Health care prioritization process for the elderly in rural Tanzania under decentralized system: Prospects and challenges.

Introduction: Beginning the early 1990s, many countries globally adopted the third-generation health sector reforms with a focus of strengthening the primary health care system through community participation. On the contrary, three decades later, primary health care systems in many Low- and Middle-Income countries (LMICs) including Tanzania have remained weak. Specifically, priority setting for the vulnerable groups including the elderly have been weak.

Health, wealth, and medical expenditures among the elderly in rural Tanzania: experiences from Nzega and Igunga districts.

Background: The per capita health expenditure (HE) and share of gross domestic product (GDP) spending on elderly healthcare are expected to increase. The gap between health needs and available resources for elderly healthcare is widening in many developing countries, like Tanzania, leaving the elderly in poor health. These conditions lead to catastrophic HEs for the elderly.

Healthcare workers´ experiences and perceptions of the provision of health insurance benefits to the elderly in rural Tanzania: an explorative qualitative study.

Background: Healthcare workers play an important part in the delivery of health insurance benefits, and their role in ensuring service quality and availability, access, and good management practice for insured clients is crucial. Tanzania started a government-based health insurance scheme in the 1990s. However, no studies have specifically looked at the experience of healthcare professionals in the delivery of health insurance services in the country.

Health insurance and health system (un) responsiveness: a qualitative study with elderly in rural Tanzania.

Background: Health insurance (HI) has increasingly been accepted as a mechanism to facilitate access to healthcare in low and middle-income countries. However, health insurance members, especially those in Sub-Saharan Africa, have reported a low responsiveness in health systems. This study aimed to explore the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania.

Responsiveness of health care services towards the elderly in Tanzania: does health insurance make a difference? A cross-sectional study.

Background: Responsiveness has become an important health system performance indicator in evaluating the ability of health care systems to meet patients' expectations. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania and to explore the association of health insurance (HI) with responsiveness in this population.

Public private partnership in the training of doctors after the 1990s' health sector reforms: the case of Tanzania.

Similar to many other low- and middle-income countries, public private partnership (PPP) in the training of the health workforce has been emphasized since the launch of the 1990s' health sector reforms in Tanzania. PPP in training aims to contribute to addressing the critical shortage of health workforce in these countries. This study aimed to analyse the policy process and experienced outcomes of PPP for the training of doctors in Tanzania two decades after the 1990s' health sector reforms.

"Doctors ready to be posted are jobless on the street…" the deployment process and shortage of doctors in Tanzania.

Background: The World Health Organization advocates that health workforce development is a continuum of three stages of entry, available workforce and exit. However, many studies have focused on addressing the shortage of numbers and the retention of doctors in rural and remote areas. The latter has left the contribution of the entry stage in particularly the deployment process on the shortage of health workforce less understood.

Retention of medical doctors at the district level: a qualitative study of experiences from Tanzania.

Background: Retention of Human Resources for Health (HRH), particularly doctors at district level is a big challenge facing the decentralized health systems in poorly resourced countries. Tanzania, with 75% of its population in rural areas, has only 26% of doctors serving in rural areas. We aimed to analyze the experiences regarding the retention of doctors at district level in Tanzania from doctors' and district health managers' perspectives.

Training and deployment of medical doctors in Tanzania post-1990s health sector reforms: assessing the achievements.

Background: The shortage of a skilled health workforce is a global crisis. International efforts to combat the crisis have shown few benefits; therefore, more country-specific efforts are required. Tanzania adopted health sector reforms in the 1990s to ensure, among other things, availability of an adequate skilled health workforce.

Exploring local knowledge and perceptions on zoonoses among pastoralists in northern and eastern Tanzania.

Background: Zoonoses account for the most commonly reported emerging and re-emerging infectious diseases in Sub-Saharan Africa. However, there is limited knowledge on how pastoral communities perceive zoonoses in relation to their livelihoods, culture and their wider ecology. This study was carried out to explore local knowledge and perceptions on zoonoses among pastoralists in Tanzania.

Women's perceptions of antenatal, delivery, and postpartum services in rural Tanzania.

Background: Maternal health care provision remains a major challenge in developing countries. There is agreement that the provision of quality clinical services is essential if high rates of maternal death are to be reduced. However, despite efforts to improve access to these services, a high number of women in Tanzania do not access them.

"Once the government employs you, it forgets you": Health workers' and managers' perspectives on factors influencing working conditions for provision of maternal health care services in a rural district of Tanzania.

Background: In many developing countries, health workforce crisis is one of the predominant challenges affecting the health care systems' function of providing quality services, including maternal care. The challenge is related to how these countries establish conducive working conditions that attract and retain health workers into the health care sector and enable them to perform effectively and efficiently to improve health services particularly in rural settings. This study explored the perspectives of health workers and managers on factors influencing working conditions for providing maternal health care services in rural Tanzania.

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

Background: The Tanzanian health insurance system comprises multiple health insurance funds targeting different population groups but which operate in parallel, with no mechanisms for redistribution across the funds. Establishing such redistributive mechanisms requires public support, which is grounded on the level of solidarity within the country. The aim of this paper is to analyse the perceptions of CHF, NHIF and non-member households towards cross-subsidisation of the poor as an indication of the level of solidarity and acceptance of redistributive mechanisms.

"We have been working overnight without sleeping": traditional birth attendants' practices and perceptions of post-partum care services in rural Tanzania.

Background: In many low-income countries, formal post-partum care utilization is much lower than that of skilled delivery and antenatal care. While Traditional Birth Attendants (TBAs) might play a role in post-partum care, research exploring their attitudes and practices during this period is scarce. Therefore, the aim of this study was to explore TBAs' practices and perceptions in post-partum care in rural Tanzania.

Risk distribution across multiple health insurance funds in rural Tanzania.

Introduction: Multiple insurance funds serving different population groups may compromise equity due to differential revenue raising capacity and an unequal distribution of high risk members among the funds. This occurs when the funds exist without mechanisms in place to promote income and risk cross-subsidisation across the funds. This paper analyses whether the risk distribution varies across the Community Health Fund (CHF) and National Health Insurance Fund (NHIF) in two districts in Tanzania.

Governing the implementation of emergency obstetric care: experiences of rural district health managers, Tanzania.

Background: Many health policies developed internationally often become adopted at the national level and are implemented locally at the district level. A decentralized district health system led by a district health management team becomes responsible for implementing such policies. This study aimed at exploring the experiences of a district health management team in implementing Emergency Obstetric Care (EmOC) related policies and identifying emerging governance aspects.

The quest for One Health: human resource training aspects.

Appropriately trained Human Resources for Health (HRH) are key inputs into One Health. '… more than 50% of all infectious diseases of humans originate from animals and that, of the emerging diseases about 75% could be traced back to animal origin' (Rweyemamu et al. 2006).

Practice of One Health approaches: bridges and barriers in Tanzania.

The practice of one health approaches in human and animal health programmes is influenced by type and scope of bridges and barriers for partnerships. It was thus essential to evaluate the nature and scope of collaborative arrangements among human, animal, and wildlife health experts in dealing with health challenges which demand inter-sectoral partnership. The nature of collaborative arrangement was assessed, and the respective bridges and barriers over a period of 12 months (July 20011 to June 2012) were identified.

Addressing the human resource for health crisis in Tanzania: the lost in transition syndrome.

Tanzania is experiencing a serious Human Resource for Health (HRH) crisis. Shortages are 87.5% and 67% in private and public hospitals, respectively.

Availability of drugs and medical supplies for emergency obstetric care: experience of health facility managers in a rural District of Tanzania.

Background: Provision of quality emergency obstetric care relies upon the presence of skilled health attendants working in an environment where drugs and medical supplies are available when needed and in adequate quantity and of assured quality. This study aimed to describe the experience of rural health facility managers in ensuring the timely availability of drugs and medical supplies for emergency obstetric care (EmOC).

Methods: In-depth interviews were conducted with a total of 17 health facility managers: 14 from dispensaries and three from health centers.

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

Background: Many countries striving to achieve universal health insurance coverage have done so by means of multiple health insurance funds covering different population groups. However, existence of multiple health insurance funds may also cause variation in access to health care, due to the differential revenue raising capacities and benefit packages offered by the various funds resulting in inequity and inefficiency within the health system. This paper examines how the existence of multiple health insurance funds affects health care seeking behaviour and utilisation among members of the Community Health Fund, the National Health Insurance Fund and non-members in two districts in Tanzania.

Challenges towards realization of health care sector goals of Tanzania development vision 2025: training and deployment of graduate human resource for health.

Background: Human resource for health (HRH) is an essential building block for effective and efficient health care system. In Tanzania this component is faced by many challenges which in synergy with others make the health care system inefficient. In vision 2025 the country recognizes the importance of the health care sector in attaining quality livelihood for its citizens.

A socio-economic approach to One Health policy research in southern Africa.

One-health approaches have started being applied to health systems in some countries in controlling infectious diseases in order to reduce the burden of disease in humans, livestock and wild animals collaboratively. However, one wonders whether the problem of lingering and emerging zoonoses is more affected by health policies, low application of one-health approaches, or other factors. As part of efforts to answer this question, the Southern African Centre for Infectious Disease Surveillance (SACIDS) smart partnership of human health, animal health and socio-economic experts published, in April 2011, a conceptual framework to support One Health research for policy on emerging zoonoses.

Group premiums in micro health insurance experiences from Tanzania.

Objective: The main objective was to assess how group premiums can help poor people in the informal economy prepay for health care services.

Methods: A comparative approach was adopted to study four groups of informal economy operators (cobblers, welders, carpenters, small scale market retailers) focusing on a method of prepayment which could help them access health care services. Two groups with a total of 714 operators were organized to prepay for health care services through a group premium, while the other two groups with a total of 702 operators were not organized to prepay through this approach.