Tanzania is rich in natural resources and saw a rapid growth of the extractive industries sector in recent years. While the extraction of natural resources can promote economic growth, strong evidence of negative effects on the health of affected communities through a series of environmental, social and economic changes has become available. In this policy brief, we present findings of the Health Impact Assessment for Sustainable Development (HIA4SD) (1) project, which has been implemented in four African countries, namely Tanzania, Mozambique, Ghana and Burkina Faso.
What We Did
The project investigated perspectives of stakeholders on how equity and inclusivity in access to social health protection schemes can be promoted in Tanzania.
How We Did It
We analyzed data from interviews carried out between June and December 2019 in Dodoma, Dar es Salaam and Kilimanjaro regions. They involved multiple stakeholders from the Government, Non-Governmental Organizations (NGO), district and regional officials, and local community members and leaders. Context mapping preceded the interviews in order to inform the design of the study.
What We Found
At higher levels, participants mentioned that involvement of communities in developing national health insurance policies was a standard procedure. Improved Community Health Fund (iCHF) policy changes, and the presence of annual budgeting by the district in order to pay iCHF premiums on behalf of low-income individuals within their districts was reported as evidence that the voices of the poor community members counted in decision-making. Yet others mentioned that the institutionalization of the Health Facility Governance Committee (HFGC), which includes community members, is a way to improve representation of local and poor communities in decision-making.
Moreover, some stakeholders mentioned that development of health insurance premiums packages for those in the informal sector is another indicator of inclusive health financing. Governance related factors such as availability of adequate funds at the health facilities to support quality of services, speed up of the single national health insurance and limited cross sector and private partnerships to address health challenges were reported as hurdles for optimal equity in social protection.
What We Conclude & Recommend
Tanzania is making progress towards achieving equity and inclusivity in its social health protection schemes. However, governance-related hurdles potentially limit optimal progress toward achieving equity and inclusivity in social health protection schemes for poor and vulnerable groups.
Therefore, policy makers should consider improving availability of funds at health facilities through government tax; speed up the implementation of a single national health insurance; and strengthen collaborations with local communities and non-health sectors, among others actions. #
> The R4D study was conducted in 2019 by Ifakara Health Institute in collaboration with the Swiss TPH with funding from the Swiss National Science Foundation to understand the governance facilitators and challenges in the implementation of the new health financing strategy in Tanzania.
> The study conducted in-depth interviews with stakeholders in three regions to assess the implementation of the health financing strategy and social health financing schemes. Governance indicators and normalization process theory (NPT) provided a framework for the inquiry.
> Governance facilitators include: coherence among government stakeholders in understanding the current health financing arrangement; a shared strategic vision on the heath financing strategy; perceived benefit of the health financing strategy; and perceived responsiveness of the health system.
> Governance challenges include: misunderstanding and miscommunication about health insurance and beneficiaries’ entitlements; limited resources for sensitization activities at community level; and poor accountability of collected premiums at community level.
> The researchers conclude: Enacting the national strategic health financing policies successfully could be facilitated by a multidimensional approach to governance and implementation. They argue that expanding health insurance coverage alone may not be adequate for achieving universal health coverage in Tanzania. They recommend the inclusion of local communities, by both government and non-government stakeholders, for the successful implementation of the health financing strategy. #
Inclusion of Health Impact Assessment (HIA) into current regulatory framework can further provide opportunities to strengthen EIA and also promote sustainable development. Moving forward, Tanzania must assess how its mineral sector can effectively contribute to sustainable development, while minimizing negative impacts to both the environment and public health.
This policy brief is aimed at policymakers and public-sector stakeholders who wish to better understand the current gaps and opportunities to strengthen the inclusion of health in Environmental Impact Assessments (EIAs) of large-scale mining projects in Tanzania.
Information presented is based on desktop review of national regulations, policy guidelines, company reports and other relevant grey literature. In addition, 7 in-depth interviews were conducted with key stakeholders including policymakers, government ministry officials, EIA experts and development partners in the country. #
This policy brief highlights findings from an impact evaluation of the SafeCare model developed by PharmAccess. SafeCare aims to improve quality of care in health facilities through a stepwise certification model. It has been widely implemented in public and private facilities across many African countries.
We studied SafeCare in private health facilities, which provide a significant and growing share of care in low and middle income countries, including Tanzania.
As in the public sector, there are concerns about safety and quality of care in private health facilities. Traditional hospital accreditation is only available to the highest-end facilities, and there is limited evidence on the effectiveness of other quality improvement interventions.
SafeCare is a model for addressing this gap. It seeks to raise both quality of care and business performance, with the intention that improvements in quality attract more patients and increase revenue, and improved business performance facilitates greater investment in quality improvement.
Tanzania has very limited information on its poor urban population, but some existing evidence highlights nutrition, WASH, social, economic, and environmental vulnerabilities among children, adolescents, and mothers. Understanding more about these factors and how they interact to affect the lives of people living in slums is paramount when advocating for improved and adequate services for this neglected group.
To address knowledge gaps and inform opportunities for action, Ifakara Health Institute, with financial support from USAID’s Health Evaluation and Applied Research Development Project based at University Research Co., LLC (URC), conducted an assessment of the nutrition, health, and WASH situation in urban slums of Tanzania.
This policy brief summarizes the results in order to facilitate better planning of interventions for poor urban communities.
This was a 3-hospital before-and-after pilot evaluation of a training intervention for hospital cleaning in Dar-es-Salaam. The
training intervention was adapted from original materials developed by the organization SoapBox (UK) with the adaptation
and implementation of the training conducted by Muhimbili University of Health and Allied Sciences (MUHAS).
Independent evaluation of the training intervention and measurement of the impacts of the intervention (in terms of
knowledge, physical behaviors and microbiological surface cleanliness) was conducted by staff from Ifakara Health
Institute (IHI), in collaboration with the London School of Hygiene and Tropical Medicine (UK). There was also some
preliminary measurement of the prevalence of Hospital-acquired Infections in the three hospitals.