Research Papers (Articles)

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Cost of dialysis in Tanzania: Evidence from the provider’s perspective
(Health Economics Review, 2015) Mushi, Lawrencia; Krohn, Markus; Flessa, Steffen
Background: Although End Stage Renal Disease (ESRD) is a disease of increasing epidemiological relevance very little is known about the cost of providing the respective dialysis services in Tanzania. This paper estimates the costs of dialysis for ESRD patients at Muhimbili National Hospital (MNH) in Tanzania in the year 2014. Methods: Cost calculations are based on the provider's perspective and include only the direct cost of dialysis treatment. The cost of drugs and consumables was obtained from the price list issued by the Medical Stores Department (MSD) in Tanzania. Additional data were collected through face-to-face interviews with experts at the dialysis unit. Results: MNH performs on average 442 hemodialysis per month (34 patients, with three sessions per week) with a personnel placement of 20 nurses, four nephrologists, eight registrars, one nutritionist, two biomedical engineers, four health attendants and nine dialysis machines. The respective average unit cost per hemodialysis is 176 US$. Consequently, an average patient requiring three dialyses per week (i.e. 156 dialyses per year) will incur annual costs of 27,440 US$. Conclusion: The cost of dialysis is enormous for a least-developed country like Tanzania where resources and technology are rather limited. Thus, from the economic point of view, it seems rational to allocate health care budgets towards curable diseases, which have a higher cost-effectiveness and cater for the majority of the population. However, before a final decision on allocation of budgets towards dialysis is made all efforts must be invested to improve technical efficiency by cutting the enormous unit cost.
The cost of dialysis in low and middle income countries: A systematic review
(BMC Health Services Research, 2015) Mushi, Lawrencia; Marschall, Paul; Fleßa, Steffen
Background: The cost of dialysis in low and middle-income countries has not been systematically reviewed. The objective of this article is to systematically review peer-reviewed articles on the cost of dialysis across low and middle-income countries. Methods: PubMed and Embase databases were searched for the years 1998 to March 2013, and additional studies were added from Google Scholar search. An article was included if two reviewers agreed that it had reported the cost of dialysis from low and middle-income countries. Results: The annual cost per patient for hemodialysis (HD) ranged from Int$ 3,424 to Int$ 42,785, and peritoneal dialysis (PD) ranged from Int$ 7,974 to Int$ 47,971. Direct medical costs especially drugs and consumables for HD and dialysis solutions and tubing for PD were the main cost drivers. Conclusion: The number of studies on the economics of dialysis in low and middle-income countries is limited. Few papers indicate that dialysis is an expensive form of treatment for the population of these countries and that the poorer countries have an over-proportional burden to finance dialysis services. Further research is needed to determine the cost of dialysis based on a standard methodology grounded on existing economic guidelines and to address the question of whether dialysis should be an element of the essential package of health in resource-poor countries. Used data should be as complete as possible. In case of missing data, proxies can be used. In the case of developing countries, expert interviews are often used for estimating missing information.
Factors affecting adherence to occupational health and safety rules and regulations in improving public health in the informal sector workers in Mabibo- Dar es Salaam
(The International Journal of Indian Psychology, 2019) Mushi, Lawrencia
Although significant advances have been made in Occupational Health and Safety (OSH) over the past decades, little is known about its adherence in the informal sector in Tanzania. Globally, it is estimated that 2.3 million workers die every year from occupational accidents and work-related diseases. Most of these deaths occur in informal sectors. We assessed factors affecting adherence to OSH rules and regulations in improving public health in the informal sector workers at Mabibo, Dar es Salaam. We used a mixed study design applying both quantitative and quantitative approach. 72 informal workers and two officials from the Occupational Safety and Health Authority were included. Both questionnaires and key informant Interviews were used to collect data. We used (SPSS) 20 and content analysis was used to analyze quantitative and qualitative data respectively. We found that a majority (55.7%) of informal sector workers had low knowledge of OHS rules and regulations. Moreover, most of them (87.1%) were not trained in OHS and a majority (37.1%) rarely used protective gear when performing their duties. Informal sector workers are at high risk of occupational accidents and diseases. This has a huge economic burden on individuals, enterprises and the nation as a whole. Therefore, the government must put in place mechanisms aimed to protecting their health and working rights by putting in place integrative and comprehensive programs and policies meant to protect their health rights.
Health insurance for informal workers: What is hindering uptake? Perspectives from female food vendors in Kinondoni district, Tanzania
(East African Journal of Applied Health Monitoring and Evaluation, 2019) Mushi, Lawrencia; Milanzi, Peter
BACKGROUND Health insurance among people of low income, such as female food vendors and others in the informal sector, is one of the vital steps towards universal health coverage in Tanzania. Little is known to explain the reasons for the low enrolment of informal workers in health insurance schemes. We studied what is hindering the uptake of health insurance among female food vendors in Kinondoni district in Dar es Salaam. METHODS The study took place from January to March 2018. A mixed methods design was employed using a quantitative questionnaire and qualitative interviews. We included 75 respondents of which 70 were female food vendors selected using the snow-balling method. Five respondents were officials from the National Health Insurance Fund, who were purposefully selected. RESULTS Almost half of respondents (45.7%) were earning less than TZS 100,000 (equivalent to US $44.80) a month. Most (82.9%) could not afford health insurance. Attitudes did not affect the uptake of health insurance as the majority (60.0%) agreed that health insurance is vital for their survival. However, a majority (63.4%) of respondents did not know how health insurance works. CONCLUSION The low level of income and limited awareness of health insurance options limited enrolment into health insurance. Interventions should ensure that everyone is enrolled irrespective of economic status. Moreover, the government should design innovative strategies to increase awareness about health insurance.
Factors to determine the adoption of online teaching in Tanzania’s universities during the COVID-19 pandemic
(PLoS ONE, 2023) Mackfallen, G.Anasel; Swai, L. Idda
Face to face mode of delivery has been a standard method of teaching courses in the majority of African Universities Tanzania included. The COVID-19 pandemic has caused the closure of all schools and universities worldwide; therefore, face-to-face teaching is no longer the only appropriate and feasible teaching method. This requires changes in the teaching method with the remarkable rise of e-learning, whereby teaching must be undertaken remotely and on digital platforms.
Women’s career move from local to national politics: The case of Tanzania
(Journal of Asian and African Studies, 2024) Yoon, Mi Yung; Swai, Idda Lyatonga
This study examines women’s career movement from the highest local authorities (district and urban councils) to the national legislature in Tanzania, focusing on the latest three parliaments (2010–2025). Using both quantitative and qualitative data, we find that less than 10% of female parliamentarians in each parliament have prior councilor experience and most of them occupy quota seats. The low upward mobility of female councilors to parliament may be due to the difficulty of winning constituency seats, affected by gender stereotypes, and the availability of other pathways to parliament, such as party leadership and commissioner positions.
Effectiveness of prime vendor system on availability of medicines and medical supplies in the selected public health facilities in Arusha district council
(BMC Health Services Research, 2024) Mushi, Lawrencia; Elias, Liberatus
Introduction The shortage of medicines and medical supplies remains to be a major issue that is facing public health facilities in Tanzania. This situation has been influenced by a lack of consistency in the supply chain, an increase in healthcare demand, a poor regulatory system, insufficient funds, and a lack of conducive infrastructure. Formerly, Government initiatives such as engagement with the Prime Vendor System (PVS) demonstrated great assistance in getting rid of this challenge. Despite the operation of PVS, a recent shortage of medicines and medical supplies has been noticed. Objectives This study aimed to assess the effectiveness of PVS on the availability of medicine and medical supplies in the selected public health facilities in Arusha District Council. Methods The study used a case study design with a mixed research approach. The study involved 77 respondents which included 25 health facility in-charges, 50 patients, 1 District Pharmacist and 1 Prime Vendor. Questionnaires, interviews, and observation methods were used to collect data. Data collected covered a period of 2021–2022. Thematic analysis was used to analyze the qualitative data whereas descriptive analysis was used to analyze the quantitative data with the help of Excel and the Statistical Package for Social Sciences (SPSS) version 28.0. Results The analysis indicates that PVS is not completely effective in supplying medicines and medical supplies due to its low capacity to conform to the orders placed by public health facilities, a lack of supply competition, and a failure to adhere to contractual terms. Furthermore, at the time of data collection, the average availability of medicines and medical supplies at the selected public health facilities was 74.8%, while 80% of the selected public health facilities reported having a scarcity of medicines and medical supplies, and 92% of the interviewed patients reported having no full access to medicines. Conclusion Despite the shortcomings associated with the operation of the PVS, the system still seems to be very important for enhancing the availability of medicines and medical supplies once its effectiveness is strengthened. This study recommends routine monitoring of PVS operations and timely interventions to reinforce adherence to the contracted terms and improve PVS effectiveness.
Attitude of community members towards the capacity of the village land councils in managing land use conflicts between farmers and pastoralists in Tanzania: A cross sectional case study analysis
(E-palli publishers, 2024) Homera , Juma Zuberi; Mollel, Henry A.
Village Land Councils have been established to resolve land use conflicts in rural Tanzania. The history reveals that Tanzania has been mostly affected with the endless land based conflicts between farmers and pastoralists. The presence of VLCs in rural Tanzania has brought significant changes in rural areas where farmers and pastoralists compete to utilize and possess scarce resources. However, rural dwellers have different opinions on the worthiness of the respective local organs in resolving land use conflicts between farmers and pastoralists. This study therefore intended to explore attitudes from the community members towards the capacity of the Village Land Councils in managing land use conflicts between farmers and pastoralists. Semi-structured interviews were used to collect data, where a semantic differential scale was used as the appropriate tool for exploring attitudes from the respondents, particularly: farmers and pastoralists who mostly rely on VLCs for mediation services. Vivo software 14 was used for analysing such data. The results indicated that majority of respondents (farmers and pastoralists) in Mbarali and Kilosa District Councils had positive attitude towards VLCs due to their performance in resolving land use conflicts between farmers and pastoralists. Similar response was obtained from the farmers operating in Tunduru District Council. However, some pastoralists in Tunduru District Councils had remained sceptical on the capacity of the VLCs to resolve conflicts and create conducive working environment for both conflicting parties. Their doubts relied on injustice practices such as corruption, nepotism and tribalism that were directly associated with VLC members. Based on the findings, the study suggests for more capacity building programs for enhancing the capacity of VLC members to act firmly and objectively and for the community members so that they develop a sense of responsibilities in supporting the VLCs’ operations for the

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