits. This study also revealed that the usability evaluation of eHealth systems should consider both common metrics and specific metrics in order to uncover both general information system and health context-specific usability issues

The Role of Religion in Shaping Gender Norms and Attitudes: A Case Study of Tanzania

Purpose: The purpose of this study was to investigate the role of religion in the shaping of gender norms and attitudes in the Tanzanian culture.
 Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library.
 Findings: The findings revealed that there exists a contextual and methodological gap relating to the role of religion in the shaping of gender norms and attitudes.
 Unique Contribution to Theory, Practice and Policy: The Social Constructionism theory, Symbolic Interactionism theory and the Intersectionality model may be used to anchor future studies on the role of religion in the shaping of gender norms and attitudes. Religious beliefs, teachings, and practices have a profound influence on societal expectations, reinforcing traditional gender roles and contributing to the perpetuation of gender inequalities. The findings highlight the complex interplay between religion and gender, with religious affiliation often associated with more conservative gender attitudes and the acceptance of gender-based violence. Recommendations drawn from the study include the promotion of gender sensitive religious education, engaging religious leaders and institutions, fostering interfaith dialogues, strengthening women’s empowerment programs, supporting grassroots initiates amongst others.

Data management system for sustainable agriculture among smallholder farmers in Tanzania: research-in-progress

ABSTRACT Smallholder farmers produce about 70% of the world’s food and employ more than one billion people. They therefore have an important role to play in eradicating food insecurity and poverty among the world’s growing population. Although there are different digital services for smallholder farmers, the existing services lack sustainability in the agriculture context and hardly meet their needs. Data management and sharing among different agriculture stakeholders has the potential to make agriculture sustainable, but there is a need to enable access to digital services in an entire farming cycle under one roof. This paper aims to propose the design of a comprehensive data management digital framework to solve common challenges of smallholder farmers in Tanzania and other countries’ agricultural systems. We follow the design science research (DSR) method to develop an artifact that interacts with the problem context. To illustrate the framework’s applicability, we use different case studies in Tanzania.

Strengthening Social and Behavior Change Programming Through Application of an Adaptive Management Framework: A Case Study in Tanzania.

Integrated social and behavior change (SBC) programs seek to achieve changes in behaviors and norms across a range of health areas. Realizing changes across multiple behaviors is inherently complex and requires programs to be designed and implemented nimbly in ways that are responsive to feedback, new learning, and contextual shifts. Responsive feedback (RF) promotes just this kind of data analysis, use, and programmatic adaptation. Under the U.S. Agency for International Development (USAID)'s flagship SBC program in Tanzania, USAID Tulonge Afya, we applied FHI 360's SBC Adaptive Management Framework, which shares many similarities with RF. It includes meaningful engagement with an array of stakeholders throughout project design, implementation, monitoring, and evaluation (M&E); requires close collaboration between M&E and programmatic staff to ensure data collection and use are informed by and contribute to refinement of the project's theory of change; and incorporates purposeful, routine opportunities for learning and course correction. Accompanying the framework is a suite of tools and activities to facilitate systematic collection, analysis, and application of data for project design, improvement, and evaluation. Use of the framework within a complex, integrated SBC program improved our ability to address emerging priorities and achieve greater scale, saturation, and quality execution of activities. It also facilitated significant input from local communities and stakeholders-through shared data analysis and feedback loops-ensuring project activities reflected their strengths, needs, and preferences rather than the perspectives and biases of program implementers. In this article, we discuss the key components of the SBC Adaptive Management Framework and its commonalities with RF, how use of the framework and the underlying principles and elements of the RF approach contributed to the project's success, and share lessons that may strengthen and expand the application of RF and similar approaches within future SBC programs.

Dynamically coupling system dynamics and SWAT+ models using Tinamït: application of modular tools for coupled human–water system models

Abstract. Participatory water resource management requires modeling techniques that are accurate and flexible yet stakeholder-friendly. While different modeling frameworks offer advantages and disadvantages, system dynamics (SDs) models have seen sustained use as a stakeholder-friendly approach for participatory water resource modeling. Physically based models (e.g., SWAT+) have seen sustained use to model the hydrological components of water systems. Proposed as a way to combine the relative strengths of both modeling paradigms, model coupling allows researchers to, for example, build participatory SD models with stakeholders, while delegating the hydrological components of the overall model to an external hydrological model. Recently developed to facilitate model coupling, the Tinamït Python package presents an extensible, outward-facing application programming interface (API). It allows for the development of extensions (wrappers) that expand compatibility with different physically based models. However, no watershed hydrological model has yet been connected to this API. In the present study, a socket and JavaScript Object Notation (JSON)-based communication protocol was developed with the goal of facilitating the coupling of models written in languages such as Fortran. This novel protocol served to develop a Tinamït-compatible wrapper for the hydrological model SWAT+, allowing it to be coupled to human–water SD models. The novel coupling protocol was then applied to a case study of Tanzania's Usa river catchment. This approach provides the modeler with the benefits of both physically based and SD models, thereby allowing the detection of potentially far-reaching effects of policy-makers' decisions.

A systems approach framework for evaluating tree restoration interventions for social and ecological outcomes in rural tropical landscapes.

The science guiding design and evaluation of restoration interventions in tropical landscapes is dominated by ecological processes and outcomes and lacks indicators and methods that integrate human wellbeing into the restoration process. We apply a new systems approach framework for tree restoration in forest-agricultural landscapes to show how this shortcoming can be addressed. Demonstrating 'proof of concept', we tested statistical models underlying the framework pathways with data collected from a case study in Tanzania. Local community perceptions of nature's values were not affected by levels of self-reported wildlife-induced crop damage. But mapped predictions from the systems approach under a tree restoration scenario suggested differential outcomes for biodiversity indicators and altered spatial patterns of crop damage risk, expected to jeopardize human wellbeing. The predictions map anticipated trade-offs in costs and benefits of restoration scenarios, which we have started to explore with stakeholders to identify restoration opportunities that consider local knowledge, value systems and human wellbeing. We suggest that the framework be applied to other landscapes to identify commonalities and differences in forest landscape restoration outcomes under varying governance and land use systems. This should form a foundation for evidence-based implementation of the global drive for forest landscape restoration, at local scales. This article is part of the theme issue 'Understanding forest landscape restoration: reinforcing scientific foundations for the UN Decade on Ecosystem Restoration'.

An Analysis of the Main Causes of Delays in the Completion of Road Construction Projects: A Case Study of Tanzania

Introduction Completing road construction projects in time is a challenge for developing countries, specifically for Tanzania, where great economic costs result from difficulties in identifying and reducing the factors that cause the delay. Methods This study addresses factors that cause the delay of a road construction project in Tanzania and proposes some methods that could potentially reduce this delay. A structured questionnaire was drawn up through an interactive online workshop with the help of experts and professionals from the road construction sector in Tanzania, and follow-up interviews were conducted. Results and Discussion In addition, the first results were analyzed, and the factors identified were combined into five important groups, namely, client-related, consultant-related, contractor-related, design-related, and external factors. These were the main contributing aspects to delays in road construction projects in Tanzania. Conclusion Furthermore, from across these groups, six significant causes of delays emerged, and these were inadequate access to finance and delayed payments for completed work, financial problems or difficulties, unwillingness or inability to sustain operations over long periods of non-payment, an unrealistic program of works (Works Schedule), inadequate site management, and political interference.

Challenges in Harmonising Conservation Laws on Living Marine Resources within the Framework of the EAC: Case Study of Tanzania and Kenya

Marine ecosystems comprise transboundary resources which occupy up to 71% of the earth’s surface. Up to 90% of the world’s living marine resources exist within the Exclusive Economic Zone (EEZ). The 1982 UN LOSC confers management and conservation of the EEZ to the coastal State’s jurisdiction. It is, however, argued that since oceans are transboundary, effective conservation of their living resources requires a coordinated approach between neighbouring coastal States. Such approaches would help to avoid a situation where living marine resources of the same ecosystem are possibly conflicting conservation measures. One way through which neighbouring Coastal States can coordinate conservation measures for their living marine resources is through the process of harmonisation of laws. Harmonisation leads to the establishment of common legal structures and institutions to aid with the intended coordination. It is therefore argued that, through harmonisation, Kenya and Tanzania would enhance theirrespective conservation capacities for their living marine resources. Key Words: Harmonisation of Conservation Laws, Transboundary Living Marine Resources, Exclusive Economic Zones, Kenya and Tanzania.

Intervening factors in health care professionals’ attitudes and behaviours towards comprehensive abortion care in the workplace: a comparative case study of Tanzania and Ethiopia

Purpose Health care professionals’ attitudes and behaviours play a fundamental role in the provision of timely comprehensive abortion care as a maternal health intervention and save hundreds of thousands of women’s lives, annually. This study explores underlying factors influencing Tanzanian and Ethiopian health care professionals’ attitudes and behaviours towards comprehensive abortion care between 2015 and 2020. Materials and methods The study inductively explored Ethiopian and Tanzanian health care professionals’ behaviours using a comparative case study design and a textual analytical approach. Published and unpublished literature, documents and newspapers were used as data sources. The two cases were selected because of their different approaches towards the governance of abortion care, one gradually legalising while the other persistently restricting. Results Results demonstrated that there are both subjective (beliefs, attitudes, images, pre-dispositions) and objective (institutional incapacity) factors that impact the actions of health care professionals in the work environment. Conclusions The study concluded that the intervention of subjective factors results from the institutional failure to effectively bridge the divide between governance and accessibility of safe abortion care.

The right to fail? Problematizing failure discourse in international conservation

• Often critiqued for ‘selling’ success, conservation efforts increasingly embrace failure as a means to eventual success. • We trace the trajectory of failure discourse in conservation, identifying key moments of development and emerging patterns. • The emerging ‘right to fail’ justifies both continuing and discontinuing dominant conservation models in problematic ways. • Attempts to embrace failure function as yet another way to ‘sell success’ rather than fully engaging reasons for failure. • We advocate an explicitly political approach to failure focused on underlying causes and transformation of current models. A growing body of critical research interrogates the tendency within international conservation circles to present interventions as successful, even when evidence points to substantial negative impacts. The flip side of this ‘selling’ success is a growing emphasis on the importance of embracing and even celebrating failure. Yet this important trend in international conservation policymaking has yet to be examined in depth. We address this research gap by first tracing the origins of the embracing failure narrative, linking it to the historical handling of failure in conservation and in fields such as business management and international development. We then explore the implications of this framing of failure for international conservation policy and practice by examining relevant policy literature and illustrative case studies in Tanzania and Peru. Based on this analysis, we demonstrate how a ‘right to fail’ can justify both continuing and discontinuing conservation interventions in highly problematic ways. We show how the framing of failure as a positive outcome for global learning can reduce accountability for significant and long-lasting negative consequences of failed interventions. Furthermore, the emphasis on approaches to learning that employ narrow technical frames can depoliticize issues and limit possibilities to fundamentally question and transform dominant conservation models with histories of persistent failure. Consequently, we argue that by affording interventions the ‘right to fail’, conservation actors with a stake in dominant models have taken control of failure discourse in ways that reinforce instead of undermine their ability to ‘sell’ success amidst negative (or limited) local outcomes. While it is of course important to acknowledge failure in order not to repeat it, we caution against embracing failure in ways that may further exacerbate conservation injustices and hinder transformative societal change. We advocate instead for an explicitly political approach to addressing failure in conservation.

Added Value of Electronic Immunization Registries in Low- and Middle-Income Countries: Observational Case Study in Tanzania

BackgroundThere is growing interest and investment in electronic immunization registries (EIRs) in low- and middle-income countries. EIRs provide ready access to patient- and aggregate-level service delivery data that can be used to improve patient care, identify spatiotemporal trends in vaccination coverage and dropout, inform resource allocation and program operations, and target quality improvement measures. The Government of Tanzania introduced the Tanzania Immunization Registry (TImR) in 2017, and the system has since been rolled out in 3736 facilities in 15 regions.ObjectiveThe aims of this study are to conceptualize the additional ways in which EIRs can add value to immunization programs (beyond measuring vaccine coverage) and assess the potential value-add using EIR data from Tanzania as a case study.MethodsThis study comprised 2 sequential phases. First, a comprehensive list of ways EIRs can potentially add value to immunization programs was developed through stakeholder interviews. Second, the added value was evaluated using descriptive and regression analyses of TImR data for a prioritized subset of program needs.ResultsThe analysis areas prioritized through stakeholder interviews were population movement, missed opportunities for vaccination (MOVs), continuum of care, and continuous quality improvement. The included TImR data comprised 958,870 visits for 559,542 patients from 2359 health facilities. Our analyses revealed that few patients sought care outside their assigned facility (44,733/810,568, 5.52% of applicable visits); however, this varied by region; facility urbanicity, type, ownership, patient volume, and duration of TImR system use; density of facilities in the immediate area; and patient age. Analyses further showed that MOVs were highest among children aged <12 months (215,576/831,018, 25.94% of visits included an MOV and were applicable visits); however, there were few significant differences based on other individual or facility characteristics. Nearly half (133,337/294,464, 45.28%) of the children aged 12 to 35 months were fully vaccinated or had received all doses except measles-containing vaccine–1 of the 14-dose under-12-month schedule (ie, through measles-containing vaccine–1), and facility and patient characteristics associated with dropout varied by vaccine. The continuous quality improvement analysis showed that most quality issues (eg, MOVs) were concentrated in <10% of facilities, indicating the potential for EIRs to target quality improvement efforts.ConclusionsEIRs have the potential to add value to immunization stakeholders at all levels of the health system. Individual-level electronic data can enable new analyses to understand service delivery or care-seeking patterns, potential risk factors for underimmunization, and where challenges occur. However, to achieve this potential, country programs need to leverage and strengthen the capacity to collect, analyze, interpret, and act on the data. As EIRs are introduced and scaled in low- and middle-income countries, implementers and researchers should continue to share real-world examples and build an evidence base for how EIRs can add value to immunization programs, particularly for innovative uses.

Improper Disposal of Waste Water and Masks during COVID-19, and the Associated Increased Cycle of Infection to Human Health in Developing Countries: A Case Study of Tanzania

Since COVID-19 was declared by the World Health Organization (WHO), wearing of protective equipment, hand washing using soap and frequent use of antiseptic solution are being applied globally to reduce the transmission rate. This study was intended to investigate handling of after wash waste water and masks among Tanzanian residents on the COVID-19 pandemic after it has been, declared by the World Health Organization (WHO) that, wearing of protective equipment, hand washing using soap and frequent use of antiseptic solution should be applied globally to reduce the transmission rate. The assessment of health care waste management in the facilities was conducted in all the 26 regions of Tanzania Mainland. A standardized checklist and tools were used to assess and monitor various aspects related to healthcare waste using open source software for collection (ODK). Data were analyzed using SPSS computer software. It has been indicated that before disposing the used mask, the best protocol is to spray 0.5% (5000 ppm) of chlorine disinfectant on the surface. In this study, about 46% consider used mask as normal municipal waste and 3% do not care they throw away the face masks in the street. Only 18% and 5% of reported to disposal as infectious and highly hazardous waste respectively. It is well documented that due to potential infectious disease like SARS-CoV-2, wastewater should be treated either on-site or conveyed off-site and treated in well-designed method or technology to kill the micro-organisms. The analysis revealed that majority of respondents (74.7%, 73.8%, 48.1% and 65% for healthcare center, district hospitals, regional hospitals and consultant hospitals respectively); dispose the waste in the open space. Continuous awareness creation programs about the negative impact of contaminated face masks and waste water on the health of individuals and introducing laws that can prohibit improper disposal are among the solutions that could help reduce the problem.

COVID 19 The pandemic and Price Volatility: An Analysis of Hospitality Industry in Emerging Market Economy - Case Study of Tanzania

Hotel industries have had the most impact in most of the countries as people went into lockdowns and quarantines as a result of the COVID-19 pandemic. The study aimed at assessing the degree of price change in relation to the profit of hotels before and during the COVID-19 pandemic. Tanzania has been considered to represent developing countries that have taken a different course in a fight against the pandemic. Price movement determines the reaction from customers and therefore performance. This study prepared to identify the knowledge gap on how supply shocks affecting prices of hotels caused by COVID-19 pandemic that are beyond control, especially on a developing country like Tanzania could have on the performance of hotels and whether the recovery of such recession can be predicted in the short run. Movement in supply, demand and management strategies were regarded as an indicator of the direction of the performance of hotels in Tanzania pre and during the COVID-19 pandemic period. The study adopted both qualitative and quantitative analysis for a period of two years, 2019 to 2021, for a sample of two hotels in Dar es salaam which are 5- star hotels. Focus group discussion was used as a way to collect data along with secondary data. The regression analysis has been adopted to analyse secondary data after considering the correlation between variables in the study. Performance of hotels was measured using daily demand generated in pre and during the pandemic period against changes in prices influenced by COVID-19 pandemic. The study found out that the influence of price movement during the pandemic period was not significant enough to have led to the deteriorating performance of hotels in Tanzania. However, hotel performance deteriorated as a result of other contributing factors such as a fall in occupancy rate, lack of markets and increasing additional costs to fight against the pandemic, supply shocks which led to a fall in efficiency. It was evidenced that this was highly triggered by the overdependence of hotels on foreign markets. Travelling restrictions and lockdowns cultivated the deteriorating performance in hotels even though Tanzania never went into lockdown. However, hotel management adopted measures to contain the impacts through various ways, such as cutting down costs and revising prices. The study concluded and recommended that Tanzania hotels management should adopt flexible strategies on pricing that would accommodate unprecedented events that are beyond the control of the market forces (demand and supply). This would enable management to have decisions that reflect the condition in the country and not get influence from companies within the group situated in other countries.

Geostatistical linkage of national demographic and health survey data: a case study of Tanzania

BackgroundWhen Service Provision Assessment (SPA) surveys on primary health service delivery are combined with the nationally representative household survey—Demographic and Health Survey (DHS), they can provide key information on the access, utilization, and equity of health service availability in low- and middle-income countries. However, existing linkage methods have been established only at aggregate levels due to known limitations of the survey datasets.MethodsFor the linkage of two data sets at a disaggregated level, we developed a geostatistical approach where SPA limitations are explicitly accounted for by identifying the sites where health facilities might be present but not included in SPA surveys. Using the knowledge gained from SPA surveys related to the contextual information around facilities and their spatial structure, we made an inference on the service environment of unsampled health facilities. The geostatistical linkage results on the availability of health service were validated using two criteria—prediction accuracy and classification error. We also assessed the effect of displacement of DHS clusters on the linkage results using simulation.ResultsThe performance evaluation of the geostatistical linkage method, demonstrated using information on the general service readiness of sampled health facilities in Tanzania, showed that the proposed methods exceeded the performance of the existing methods in terms of both prediction accuracy and classification error. We also found that the geostatistical linkage methods are more robust than existing methods with respect to the displacement of DHS clusters.ConclusionsThe proposed geospatial approach minimizes the methodological issues and has potential to be used in various public health research applications where facility and population-based data need to be combined at fine spatial scale.

Unpacking authoritarian governance in electricity policy: Understanding progress, inconsistency and stagnation in Tanzania

In Africa, the 21st century has seen increased policy focus on the electricity sector, with targets for providing reliable, affordable power and achieving universal electricity access. But how to understand the policymaking affecting these goals? Recent academic and policy literature has tended to focus on factors like ‘political will’ and on the positive impacts of democratic and liberal-market institutional reform. However, given the predominance of authoritarianism in Africa, we also need to unpack countries ruled by dominant political elites. This article, using insights from the political settlements framework, addresses this by using the case study of Tanzania. Whilst under consistent de-facto 1-party rule, it experienced two markedly different periods of electricity policymaking in electricity generation, first under President Kikwete (2005–2015) and second President Magufuli (2015–2021). Meanwhile consistent, substantive increases were achieved in electricity access. Using insights from the ‘political settlements framework, the article explains these contrasts through shifts in the nature of political power. The article demonstrates that centralised, fragmented regimes contain weaknesses in their ability to implement policy and pursue long-term development, whilst centralised dominant regimes have a weakness from supressing critique. Overall, this reinforces the importance of analysing the manifestation of political power within the ruling elite, and the way this shapes key political pressures and policymaking horizons.

National Health Insurance Fund\u2019s relationship to retail drug outlets: a Tanzania case study

BackgroundAchieving universal health coverage will require robust private sector engagement; however, as many low- and middle-income countries launch prepayment schemes to achieve universal health coverage, few are covering products from retail drug outlets (pharmacies and drug shops). This case study aims to characterize barriers and facilitators related to incorporating retail drug outlets into national prepayment schemes based on the experience of the Tanzanian National Health Insurance Fund’s (NHIF) certification of pharmacies and accredited drug dispensing outlets.MethodsWe reviewed government documents and interviewed 26 key informants including retail outlet owners and dispensers and central and district government authorities representing eight districts overall. Topics included awareness of NHIF in the community, access to medicines, claims processing, reimbursement prices, and how the NHIF/retail outlet linkage could be improved.ResultsImportant enablers for NHIF/retail outlet engagement include widespread awareness of NHIF in the community, NHIF’s straightforward certification process, and their reimbursement speed. All of the retail respondents felt that NHIF helps their business and their clients to some degree. As for barriers, retailers thought that NHIF needed to provide more information to them and to its members, particularly regarding coverage changes. Some retailers and government officials thought that the product reimbursement prices were below market and not adjusted often enough, and pharmacy respondents were unhappy about claim rejections for what they felt were insignificant issues. All interviewees agreed that one of the biggest problems is poor prescribing practices in public health facilities. They reiterated that prescribers need more supervision to improve their practices, particularly to ensure adherence to standard treatment guidelines, which NHIF requires for approving a claim. In addition, if a prescription has any problem, including a wrong date or no signature, the client must return to the health facility to get it corrected or pay out-of-pocket, which is burdensome.ConclusionsLittle published information is available on the relationship between health insurance plans and retail providers in low- and middle-income countries. This case study provides insights that countries can use when designing ways to include retail outlets in their health insurance schemes.

Assessment of eye movements and selected vision function tests in three pupils with albinism: A case study in Tanzania

Albinism is a huge challenge both socially and educationally in Tanzania and many other countries. Pupils with albinism are normally encouraged to read with a fixed gaze due to their nystagmus, and there are doubts about whether refraction improves their reading. The aim is to get more knowledge about their functional vision as a fundament for educating pupils with albinism. The article presents a case study with three pupils from a primary school in Tanzania who went through a functional assessment of vision using standardized methods and a new eye-tracker software measuring smooth pursuits. The assessment reveals large individual differences not only in visual acuity but also in ocular motor functions. There is a need for better understanding of the vision challenges these pupils face so that professionals can develop more suitable methods in school for securing their education.