Health Care System In Tanzania Research Articles

Views of biomedical practitioners and traditional healers on concerted mental health care provision in Tanzania: A study protocol for a qualitative explorative study

Access to mental healthcare in low- and middle-income countries (LMICs) remains low. In Tanzania specifically, there is an urgent need to scale up mental health care, decrease the mental health treatment gap, and make mental health care more accepted and accessible within the community. Since traditional medicine plays a prominent role in the mental health care system in Tanzania, improving access through collaboration between biomedical practitioners and traditional healers could be a possible way forward. The aim of the current study is to explore views among biomedical practitioners and traditional healers on collaboration between both groups in mental health care in the Dodoma region, Tanzania. We will conduct qualitative interviews using key informant interviews (KII) and in-depth-interviews (IDI) with mental health care providers, traditional healers, and coordinators from the Dodoma region till saturation is achieved. Interviews will be transcribed verbatim and coded, followed by a thematic analysis. This qualitative study is the first to explore opportunities for strengthening the mental health care system by establishing views on collaboration among biomedical practitioners and traditional healers in Tanzania mainland.

It is beyond remuneration: Bottom-up health workers' retention strategies at the primary health care system in Tanzania.

Although Tanzania is operating a decentralized health system, most of the health workers' retention strategies are designed at the central level and implemented at the local level. This study sought to explore the bottom-up health workers' retention strategies by analyzing experiences from two rural districts, Rombo and Kilwa in Tanzania by conducting a cross-sectional exploratory qualitative study in the said districts. Nineteen key informants were purposefully selected based on their involvement in the health workers' retention scheme at the district and then interviewed. These key informants included district health managers, local government leaders, and in-charges of health facilities. Also, three focused group discussions were conducted with 19 members from three Health Facility Governing Committees (HFGCs). Qualitative content analysis was deployed to analyze the data. We uncovered health-facility and district level retention strategies which included, the promotion of good community reception, promotion of good working relationships with local government leaders, limiting migration within district facilities and to districts within the region, and active head-hunting at training institutions. Retention of health workers at the primary health care level is beyond remuneration. Although some of these strategies have financial implications, most of them are less costly compared to the top-bottom strategies. While large scale studies are needed to test the generalizability of the strategies unveiled in our study, more studies are required to uncover additional bottom-up retention strategies.

Reproducibility of a Rapid Human Papillomavirus Test at Different Levels of the Healthcare System in Tanzania: The AISHA Study

To inform policy makers in Tanzania if and how best to implement rapid HPV testing, we assessed the interobserver reproducibility of careHPV test at three different levels of the healthcare system in an urban and a rural region of Tanzania. Women aged 30 to 50 years were screened by careHPV testing in two primary healthcare centers (PHC), two district hospitals (DiH), and two regional hospitals (ReH). Aliquots were retested at regional (ReH) and national referral laboratories (NRL). Reproducibility was evaluated using agreement and kappa index measures. Intralaboratory reproducibility was also evaluated in a set of 10 positive and 10 negative samples. Samples from 1,134 women were locally tested and retested at ReH and/or NRL. Test results from Dar es Salaam ReH and Kilimanjaro PHC showed clear quality problems including suspicion of contamination during testing or aliquoting. After excluding these samples, 18.8% of 743 women were HPV positive at clinic level. The resulting careHPV reproducibility at different levels of the healthcare system was very good [agreement 95.7%, 95% confidence interval (CI), 94.0-96.9; kappa, 0.86, 95% CI, 0.81-0.91]. Intralaboratory agreement was also very good across four different experiments, with Fleiss' kappa between 0.87 (95% CI, 0.61-1.00) and 1.00 (0.75-1.00). Rapid HPV testing was highly reproducible between lower and higher levels of the healthcare system in Tanzania; however, performance seems to be operator dependent. The careHPV test seems to be a feasible option for cervical cancer screening in an organized, decentralized system and in limited-resource settings if quality assurance measures are in place.

Preparedness of lower-level health facilities and the associated factors for the outpatient primary care of hypertension: Evidence from Tanzanian national survey.

IntroductionSub-Saharan Africa is experiencing a rapid rise in the burden of non-communicable diseases in both urban and rural areas. Data on health system preparedness to manage hypertension and other non-communicable diseases remains scarce. This study aimed to assess the preparedness of lower-level health facilities for outpatient primary care of hypertension in Tanzania.MethodsThis study used data from the 2014–2015 Tanzania Service Provision Assessment survey. The facility was considered as prepared for the outpatient primary care of hypertension if reported at least half (≥50%) of the items listed from each of the three domains (staff training and guideline, basic diagnostic equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Data were analyzed using Stata 14. An unadjusted logistic regression model was used to assess the association between outcome and explanatory variables. All variables with a P value < 0.2 were fitted into the multiple logistic regression models using a 5% significance level.ResultsOut of 725 health facilities involved in the current study, about 68% were public facilities and 73% located in rural settings. Only 28% of the assessed facilities were considered prepared for the outpatient primary care of hypertension. About 9% and 42% of the assessed facilities reported to have at least one trained staff and guidelines for hypertension respectively. In multivariate analysis, private facilities [AOR = 2.7, 95% CI; 1.2–6.1], urban location [AOR = 2.2, 95% CI; 1.2–4.2], health centers [AOR = 5.2, 95% CI; 3.1–8.7] and the performance of routine management meetings [AOR = 2.6, 95% CI; 1.1–5.9] were significantly associated with preparedness for the outpatient primary care of hypertension.ConclusionThe primary healthcare system in Tanzania is not adequately equipped to cope with the increasing burden of hypertension and other non-communicable diseases. Rural location, public ownership, and absence of routine management meetings were associated with being not prepared. There is a need to strengthen the primary healthcare system in Tanzania for better management of chronic diseases and curb their rising impact on health outcomes.

English

A study to document medicinal plants parts and practices in relation to sustainable use was performed in communities around the Miombo woodland of Urumwa in Tanzania. Data collection was based on semi-structured interviews and discussion with key stakeholders. G-tests were used to ascertain differences in medicinal plants practices between women and men. Roots were the commonly used parts for medicine followed by barks. In practice, boiling and grinding were the preferred methods for preparing remedies. Remedies are admistered orally in decoctions form with lack of standardized dosages. Medicinal plants are collected from the reserve using both root digging and bark stripping methods. Local communities need sensitization through trainings on various aspects of medicinal plants practices especially issues of sustainable harvesting methods, simple processing, domestication and the importance of standardized dosages so as to improve work performance, ensure resource sustainability and contribute to development of the primary health care system in Tanzania. Key words: Medicinal plants, practices, sustainability, Miombo woodlands, Tanzania.

“When in the body, it makes you look fat and HIV negative”: The constitution of antiretroviral therapy in local discourse among youth in Kahe, Tanzania

Antiretroviral therapy (ART) is becoming increasingly more accessible within the health care system in Tanzania. However, the impact of the increased availability of ART on local conceptions about medicines, health and physical wellbeing has not been fully explored. In this article we examine how ART is constituted within local discourses about treatment and healing. Based on 21 focus group discussions with young people aged 14–24 years in a rural area (Kahe), we examine how local terms and descriptions of antiretroviral therapy relate to wider definitions about the body, health, illness and drug efficacy. Findings illustrate how local understandings of ART draw on a wider discourse about the therapeutic functions of medicines and clinical dimensions of HIV/AIDS. Therapeutic efficacy of antiretroviral medication appeared to overlap and sometimes contradict locally shared understandings of the clinical functions of medicines in the body. Implications of ART on bodily appearance and HIV signs may influence conceptions about sick role, perpetuate stigma and affect local strategies for HIV prevention. Structural inequities in access, limited information on therapeutic efficacy of ART and perceived difficulties with status disclosure appear to inform local conceptions and possible implications of ART. Policy and programme interventions to foster public understanding and acceptability of ART should emphasize treatment education about the benefits and limitations of therapy and increased access to ART in rural areas, and should integrate voluntary status disclosure and HIV prevention.

Between the state and civil society: medical discipline in Tanzania

This article seeks to examine the status of the medical profession in Tanzania, in the context of political and economic developments since independence. It demonstrates that doctors have maintained a relatively privileged position within the health care system and in the wider society from the colonial period, through the early years of indpendence, to the present. This has been achieved by a variety of means. During the 1970s and early 1980s the profession was closely associated with the developmentalist project of the state. Because of economic restructuring since then it has had to adopt the rhetoric and techniques of accountability, to distance itself from the state and position itself in the notional realm of civil society. Recent cases of the Medical Council are used to demonstrate this trend. Renewed legitimation is most significant as a means of maintaining the profession's links with its international counterparts, and with foreign donors who support the health care system in Tanzania.

Phytochemical screening of tanzanian medicinal plants. I

To evaluate traditional medicine, which is an important part of the health-care system in Tanzania, three different regions, Coast, Morogoro and Kilimanjaro were surveyed for the herbs used by traditional healers. For each species, the botanical name, vernacular name, collection number and medical uses are given. Phytochemical screening of the 52 plant samples collected representing 49 species, 42 genera and 28 families was carried out. The analyses indicated that 94% plant samples contained steroids/ triterpenoids, 50% saponins, 40% carotenoids and 17% alkaloids.