Health Services In Tanzania Research Articles

‘ … You become a prisoner of your life’: A qualitative study exploring the experience of joint pain and accessing care in Hai, Tanzania

The increased prevalence of non-communicable diseases (NCDs) in recent years has led many Low- and Middle-Income Countries (LMICs), including Tanzania, to develop policies to manage their burden. Musculoskeletal (MSK) conditions, such as arthritis, account for 20% of all years lived with disability in LMICs, but the NCD strategies rarely address them. There is substantial research on the disruption MSK conditions cause to people's lives within High-Income Countries, but very little is known about the lived experiences in LMICs. We investigated the experience of MSK conditions in 48 in-depth qualitative interviews with participants from the Hai District in Tanzania, East Africa, all of whom had a MSK disorder (confirmed through clinical examination as part of a broader study). We found that loss of mobility and pain associated with MSK disorders severely limits people's everyday lives and livelihoods. Help from others, mainly those within a household, is necessary for most tasks and those with limited or no support experience particular problems. We found barriers to accessing care and treatment in the form of high direct and indirect (through travel) care costs within formal health services in Tanzania. We argue for increased attention to the growing problem of MSK disorders in LMICs and that this agenda should be driven by a patient-centred approach which designs services accessible to the target population and designed to recognise their embodied expertise.

Handling of Electronic Health Records in Tanzania: Awareness and Use of Available Regulations

This paper sought to establish the awareness of the importance of patient privacy as well as the awareness of available policies guiding the handling of patients’ personal and health records. Using the case study design, the study collected data from doctors, nurses, ICT officers as well as patients from four hospitals selected purposively in Dar es Salaam and Dodoma regions of Tanzania. A total of 43 respondents participated in this study. Data was subjected to thematic analysis using the NVIVO 12 plus computer package. Results show that both providers and users of e – health services in Tanzania consider patient privacy to be an important issue and they relate it to morality, personal respect and dignity. Level of awareness of existing government institutions guiding the work of health service providers was found to be low. It is concluded that, the presence of regulatory institutions is not enough if these institutions are not known, valued, considered and used by members of organizations. There is a need for the e – health service providers and patients to familiarize themselves with available policies and regulations for the health providers and for the government to promote these regulatory institutions.

The role of gender inequities in women's access to reproductive health services: a population-level study of Simiyu Region Tanzania

BackgroundAmref Health Africa, with support from Global Affairs Canada, examines if women's access to reproductive health services in Tanzania is affected by Gender social norms, decision-making power, roles and responsibility, and access to resources in relation to the utilization of reproductive Health Services in Tanzania. A Gender Need Assessment (GNA) was conducted in five districts in ' 'Tanzania Simiyu Region to improve the infrastructure, supply, quality, and demand for integrated Reproductive, Maternal, Newborn, and Child and Adolescent Health (RMNCAH), Nutrition, and Water, Sanitation, and Hygiene (WASH) services. The analysis identifies gender as a fundamental maternal and child health driver through existing gender inequality at the household and community levels that dictates women's status.MethodsThe qualitative assessment involved data collected from gender- and age-desegregated focus group discussions (FGDs) and in-depth interviews (IDIs) of key informants in three districts; Bariadi, Busega, and Meatu, in Simiyu region, Tanzania. Participants comprised 8-10 married women and men, unmarried women and men, and adolescent boys and girls. A total of 129 participants were involved in the FGDs.ResultsThis paper reports the critical drivers influencing gender inequality in Simiyu by detailing how Gender inequality affected women's access to reproductive health care in relation to; gender social norms, decision-making power, access to resources at the household and community level, roles and responsibilities, including men's and 'boys' roles are more valued than the roles and responsibilities of women and girls resulted to limited free time to do things for themselves, such as visiting the health facilities for RMNCAH.ConclusionsThis paper explored gender-based enablers and/or barriers influencing women and girls' realization of their sexual and reproductive health and rights. It was found that social norms, decision-making powers, and lack of access to and control over resources presented as key barriers. In contrast, continuous community sensitization and increased scope of women's participation in decision-making served as enabling environment to overcome gender inequities that influence woman's use of RMNCAH services in Tanzania. Such insights will shape interventions geared towards valuing differences in a manner that overcome gender inequities that influence woman's use of RMNCAH services in Tanzania.

The impacts of COVID-19 and its policy response on access and utilization of maternal and child health services in Tanzania: A mixed methods study.

The SARS-Cov-2 virus (COVID-19) has had a global social and economic impact. Despite the growing evidence, its effects on access and delivery of maternal and child health services in low-income countries are still unclear. This cross-sectional case study was conducted in Mjini Magharibi, Chake Chake, and Ilala districts in Tanzania to help fill this gap. The study combined qualitative and quantitative data collection methods, providing an account of the evolution of the pandemic and the associated control measures in Tanzania. We drew from 34 in-depth interviews, 60 semi-structured interviews, and 14 focus group discussions with key informants, patients, and health providers, and complemented the findings with a review of pandemic reports and health facility records. We followed the Standards for Reporting Qualitative Research (SRQR) to provide an account of the findings. Our account of the pandemic shows that there was at times an inconsistent policy response in Tanzania, with diverse control measures adopted at various stages of the epidemic. There was a perception that COVID-19 services were prioritized during the epidemic at the expense of regular ones. There were reports of reorganisation of health facilities, reallocation of staff, rescheduled antenatal and postnatal clinics, and reduced time for health education and child monitoring. Scarcity of essential commodities was reported, such as vaccines, equipment, and medical supplies. Such perceptions were in part supported by the routine utilization evidence in the three districts, showing a lower uptake of antenatal, postnatal, family planning, and immunization services, as well as fewer institutional deliveries. Our findings suggest that, although the policy response in Tanzania was erratic, it was rather fear of the pandemic itself and diversion of resources to control COVID-19, that may have contributed most to lower the utilization of mother and child services. For future emergencies, it will be crucial to ensure the policy response does not weaken the population's demand for services.

Feasibility and sustainability of a school-based platform for integrated delivery of HPV vaccination with adolescent health services in Tanzania: qualitative insights from stakeholders.

To meet lofty human papillomavirus (HPV) immunization goals in Tanzania, the Ministry of Health integrated HPV vaccination with adolescent health services using a school-based approach. A qualitative study was conducted in June-July 2021, examining the feasibility and sustainability of an integrated service package, HPV Plus. In-depth interviews with 46 programme implementers (i.e. health-care workers and teachers) and planning stakeholders (i.e.government officials and school administrators) in Dar es Salaam and Njombe Regions explored enablers and constraints to HPV Plus programme implementation, including resource and staffing requirements. Two facilitators and three barriers to HPV Plus feasibility and sustainability were identified from thematic analysis of interviews. Interviewed stakeholders emphasized the programme's feasibility, especially if the efficiencies offered by a school-based platform were optimized. Implementation facilitators included (1) optimized service delivery efficiency through a school-based platform and (2) resources saved by combining adolescent health services and HPV immunization into a single programme package. Key barriers to HPV Plus feasibility and sustainability were (1) time, space and resource constraints (e.g. commodity stockouts and challenges delivering the complete service package to large cohorts of students within allotted times); (2) human resource gaps and increased workloads within the health workforce and (3) insufficient referral mechanisms linking schools to health facilities. Scaling up HPV Plus will require proactive commodity procurement and security; resource mobilization to reach ambitious service delivery targets and close co-ordination of programme implementation with school administrators.

Factors for Late Initiation of Antenatal Care in Kahama Municipal, Tanzania

Background: Maternal mortality is a major public health issue in developing countries due to its shocking magnitude and lower declining pattern, 295 000 women died of pregnancy or childbirth related complications in 2017. Late initiation of Antenatal Care (ANC) services in most low-income countries like Tanzania has been reported as a major problem which increase maternal mortality rate (MMR). However, different factors for late initiation of antenatal care are not well identified. Therefore, this study aimed to identify factors for late initiation of antenatal care both individual factors and health policy factors as per pregnant women and health care providers opinions in Kahama Municipal, Tanzania. 
 Broad Objective: The study focused on assessment of factors for late initiation of Antenatal Care (ANC) in Kahama Municipal, Tanzania. 
 Materials and Methods: This study was conducted using a qualitative method with exploratory approach which was carried out to explore factors for late initiation of antenatal care in Kahama Municipal. An in-depth interview (IDI) and Focus Group Discussion (FGD) were methods used to collect data. The study comprised of 14 in-depth interviews (IDIs) with pregnant women with age range of 18 years to 49 years attending antenatal care clinics in two health facilities and 4 in-depth interviews (IDIs) with health care providers attending pregnant women during antenatal care clinic visit. Furthermore, two Focus Group Discussions (FGDs), one from each health facility with pregnant women were conducted. 
 Data Analysis: Thematic analysis was conducted through use of inductive approach. The audio recordings were conducted using the Swahili language then transcribed and translated into the English language where themes were obtained after translation. 
 Results: Findings obtained from this study were factors for late initiation of antenatal care as reported by both pregnant women and health care providers. Factors for late initiation of antenatal care were under guidance of Health Behavioral Modal (HBM): Factors mentioned by pregnant women included pregnant women education level, negligence of pregnant women to attend clinic, unplanned pregnancy among couples, distance from pregnant women settlement to the facility, pregnant women misconceptions related to antenatal care services, use of local herbs, pregnancy complications, , unfriendly services and unequal gender power relation within a family. Factors mentioned by health care providers based on health policy and managerial factors such as Partner accompanying policy, distant allocation of health facility from people’s settlement and unfriendly services provided by health care providers. Conclusion: This study focused on assessing factors for late initiation of antenatal care in Kahama municipal council in Shinyanga, Tanzania. Different factors for late initiation of antenatal care were reported which included pregnant women and health care providers. Pregnant women education level, negligence of pregnant women to attend clinic, unplanned pregnancy among couples, and distance from pregnant women settlement to the facility, pregnant women misconceptions related to antenatal care services, use of local herbs, pregnancy complications. Health policy and managerial related factors were partner accompanying policy, unfriendly services, and allocation of health facility. 
 Recommendation: However different improvement made on maternal health services in Tanzania but still some of pregnant women are not utilizing it efficiently because of different obstacles like distance from people’s settlement to the health facility, Partner accompanying policy and unfriendly services provided by health care providers. Through such obstacles as a policy maker, I would like to advice Government through Ministry of Health to allocate health facility nearby people’s settlement, providing outreach program to educate the community about antenatal care rather than relying on partner accompanying policy and lastly is provision of refresher training related to client’s rights during health care services provision to all staff.

Challenges in health service delivery under public-private partnership in Tanzania: stakeholders\u2019 views from Dar es Salaam region

BackgroundPublic-private partnership in the health sector was introduced to improve the delivery of health services in Tanzania. Contrary, the expected outcomes have not been fully realised. This study aimed at investigating challenges encountered in implementing public-private partnership institutional arrangements in health service delivery in Kinondoni Municipality, Dar es Salaam, Tanzania.MethodsA qualitative case study design was employed, where in-depth interviews with stakeholders were held and document reviews conducted. Fourteen (n = 14) participants engaged in this study. Eight (n = 8) and six (n = 6) of the fourteen participants were from the public and private sector respectively. The thematic approach was used to analyse data, and ethical principles in the research process were upheld.ResultsFindings revealed that although public-private partnerships are hailed for supplementing the government’s efforts in the provision of health services, institutional arrangements for the smooth provision of these services are lacking. Several challenges encumber smooth provision of health services and these include inadequate resources, ineffective monitoring and evaluation, and insufficient consultations between partners.ConclusionInadequate legal and policy framework, or ineffective implementation practices may influence challenges facing institutional arrangements for public-private partnerships. Therefore, strengthening of public-private partnerships is recommended to improve implementation mechanisms and practices such as adherence to partnership agreements and compliance to the policies, laws and regulations.

The effects of medicines availability and stock-outs on household's utilization of healthcare services in Dodoma region, Tanzania.

Low- and middle-income countries have been undertaking health finance reforms to address shortages of medicines. However, data are lacking on how medicine availability and stock-outs influence access to health services in Tanzania. The current study assesses the effects of medicine availability and stock-outs on healthcare utilization in Dodoma region, Tanzania. We conducted a cross-sectional study that combined information from households and healthcare facility surveys. A total of 4 hospitals and 89 public primary health facilities were surveyed. The facility surveys included observation, record review over a 3-month period prior to survey date, and interviews with key staff. In addition, 1237 households within the health facility catchment areas were interviewed. Data from the facility survey were linked with data from the household survey. Descriptive analysis and multivariate logistic regressions models were used to assess the effects of medicine availability and stock-outs on utilization patterns and to identify additional household-level factors associated with health service utilization. Eighteen medicines were selected as ‘tracers’ to assess availability more generally, and these were continuously available in ∼70% of the time in facilities across all districts over 3 months of review. The main analysis showed that household’s healthcare utilization was positively and significantly associated with continuous availability of all essential medicines for the surveyed facilities [odds ratio (OR) 3.49, 95% confidence interval (CI) 1.02–12.04; P = 0.047]. Healthcare utilization was positively associated with household membership in the community health insurance funds (OR 1.97, 95% CI 1.23–3.17; P = 0.005) and exposure to healthcare education (OR 2.75, 95% CI 1.84–4.08; P = 0.000). These results highlight the importance of medicine availability in promoting access to health services in low-income settings. Effective planning and medicine supply management from national to health facility level is an important component of quality health services.

Acceptability of malaria rapid diagnostic tests administered by village health workers in Pangani District, North eastern Tanzania.

BackgroundMalaria continues to top the list of the ten most threatening diseases to child survival in Tanzania. The country has a functional policy for appropriate case management of malaria with rapid diagnostic tests (RDTs) from hospital level all the way to dispensaries, which are the first points of healthcare services in the national referral system. However, access to these health services in Tanzania is limited, especially in rural areas. Formalization of trained village health workers (VHWs) can strengthen and extend the scope of public health services, including diagnosis and management of uncomplicated malaria in resource-constrained settings. Despite long experience with VHWs in various health interventions, Tanzania has not yet formalized its involvement in malaria case management. This study presents evidence on acceptability of RDTs used by VHWs in rural northeastern Tanzania.MethodsA cross-sectional study using quantitative and qualitative approaches was conducted between March and May 2012 in Pangani district, northeastern Tanzania, on community perceptions, practices and acceptance of RDTs used by VHWs.ResultsAmong 346 caregivers of children under 5 years old, no evidence was found of differences in awareness of HIV rapid diagnostic tests and RDTs (54 vs. 46 %, p = 0.134). Of all respondents, 92 % expressed trust in RDT results, 96 % reported readiness to accept RDTs by VHWs, while 92 % expressed willingness to contribute towards the cost of RDTs used by VHWs. Qualitative results matched positive perceptions, attitudes and acceptance of mothers towards the use of RDTs by VHWs reported in the household surveys. Appropriate training, reliable supplies, affordability and close supervision emerged as important recommendations for implementation of RDTs by VHWs.ConclusionRDTs implemented by VHWs are acceptable to rural communities in northeastern Tanzania. While families are willing to contribute towards costs of sustaining these services, policy decisions for scaling-up will need to consider the available and innovative lessons for successful universally accessible and acceptable services in keeping with national health policy and sustainable development goals.

Effect of Paying for Performance on Utilisation, Quality, and User Costs of Health Services in Tanzania: A Controlled Before and After Study.

BackgroundDespite widespread implementation across Africa, there is limited evidence of the effect of payment for performance (P4P) schemes in low income countries on the coverage of quality services and affordability, consistent with universal health coverage objectives. We examined the effect of a government P4P scheme on utilisation, quality, and user costs of health services in Tanzania.MethodsWe evaluated the effects of a P4P scheme on utilisation of all maternal and child immunization services targeted by the scheme, and non-targeted general outpatient service use. We also evaluated effects on patient satisfaction with care and clinical content of antenatal care, and user costs. The evaluation was done in 150 facilities across all 7 intervention districts and 4 comparison districts with two rounds of data collection over 13-months in January 2012 and February 2013. We sampled 3000 households of women who had delivered in the 12 months prior to interview; 1500 patients attending health facilities for targeted and non-targeted services at each round of data collection. Difference-in-difference regression analysis was employed.FindingsWe estimated a significant positive effect on two out of eight targeted indicators. There was an 8.2% (95% CI: 3.6% to 12.8%) increase in coverage of institutional deliveries among women in the intervention area, and a 10.3% (95% CI: 4.4% to 16.1%) increase in the provision of anti-malarials during pregnancy. Use of non-targeted services reduced at dispensaries by 57.5 visits per month among children under five (95% CI: -110.2 to -4.9) and by 90.8 visits per month for those aged over five (95% CI: -156.5 to -25.2). There was no evidence of an effect of P4P on patient experience of care for targeted services. There was a 0.05 (95% CI: 0.01 to 0.10) increase in the patient satisfaction score for non-targeted services. P4P was associated with a 5.0% reduction in those paying out of pocket for deliveries (95% CI: -9.3% to -0.7%) but there was no evidence of an effect on the average amount paid.ConclusionThis study adds to the very limited evidence on the effects of P4P at scale and highlights the potential risks of such schemes in relation to non-targeted service use. Further consideration of the design of P4P schemes is required to enhance progress towards universal health coverage, and close monitoring of effects on non-targeted services and user costs should be encouraged.

The precariousness of the franchise state: Voluntary sector health services and international NGOs in Tanzania, 1960s – mid-1980s

This paper challenges conventional narratives on the role of international non-governmental organisations (INGOs) in the delivery of health services in Tanzania. Adopting an historical gaze which focuses on the 1960s to mid-1980s the paper argues that the ‘franchise state’ in the Tanzanian health system was not created by collusion between international donors and INGOs, underpinned by a set of health sector reforms that advocated the use of non-state actors; but was rather the legacy of the colonial health system bequeathed to the post-independence state. It was a system in which voluntary non-state actors (but, importantly, not INGOs) were already entrenched as key providers; and in which many of the features of the franchise state – fragmentation, structural weaknesses, lack of accountability to users – were already long established. But if INGOs did not create these features, as their critics attest, they did contribute to the maintenance and extension of these features. The short-term perspectives of NGOs, their small-scale piecemeal engagement, and the extra demands they placed upon their voluntary actor partners, left little scope for the development of sustainable, national and accountable solutions to the health needs of the country. In exploring these ideas, the paper contributes to a more nuanced understanding of the path dependency that created Tanzania's health system. The analysis also contributes to a deepening of the understanding of the make-up of the voluntary sector beyond a narrow gaze on the institution of the INGO.

Trends in stroke admissions to a Tanzanian hospital over four decades: a retrospective audit.

The aim of this study was to record stroke admissions to a tertiary referral hospital in Tanzania over four decades. We audited the medical records held at a large teaching and tertiary referral hospital in northern Tanzania over four decades. We collected records for the years 1974-1976, 1984-1986, 1994-1995 and 2008. All patients admitted as inpatients with a primary diagnosis of stroke were included in the study. Data collected included age, sex, stroke subtype, predominant side of symptoms and survival to discharge. The number of stroke admissions rose from just four in the three-year period 1974-1976 (mean 1.3 cases annually) to 153 cases annually in 2008. The mean age of those admitted rose steadily during this period, as did the proportion of females admitted. The burden of stroke on health services in Tanzania appears to have increased rapidly. If this increase is to be slowed, then sustainable primary preventative measures to target known stroke risk factors will be required.

A 'mystery client' evaluation of adolescent sexual and reproductive health services in health facilities from two regions in Tanzania.

Unwelcoming behaviours and judgemental attitudes have long been recognised as a barrier to young people’s access to reproductive health services. Over the last decade youth friendly reproductive health services have been promoted and implemented world-wide. However, long term evidence of the impact of these programmes is lacking. We report the results of a large mystery client evaluation of adolescent sexual and reproductive health services in Tanzania, a country that has had a long established youth friendly policy. Forty-eight visits made to thirty-three health facilities were conducted by twelve young people (six in each region) trained to perform three different scripted scenarios (i.e., condom request, information on sexually transmitted infections and family planning). The study revealed barriers in relation to poor signage and reception for services. In addition health workers demonstrated paternalistic attitudes as well as lack of knowledge about adolescent sexual and reproductive health services. In some cases, health workers discouraged young people from using services such as condoms and family planning methods. Lack of confidentiality and privacy were also noted to be common challenges for the young people involved. Intervention strategies that focus on changing health workers’ mind-set in relation to adolescent sexual and reproductive health are crucial for ensuring quality provision of sexual and reproductive health services to young people. The study identified the importance of reception or signs at the health units, as this can facilitate young people’s efforts in seeking sexual and reproductive health services. Likewise, improvement of health workers knowledge of existing policy and practice on sexual and reproductive health services and youth friendly services is much needed.

Determinants of delay in care seeking among children under five with fever in Dodoma region, central Tanzania: a cross-sectional study.

BackgroundEarly diagnosis and timely treatment of malaria is recognized as a fundamental element to the control of the disease. Although access to health services in Tanzania is improved, still many people seek medical care when it is too late or not at all. This study aimed to determine factors associated with delay in seeking treatment for fever among children under five in Tanzania.MethodsA three-stage cluster sampling design was used to sample households with children under five in Dodoma region, central Tanzania between October 2010 and January 2011. Information on illness and health-seeking behaviours in the previous four weeks was collected using a structured questionnaire. A multivariable logistic regression was used to investigate determinants of delay in treatment-seeking behaviour while accounting for sample design.ResultsA total of 287 under-five children with fever whose caretakers sought medical care were involved in the study. Of these, 55.4% were taken for medical care after 24 hours of onset of fever. The median time of delay in fever care seeking was two days. Children who lived with both biological parents were less likely to be delayed for medical care compared to those with either one or both of their biological parents absent from home (OR = 0.42, 95% CI: 0.24, 0.74). Children from households with two to three under-five children were more likely to be delayed for medical care compared to children from households with only one child (OR = 1.54, 95% CI: 1.04, 2.26). Also, children living in a distance ≥5 kilometres from the nearest health facility were about twice (95% CI: 1.11, 2.72) as likely to delay to be taken for medical care than those in the shorter distances.ConclusionLiving with non-biological parents, high number of under-fives in household, and long distance to the nearest health facility were important factors for delay in seeking healthcare. Programmes to improve education on equity in social services, family planning, and access to health facilities are required for better healthcare and development of children.

Analysis of the Impact of Rural Households Membership in the Micro Health Insurance on the Utilization of Health Services in Tanzania

This paper analyses the utilization of health services among the members of micro health insurance schemes in rural areas in Tanzania. Most literature on health insurance in rural areas in developing countries, including Tanzania, had analyzed socio-economic determinants of the households’ demand for health insurance plans. Little attention has been given to the outcomes of purchasing the health insurance plans as the determinants of membership in the schemes. This is the research knowledge gap that this study seeks to fill. In order to examine the effect of households’ membership in the micro health insurance schemes, on the utilization of health services, the matching estimator method has been adopted. In addition, the data from Tanzania Demographic and Health Survey of 2011 were used to analyse the outcome of households’ membership in the health insurance schemes on the utilization of health services. The findings revealed that the membership in the micro health insurance plans increased the utilization of the health services among the poor households, but not for the non-poor. Moreover, the insurance schemes did not provide protection against catastrophic health spending among the rural households in the episodes of illness. The reasons are that the households had to incur additional expenditures when visiting the health facilities in episodes of illness and that the plans provide limited range of benefits to households. Thus, it is recommended that poor households should be encouraged to enrol in the micro health insurance schemes. Moreover, the health facilities should provide adequate supplies so as to minimize out of pocket spending for households in the episode of illness.

Standardizing and scaling up quality adolescent friendly health services in Tanzania

BackgroundAdolescents in Tanzania require health services that respond to their sexual and reproductive health – and other – needs and are delivered in a friendly and nonjudgemental manner. Systematizing and expanding the reach of quality adolescent friendly health service provision is part of the Tanzanian Ministry of Health and Social Welfare's (MOHSW) multi-component strategy to promote and safeguard the health of adolescents.ObjectiveWe set out to identify the progress made by the MOHSW in achieving the objective it had set in its National Adolescent Health and Development Strategy: 2002–2006, to systematize and extend the reach of Adolescent Friendly Health Services (AFHS) in the country.MethodsWe reviewed plans and reports from the MOHSW and journal articles on AFHS. This was supplemented with several of the authors’ experiences of working to make health services in Tanzania adolescent friendly.ResultsThe MOHSW identified four key problems with what was being done to make health services adolescent friendly in the country – firstly, it was not fully aware of the various efforts under way; secondly, there was no standardized definition of AFHS; thirdly, it had received reports that the quality of the AFHS being provided by some organizations was poor; and fourthly, only small numbers of adolescents were being reached by the efforts that were under way. The MOHSW responded to these problems by mapping existing services, developing a standardized definition of AFHS, charting out what needed to be done to improve their quality and expand their coverage, and integrating AFHS within wider policy and strategy documents and programmatic measurement instruments. It has also taken important preparatory steps to stimulate and support implementation.ConclusionThe MOHSW is aware that the focus of the effort must now shift from the national to the regional, council and local levels. The onus is on regional and council health management teams as well as health facility managers to take the steps needed to ensure that all adolescents in the country obtain the sexual and reproductive health (SRH) services they need, delivered in a friendly and non-judgemental manner. But they cannot do this without substantial and ongoing support.

Socio-demographic and behavioural correlates of oral health related quality of life among Tanzanian adults: A national pathfinder survey.

In response to the growing recognition of quality of life measurement in health care, indicators that address the social and psychological consequences of oral disorders have been developed to complement conventional clinical assessment. The objective of this study was to determine socio-demographic and behavioural correlates of oral health related quality of life (OHRQoL) among Tanzanian adults. The national pathfinder survey methodology described in the WHO Oral Health Surveys - Basic Methods was used to obtain a total of 1,759 Tanzanian adults aged 18 years and above. In line with the pathfinder methodology clusters were purposively selected to represent cities, towns and rural areas. In each cluster individuals were stratified by age and sex. The outcome variable was the OHRQoL in terms of oral impacts on daily performances (OIDP). Frequency distribution, bivariate analyses, and generalized linear models using log binomial regression models were performed by SPSS version 15. About half (49.1%) of the respondents reported at least one oral impact during a period of three months before the survey. Difficulty in chewing was the most prevalent impact affecting 3 9.9% of participants. A higher proportion of those who reported poor conditions of teeth had difficulties in chewing and sleeping was often interrupted. Multivariate analysis indicated that those who perceived their teeth conditions to be good (PR=0.38; CI: 0.32-0.44), were of younger age (PR=0.84; CI: 0.77-0.90), and had visited a dentist during the past five years or more (PR=0.84; CI: 0.77-0.90) and were less likely to have an oral impact. On the other hand those who restricted their sugar consumption (PR=1.12; CI: 1.03-0.1.22) were more likely to have an impact on at least one daily performance. It is concluded that the prevalence of OIDP was high while perceived teeth conditions and age varied with OHRQoL in terms of OIDP in the expected direction. Those who visited the dental clinic in the recent past had more impacts than those who did not. The findings of this study confirm the usefulness of subjective indicators in explaining peoples' suffering. In this regard it is recommended that in the next national pathfinder survey traditional clinical oral health indicators should be complemented with subjective indicators in order to obtain triangulated data for planning oral health services in Tanzania.

Cognitive behaviour therapy training in a developing country: a pilot study in Tanzania

Abstract:Cognitive behaviour therapy (CBT) has been found to be effective in treating mental health problems in the UK, but little has been done to evaluate the potential of CBT in developing countries. This paper aims to discuss the development and implementation of a CBT training course for clinicians working in Tanzania's main psychiatric hospital in the capital city, Dodoma. A 12-session training course in CBT was delivered to nine clinicians. An outcome evaluation was conducted using multiple measures and methods, taken before and after the training. Information on cultural adaptations of the training was obtained. All participants completed the course, but there were several obstacles to full completion of the evaluation measures. Despite this, there were significant improvements in clinicians’ basic understanding of CBT concepts, and their ability to apply the CBT model to formulate and recommend treatment strategies in response to a clinical case. Qualitative information indicated the potential of developing CBT training and implementation further. As a pilot study, this investigation shows the promise that CBT holds for mental health services in Tanzania. Further research into the training and clinical effectiveness of CBT in Tanzania is indicated.

A telemedicine network to support paediatric care in small hospitals in rural Tanzania

We reviewed our experience with the Tanzanian Telemedicine Network in supporting paediatric care at 40 small, rural hospitals in the country. The network began operating in 2008. Store and forward telemedicine was provided via the open source software iPath. The 33 volunteer consultants were based in several countries, although most of them had practical experience in Tanzania. During the first three years of network operation there were 533 referrals. There were 159 paediatric cases (median age five years). Three paediatric specialists provided most consultations (64%), but other specialists provided recommendations when required. The response time was usually less than two days (median 6 h; inter-quartile range 2-24 h). A precise recommendation was not always provided, but since all consultants had an intimate knowledge of the state of health services in Tanzania, their advice was usually well adapted to the local circumstances of the hospitals. Referral to a higher level of care was recommended in 26 cases (16%). A simple web-based telemedicine system combined with email alerts is feasible in remote locations in Tanzania, even where fast Internet connections are not available.

Iterative intervention development for improvement of adolescent reproductive health services in Tanzania and Niger

Iterative intervention development for improvement of adolescent reproductive health services in Tanzania and Niger