Health System Management Monitoring & Evaluation(HSME)
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Item Framing reproductive narratives(2026) Taqwim, SF; Xu, W; Kang, YH; Aweesha, H; Rashmi, R; Amani, PJ, et al.Childlessness is an increasingly visible phenomenon. Once predominantly associ ated with high-income settings, it now spans diverse cultural, economic, and political contexts, including the Global South. Among recent demographic shifts, childless ness has emerged as one of the most ideologically charged and widely debated topics in public discourse, particularly through media narratives. Although media are often overlooked in mainstream public health models, they play critical roles as structural and intermediary determinants of health - shaping issue framing, amplifying voices, and legitimizing solutions. Yet little is known about how childlessness is repre sented in global media, especially outside the Global North and in the post- pandemic era. This study analysed news media representations of childlessness from a public health perspective, drawing on 131 news articles from 101 outlets across 86 coun tries (2015–2025). Articles were identified through systematic keyword searches in English and 12 additional languages, screened for relevance, and analysed the matically using Braun and Clarke’s inductive method. Our approach was discourse- sensitive, drawing on a social constructionist lens and informed by framing theories and reproductive justice. Five themes were identified: The guinea pig of the state; Crazy rich selfish animal lovers; No baby, no cry; Bringing children into a broken world; and Winter regret and loneliness. These narratives operate across structural, intermediary, and individual levels, fulfilling four discursive functions: politicising, moralising, pathologising, and humanising. By examining how childlessness is prob lematized or legitimized, this study highlights the media’s role in shaping reproductive narratives, stigma, and health equity across diverse contextsItem Does health insurance contribute to improving responsiveness of the health system?: The case of elderly in rural Tanzania(Umeå University, 2022) Amani, Paul JosephBackground: Financing healthcare in Tanzania has for years depended on out-of-pocket payments. This mechanism has been criticized as being inefficient, contributing to inequity and high cost as well as denying access to healthcare to those most in need, including the elderly in rural areas. Health insurance (HI) was recently introduced as an instrument to enable equitable access to healthcare and thus to improve the responsiveness of the health system. Even though health insurance is expected to bring benefits to those who are insured, there is a lack of specific studies in the country looking at the role of HI in facilitating the health system responsiveness among vulnerable populations of remote areas. Aim: The aim of this thesis is to understand if and how health insurance contributes to improving the responsiveness of the healthcare system among the elderly in rural Tanzania. Methods: Four interrelated sub-studies (2 quantitative and 2 qualitative) were conducted in Igunga and Nzega districts of Tabora region between July 2017 and December 2018. The first two sub-studies are based on a household survey using an adapted version of the World Health Organization’s Study on Global Ageing and Adult Health questionnaire. Elderly people aged 60 years and above who had used both outpatient and inpatient healthcare three and twelve months prior to the study, respectively, were interviewed. Whereas in sub-study 1 the focus was to investigate the role of health insurance status on facilitating access to healthcare, sub-study 2 assessed the relationship between health insurance and the health system responsiveness domains. In sub-study 3, interviews with healthcare providers were carried out to capture their perspective regarding the functioning of the health insurance. In the final sub-study 4, focus group discussions with elderly were conducted in order to explore their experience of healthcare, depending on their health insurance status. Crude and adjusted logistic and quantile regression models were applied to analyse the association between health insurance and access to healthcare (sub-study 1) and responsiveness (sub-study 2), respectively. For both sub-studies 3 and 4, qualitative content analysis was used to analyse the data. Results: Sub-studies 1 and 2 involved a total of 1899 insured and uninsured elderly, while sub-studies 3 and 4 included 8 health providers and 78 elderlies respectively. Sub-study 1 showed that about 45% of the elderly were insured and HI ownership improved access and utilization of healthcare, both outpatient and inpatient services. In sub-study two, however, health insurance was associated with a lower responsiveness of the healthcare system. In general, all six domains: cleanliness, access, confidentiality, autonomy, communication, and prompt attention were rated high, but three were of concern: waiting time; cleanliness; and communication. Sub-study 3 uncovered several challenges coexisting alongside the provision of insurance benefits and thus contributing to a lower responsiveness. These included shortage of human resources and medical supplies, as well as operational issues related to delays in funding reimbursement. In sub-study 4, the elderly revealed that HI did not meet their expectations, it failed to promote equitable access, provided limited-service benefits and restricted use of services within residential areas. Conclusion: While HI seems to increase the access to and use of healthcare services by the elderly in rural Tanzania, a lower responsiveness by the healthcare system among the insured elderly was reported. Long waiting times, limited-service benefits, restricted use of services within schemes, lack of health workforce in both numbers and skills as well as shortage of medical supplies were important explanations for the lower responsiveness. The results of this thesis, while supporting the national aim of expanding HI in rural areas, also exposed several weaknesses that require immediate attention. There is a need to, first, review the insurance policy to improve its implementation, expand the scope of services coverage, and where possible, to introduce cross-subsidization between the publicly owned schemes; additionally, improvements in the healthcare infrastructure, increasing the number of qualified health workforce and the availability of essential medicines and laboratory services, especially at the primary healthcare facilities, should be prioritized and further investments allocated.Item Governing climate change adaptation in urban Tanzania(2026-06-05) Mushi, Lawrencia; Ogweyo, Noel O.; Cosmas, Faraja U.Climate change is one of the greatest global health threats of the twenty-first century, with profound implications for health systems and progress toward universal health coverage. In Tanzania, urban areas such as Dar es Salaam are increasingly experiencing climate-related health challenges, including flooding, heat stress, and outbreaks of climate-sensitive diseases such as cholera, malaria, and respiratory infections, placing growing pressure on already constrained urban health systems. Although urban health systems in low- and middle-income countries are increasingly exposed to these risks, evidence on their capacity to govern and implement climate change adaptation actions remains limited. This study aimed to explore the governance capacity of the urban health system for climate change adaptation in Dar es Salaam, Tanzania. An exploratory qualitative study was conducted using in-depth interviews (IDIs) and focus group discussions (FGDs) with key stakeholders involved in health governance, policy development, and health service delivery. A total of 68 participants were purposively selected from municipal health management teams, public health facilities, and academic institutions across four municipal councils in Dar es Salaam. Data were analysed thematically and organised using ATLAS.ti software. The findings revealed strengths and gaps across three key areas of climate change adaptation governance. First, early warning and preparedness mechanisms existed but were constrained by fragmented disease surveillance systems, weak emergency response team functionality, and inadequate climate–health data for decision-making. Second, human resource capacity was supported by available training and research institutions; however, staffing shortages, limited training coverage, and irregular refresher training reduced preparedness for climate-related health emergencies. Third, institutional and material capacity remained inadequate, characterized by limited operational climate change guidelines at the facility level, infrastructure gaps, and insufficient financial and material resources to support effective adaptation. Although municipal health systems in urban Tanzania have initiated climate change adaptation efforts, the governance of these actions remains constrained by uneven and inadequate institutional capacity. Persistent shortages in human resources, infrastructure, and sustainable financing undermine the effectiveness of early warning systems and preparedness mechanisms. Consequently, urban health systems remain insufficiently resilient to complex climate-related health risks. Therefore, strengthening climate-resilient health governance will require targeted investments in workforce capacity, infrastructure, integrated climate-health information systems, sustained financing, and clearer institutional guidelines to support proactive and coordinated adaptation across governance levels.Item Changing Dietary Practices: The new food insecurity among the pastoralists in Mabwegere village Kilosa district(The Mwalimu Nyerere Memorial Academy, 2020-06-15) Massoi, Lucy; Saruni, ParitWhile global and national efforts are increasingly aiming at ending all forms of malnutrition by 2030, food insecurity levels are increasingly high among the pastoralist communities in the sub-Saharan Africa. This scenario is attributed to by the existing efforts and strategies, which are predominantly preoccupied with the narrative that, people are food secured when everyone has access to sufficient, safe, nutritious food to maintain a healthy and active life at all the time. This perspective overlooks the presence of heterogeneous communities with different cultural beliefs about health, livelihoods, and sustainability of food supply. This article argues that, food security does not only concern with food availability but also traditional dietary preferences. This study used a qualitative case oriented design and data were collected through key informant interviews and focus group discussions. Food production among the Maasai is increasingly inadequate, and traditional dietary practices among the Maasai pastoralists is increasingly changing as a result of agrarian transformation in the Kilosa District in Tanzania. This is where large chunks of land are transformed for agricultural activities as a way of increasing food availability in terms of the number of meals intake and the type of meals consumed. Conventional dietary meals such as cereals and green leaves are increasingly consumed with a decreasing number of meals consumed per day and the changing of the type of meals consumed. Therefore, the analysis of food and nutrition security should understand that, cultural food preferences are important because they are interconnected with beliefs about health, livelihoods and sustainability of food supply. This study suggests that policies that address food and nutrition insecurity need to take on board the close relationship between food, nutrition security, and culture. It is important for communities to embrace other alternatives for livelihood, including farming and government support in irrigation to improve food access and availability.Item Provider fidelity in tuberculosis screening practices among adolescents and adults living with HIV in public health facilities in Tanzania(Frontiers Public Health, 2025-11-19) Shilugu,Lucas L.; Mushi, Lawrencia D.; Anasel, Mackfallen G.Tuberculosis (TB) remains the leading cause of morbidity and mortality among people living with HIV (PLHIV) in high-burden countries like Tanzania. Despite national and global guidelines recommending routine TB screening at every clinical encounter, missed and delayed TB case notifications persist, suggesting gaps in screening practices. This study evaluated the implementation fidelity of the TB screening algorithm and associated factors within routine HIV care in public health facilities in Geita, Tanzania. A facility-based cross-sectional study was conducted, involving the extraction of data from 423 client treatment records and observation of 423 screening sessions. Simple random and systematic sampling methods were employed to select the records and sessions, respectively. Descriptive and inferential analyses were performed using Excel and Stata. Modified Poisson regression with robust variance was used to estimate prevalence ratios (PRs) to determine factors associated with two binary outcomes: (1) consistent TB screening over 12-month period, and (2) correct utilization of the screening tool. TB screening was documented in 82.8% of clinical encounters. Overall, 70.7% of clients were screened at every encounter, and 75.4% screened at their most recent visit. Laboratory investigations were recorded in 94% of presumptive cases, with all confirmed TB cases initiated on treatment. Additionally, 80.6% of eligible clients were initiated on TB preventive therapy (TPT). The WHO Four-Symptom Screening (W4SS) was widely used (98.8%), and the tool was correctly administered in 62% of the sessions observed. Factors associated with inconsistent screening included age 40–49 years [Adjusted Prevalence Ratio (aPR) = 0.82; p = 0.046], age ≥50 years (aPR = 0.76; p = 0.025), suppressed viral load (aPR = 0.63; p < 0.001), monthly drug refill model (aPR = 0.55; p = 0.006), refill by treatment supporter (aPR = 0.09; p < 0.001), being traced back from a lost to follow up (aPR = 1.38; p = 0.019), and absence of prior TB (aPR = 0.81; p = 0.001). The correct use of the W4SS tool was less likely at PMTCT clinics (aPR = 0.55; p < 0.001). Although TB screening is widely integrated into HIV care, fidelity to the screening algorithm remains suboptimal in the initial stages of symptom screening. The completion of the algorithm cascade was well-implemented. Fidelity at earlier stages of the algorithm, such as the consistent and correct use of the W4SS, should be enhanced by strengthening provider capacity and routine monitoring to improve adherence to the protocol.Item 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 theItem 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, LiberatusIntroduction 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.Item 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 LyatongaThis 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.Item 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. IddaFace 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.