Health System Management Monitoring & Evaluation(HSME)

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    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.
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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.
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    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.