Country
Tanzania
Tanzania_SDHNet_mappingreport_FINAL.pdf
Tanzaniadevelopmentvision2025.pdf TanzaniaNSGRP_MKUKUTA.pdfSDH addressed in the document
Tanzania Development Vision 2025
(URT. 1999. Tanzania Development Vision 2025. President's Office, Planning Commission, Dar es Salaam.)
The overall National plans stipulated under Vision 2025 are to achieve the following:
• High quality livelihood
• Free from abject poverty by 2025
• With respect to growth, a strong, diversified, resilient and competitive economy
• A growth rate of the economy of eight per cent per annum or more is targeted
• A high quality of livelihood for all Tanzanians is expected to be attained through strategies which will ensure the realization of the following health service goals:
• access to high-‐quality PHC for all
• access to high-‐quality reproductive health services for all individuals of appropriate ages
• reduction in infant and maternal mortality rates by three quarters from current levels
• universal access to clean and safe water
• life expectancy comparable to the level attained by typical middle-‐income countries
• food self-‐sufficiency and food security
• gender equality and empowerment of women in all health parameters; and encourage the participation of community in the delivery of health services.
| Type of Institution | Institution Name | Institution role |
|---|---|---|
| Government | Tanzania Commission of Science and Technology (COSTECH) |
COSTECHparliamentaryact.pdf
Nhrs_map_tanzania.jpg
Research system coordination mechanisms between governing and coordinating institutions
The Tanzania Commission for Science and Technology (COSTECH, Act No. 7 of 1986) that is under the Ministry of Communication, Science and Technology is the principal advisory organ to the Government and the coordinator of all research and development in the Country. In principle, COSTECH should therefore involve all important stakeholders in its activities. COSTECH is reported to have twelve research and development (R&D) committees in place with members coming from the industry, academia and the private sector. COSTECH does not undertake research but facilitates and provides a forum for cutting edge discussions. Researchers are reportedly encouraged to collaborate with COSTECH for effective dissemination of their research results.
Research system coordination mechanisms to promote partnerships and networks at different levels of the research systems (for sharing of resources collectively - skills, funds, data sharing, information sharing)
At national level, there are a number of formal mechanisms in place that to some extent does facilitate a discourse, an exchange, between various stakeholders; a potential venue for sharing and discussing some major research/ policy outcomes. National performance is for example, discussed annually during the annual ‘poverty policy week' that is attended by representatives from the Government, Civil Society and the Development Partners; as well as in national MKUKUTA cluster groupings – a review and discussion of milestones achieved, pending constraints and future priorities. Sectoral performance is also reviewed annually during the technical and sector performance review meetings – for example during the annual health or education or water sector review meetings. The focus of these annual assessment forums is largely on the overall implementation and performance of national and sectoral plans, if they are on track to achieving the MKUKUTA and sector targets and milestones, and the MDGs. Additionally, there are a number of sector-‐specific technical working groups addressing specific MKUKUTA priorities (health finance working group, social protection working group, HIV/AIDS working group, maternal and neonatal health technical working group, governance working group, etc.), and these also present a venue for presenting specific research findings and informing relevant stakeholders .
To influence and feed into policy level decisions, research institutions can (and some do) also present some of their nationally relevant research outputs to the Research and Analysis Working Group (RAWG)5 where research findings are critically reviewed by a cross-‐section of members from the government, civil society, research institutions and development partners. Some of the most relevant findings of this poverty analysis feeds into the making of the Tanzania Poverty and Human Development Report (PHDR) that usually comes out every other
year and as noted earlier in Section 4.1, contributes to the Government Monitoring and Reporting Processes. The PHDR presents a consolidated view of the progress of in implementation of the three clusters of MKUKUTA, including an overview on the status of well-‐being, highlighting emerging challenges and future priorities. The PHDR assesses major
5 A part of Tanzania's MKUKUTA poverty monitoring system.
changes over time by using indicators from a combination of commissioned studies by the RAWG, analysis of data from national surveys and routine administrative data systems, and independent research undertaken by a range of institutions in Tanzania. It also draws from public expenditure reviews. Findings and recommendations from the PHDR aim at influencing both National and Sector Strategic Plans and Budgets.
TanzaniaNationalHealthResearchPriorities20062010.pdf
1: Malaria-HIV/AIDS (TB)
2: Non- Communicable Diseases (Diabetes, Cancer, Mental disorder, Hypertension)
3: Environmental Health Water Born Diseases (e.g. diarrhoea, schistosomiasis, worms)
4: Maternal, Neonatal and Child Health (MNCH)
5: Health Systems (quality of care, public private partnership, universal access to care, drug supply, human resources for health, governance)
6: Vulnerability/ Social Protection
Year of last priority setting effort: 2006
key international financers and funding: Irish Aid
(IA)
To date, IA does not have a specific focus on SDH/ health inequities; emphasis is on “poverty alleviation” and approach is to fund sectors and actors on ”aspects of poverty” that would address equity e.g. education, nutrition, health and agriculture, with governance cutting across each of these sectors
IA supports the government (General Budget Support), Health sector (Basket Fund), and CSO's (an indirect means of addressing inequities, as well as get independent alternative information). For FY 2011-‐2012, IA's total support to the Tanzanian Health Sector was close to Euros 30,500,000: Euros 9,000,000 towards GBS, Euros 6,300,000 to the Health Basket and approx.. Euros 3,000,000 towards Health and Nutrition Programme (project based support), includes funding to CSOs (CCBRT, IHI, Sikika, TWAWEZA, Wildaf, UNICEF, HKI, STC and Consenuth)
IA is core funding to IHI is largely towards “policy analysis” -‐ pulling together existing data and research information; to learn what we know, what we don't know and what we need to know.
| Institution Name | Funding source | Amount to health | Amount to health research | Amount to SDH and health inequities | Amount to research in SDH and health inequities |
|---|
| Institution Name | Type of Institution | collaboration level | collaboration type | link to research on SDH |
|---|---|---|---|---|
| African Medical and Research Foundation (AMREF), Tanzania (www.amref.org ) | Academic Institutions and Research Institutions (non-profit) | International | Public Sector | |
| Ifakara Health Institute (IHI) www.ihi.or.tz | Academic Institutions and Research Institutions (non-profit) | International | Mixed | |
| National Institute of Medical Research NIMR | Academic Institutions and Research Institutions (non-profit) | International | Mixed | |
| Research on Poverty Alleviation (REPOA) www.repoa.or.tz | Civil Society Organisations | |||
| Muhimbili College of Health and Allied Sciences (MUCHAS), Department of Behavioural Sciences | Academic Institutions and Research Institutions (non-profit) | |||
| SIKIKA (www.sikika.or.tz ) | Civil Society Organisations | International | Mixed | |
| TWAWEZA www.twaweza.org | Civil Society Organisations | National | Mixed | |
| Tanzania Gender Programme (TGNP) www.tgnp.org | Civil Society Organisations | Regional | Public Sector |
| Institution Name | Type of Institution | Strategies considered in the institutional plan | Breakdown of percentage of researchers by specific disciplines | Breakdown of percentage of researchers by level of seniority | Proportion of researchers involved in research on SDH and health inequity | Trainings to build capacity in research in SDH and health inequities specific courses/ programmes |
|---|
Promoting research on SDH and health inequity:
An increased awareness and public debate on SDH and health inequities amongst all stakeholders - trying out innovative approaches to enable participants to increase their knowledge of integrated approaches to issues surrounding health and well-being; and in raising awareness of the importance of addressing determinants of health and informing and monitoring public policy to address determinants of health -? for example, researchers need to closely engage with all civil society actors who have a role to play in mitigating problems of poverty (such as NGOS, media, trade unions, schools and religious networks, etc.); identify people with ?spectacles? to iron the SDHs from the existing literature and synthesize the knowledge for action and transformation; and generate an interest and willingness to engage in researching and addressing health inequities and their social determinants. Formal, 'institutional' avenues would be to get SDH into the agenda of the Annual Poverty Policy Dialogue or the REPOA Annual Conference. Less formal would involve, for example, organizing special sessions with relevant parliamentary committees or major Conference on SDH every couple of years, hold regular media seminars or Policy Forum breakfasts, a portal/gateway on SDH within a larger Observatory of Human Rights hosted by a coalition of CSOs sponsored by COSTECH under the lead of REPOA, TWAWEZA or similar; or perhaps build on existing platforms for dissemination, such as the Regional Capacity for Evidence-?based Health Policy in East Africa (REACH) or the Tanzania Knowledge Network (TAKNET) (a platform for professionals and experts to meet , share and exchange experiences www.taknet.or.tz ) or the Commonwealth Regional Health Community Secretariat (CRHCS) 6 that is an effective clearinghouse of research information.
- Strengthening communication networks and getting researchers/policy makers/ advocates/ communication specialists within and between institution(s) ?talking to and working with each other? -? bringing together different disciplines that can contribute to research on SDH and health inequity, and promoting collaborative interdisciplinary research partnerships within and across research institutions (and with advocacy groups and policy makers at all levels), ensuring complementarity between ongoing research within and between institutions; and in the translation of research findings into policy. Collaboration between researchers and policy makers, (a relationship of trust between researchers and the policy community) was encouraged at various stages in the research process by the respondents and policy makers ? during designing research questions, and particularly in shaping policy recommendations to be sure that they are realistic and relevant to the resource constraints of the concerned ministries. Ensuring that policymakers gain a sense of ownership of the research is seen as crucial to the uptake of findings, illustrating the importance of giving careful consideration to appropriate. The key challenge for researchers is how to involve and promote effective participation of all stakeholders (advocates, decision makers, funders) at all stages of the research ? i.e. make research a truly participatory process ? without compromising on the research process and ensuring the objectivity and credibility of the findings.
Attracting partners & resources:
A central depositories of research information ? a self driven coordination of research within specific broad areas of analysis and research, including health ? it should be coordinated by a public institution to enable greatest access and be publicized widely amongst policymakers and health and advocacy practitioners. Making information more accessible institutionally as well as to other stakeholders within the country (will also facilitate horizontal and vertical linkages between policy makers, research institutions, advocacy groups and the media).
- A roaster of researchers and topics of specialization to facilitate easier identification by policymakers and ensuring a critical mass of researchers with appropriate skills base, and out of the box thinking; instill critical thinking along the course of research, from conceptualization to interpretation of findings ? Why do some people access care and others not? Why are some people better off and others not? Why are some treatments more effective in certain contexts than others? Why is the government more willing to support and subsidise the better off and not the poor? Why despite sustained growth in the last ten years, are inequities on the increase?
- Researchers need to be proactive to include a dissemination phase in research proposals that include a dissemination plan, target audiences, dissemination activities, research ?products?, the range of communication media to be used, and a budget.
- Donors can enable and encourage dissemination activities and communication between researchers and policymakers or practitioners by encouraging researchers to incorporate dissemination strategies into a research proposal, so that funding for project-?based dissemination is available and the researchers remain involved in in?country dissemination activities; and by giving priority to research proposals that have planned collaborative activities with key stakeholders at various stages in the research process, in particular, joint development of the proposal or identification of the research problem.
Bridging the gap between researchers and policy/decision makers:
Identify, working with and through some potentially influential ?champions? of SDH and mainstreaming SDH in policy and in strategy framework documents; an acknowledgement of SDHs in the National Strategic Framework (MKUKUTA)
- A representation of the ?SDH? body in ministerial advisory boards to identify priority research areas and to define appropriate research agendas to allow research activities to respond to programmatic needs.
Informing and influencing national priorities and policies:
Packaging of research findings that consider the needs of different policy audiences and to widen the target audiences for research dissemination ? for example, policy briefs tailored to specific audiences; media seminars; popularisation of research through advertisements/videos/comic books etc. (even linked to a broad based adult education programme), monthly seminar series on health and development issues, which is open to the public and endeavours to attract practitioners as well as researchers, analysts, and activists, etc.
Informing national research agenda:
Use the present Constitutional Review to get SDH on the agenda..?. Brazil and South Africa have managed to make big strides by ensuring a strong human rights focus in their Constitutions, and then following through on the commitments made to ensure the progressive realization of the right to health and other human rights. THINK BIG, build a coalition and don't fall prey to ?.'churning out' policy briefs.?
- Establish an organ, a ?SDH? body that will champion the mainstreaming of SDHs in health research priority and agenda?.?There are many possible arrangements, but if you want to push this (SDH) agenda some sort of consortium of organizations interested in the subject would probably be a good idea?
| Institution Name | Type of Institution | Details |
|---|---|---|
| African Medical and Research Foundation (AMREF), Tanzania (www.amref.org ) | Academic Institutions and Research Institutions (non-profit) | Key research areas in SDH and health inequity: Research skills and disciplines involved: General strategies in place for disseminating and sharing research findings nationally and internationally: |
| Ifakara Health Institute (IHI) www.ihi.or.tz | Academic Institutions and Research Institutions (non-profit) | Research skills and disciplines involved: General strategies in place for disseminating and sharing research findings nationally and internationally: Research projects in SDH and health inequity (2005-2015): |
| National Institute of Medical Research NIMR | Academic Institutions and Research Institutions (non-profit) | General trends in research activity on SDH and health inequity: Research skills and disciplines involved: General strategies in place for disseminating and sharing research findings nationally and internationally: |
| Research on Poverty Alleviation (REPOA) www.repoa.or.tz | Civil Society Organisations | General trends in research activity on SDH and health inequity: Research skills and disciplines involved: General strategies in place for disseminating and sharing research findings nationally and internationally: |
| Muhimbili College of Health and Allied Sciences (MUCHAS), Department of Behavioural Sciences | Academic Institutions and Research Institutions (non-profit) | General trends in research activity on SDH and health inequity: Research skills and disciplines involved: General strategies in place for disseminating and sharing research findings nationally and internationally: |
| SIKIKA (www.sikika.or.tz ) | Civil Society Organisations | General trends in research activity on SDH and health inequity: Research skills and disciplines involved: General strategies in place for disseminating and sharing research findings nationally and internationally: |
| TWAWEZA www.twaweza.org | Civil Society Organisations | General trends in research activity on SDH and health inequity: Research skills and disciplines involved: General strategies in place for disseminating and sharing research findings nationally and internationally: |
| Tanzania Gender Programme (TGNP) www.tgnp.org | Civil Society Organisations | General trends in research activity on SDH and health inequity: Research skills and disciplines involved: General strategies in place for disseminating and sharing research findings nationally and internationally: |
General trends in research activity on SDH and health inequity:
MALARIA
Bernard J, George Mtove, Renata Mandike, Frank Mtei, Caroline Maxwell and Hugh Reyburn. 2009. Equity and coverage of insecticide-‐
treated bed nets in an area of intense transmission of Plasmodium falciparum in Tanzania. Malaria Journal 8:65 .
Bruno P Mmbando et al. 2011. Spatial variation and socio-‐economic determinants of Plasmodium falciparum infection in north eastern
Tanzania. Malaria Journal, 10:145
Kahigwa E. undated. Social-‐cultural factors that influence the implementation of malaria prevention diagnosis and treatment interventions in Tanzania. www.ihi.or.tz
Manuel W, Hetzel et al. 2008. Malaria risk and access to prevention and treatment in the paddies of the Kilombero valley, Tanzania. Malaria Journal 2008.
Masanja H. Information and beliefs about malaria and bed net usage in Rufiji DSS: www.ihi.or.tz
Mulligan JA, Joshua Yukich and Kara Hanson. 2008. Research on Costs and effects of the Tanzanian national voucher scheme for insecticide-‐treated nets. Malaria Journal 7:32.
Rashid A Khatib et al, Market, Voucher, subsidies and free nets combine to achieve high bed net coverage in rural Tanzania. (IHI) Smithson P. 2009. Down but not out: the impact of malaria control in Tanzania. Spotlight, 2. Dar es Salaam: IHI.
HIV/AIDS
Bastien S. 2008. Out-‐of-‐School and "At Risk?" Socio-‐Demographic Characteristics, AIDS Knowledge and Risk Perception among Young
People in Northern Tanzania. International Journal of Educational Development, v28 n4, pp393-‐404.
Fox A. 2010. Social determinants of sero-‐status in Sub-‐Saharan Africa. An inverse Relationship between Poverty and HIV. Public Health
Reports, Supplement 4, Volume 125, 16-‐25.
Kessy F, Mayumana I and Msongwe Y. 2010. Widowhood and vulnerability to HIV and AIDS-‐related shocks: exploring resilience avenues. REPOA Research Report 10/5.
Mtenga S and Nathan R. (date?) Reaching the poor with Voluntary Counselling and Testing for HIV/AIDS and Treatment of Opportunistic infections.
Mamdani M, Rajani R & Leach V. 2008. How best to enable support for children with HIV/AIDS: A policy case study in Tanzania. IDS Bulletin, 39(5): 52-‐61.
TACAIDS, ZAC, NBS, OCGS, and Macro International, Tanzania HIV and AIDS and Malaria Indicators Survey (THMIS) 2007/08, TACAIDS, ZAC, NBS, OCGS and Macro International, Dar es Salaam, Tanzania, 2008.
UNESCO with EducSector AIDS Response Trust ,RAISON Namibia and TAMASHA Tanzania. December 2008. Supporting the Educational Needs of HIV-‐positive learners: lessons from Namibia and Tanzania. Report written by Peter Badcock-‐Walters, Director of ESART. (participatory research, funded by UNESCO's Section on HIV and AIDS (http://unesco.org/aids)
REPRODUCTIVE, NEONATAL AND CHILD HEALTH
Alderman H, Hoogejveen J & Rossi M. 2006. Pre-‐school nutrition and subsequent schooling attainment: Longitudinal evidence from
Tanzania. World Bank.
Amury Z & Korriba A. 2010. Coping strategies used by street children in the event of illness”. REPOA Research Report 10/1.
Care International (Tanzania) and Women's Dignity Project. 2008. “We have no choice”: Facility-‐based childbirth – the perceptions and experiences of Tanzanian women, health workers and traditional birth attendants.
Elisaria E. December 2009. Malnutrition in Tanzania: Declining but not on track. IHI Spotlight. Issue 3.
FAO, Urban Food Insecurity and Malnutrition in Tanzania, Revised Report prepared by Bureau for Agricultural Consultancy and Advisory
Services (BACAS) of Sokoine University of Agriculture, March, 2009.
Masanja H, de Savigny D, Smithson P, Schellenbert J, John T, Mbuya C et al. 2008. Child survival gains in Tanzania: analysis of data from demographic and health surveys. Lancet, 371, 1276-‐1283.
Mascarenhas O & Sigalla H. 2010. Poverty ad the Rights of Children at Household Level: Findings from Same and Kisarawe Districts, Tanzania”. REPOA Research Report 10/3.
Radboud University Nijmegen, CIDIN/NICE/NICHE & Muhimbili University for Health and Allied Sciences. Forthcoming. Impact of Reproductive Health Services on Socio-‐Economic Development in Sub-‐Saharan Africa: Connecting Evidence at Macro, Meso and Micro-‐ Level. A Reproductive Health and Development Research Programme. Draft Discussion Document on Policy Implications. (Research Programme initiated in 2008).
Sommer M. 2009. Where the education system and women's bodies collide: the social and health impact of girls' experiences of menstruation and schooling in Tanzania. Journal of Adolescence.
Van de Poel E, Hosseinpoor AR, Speybroeck N, Van Ourti T & Vega J. 2008. Socioeconomic inequality in malnutrition in developing countries. Bulletin of World Health Organisation 86(4): 282-‐291.
Victora CG. October 2006. ‘Are health interventions implemented where they are most needed? District uptake of the Integrated Management of Childhood Illness strategy in Brazil, Peru and the United Republic of Tanzania', Bulletin of the World Health Organization 84 (10)
NCD
Health care seeking behaviour in the context of epidemiological transition in Tanzania: a case of malaria and diabetes. (IHI -‐ PhD)
ENVIRONMENTAL HEALTH
Castro et al (2010) in World Bank, Mayor's Task Force: Urban Poverty & Climate Change in Dar es Salaam, Tanzania: A Case Study, Final
Report, World Bank, Washington D.C., May 31, 2011.
Climate Works Foundation et al (2009) in World Bank, Mayor's Task Force: Urban Poverty & Climate Change in Dar es Salaam, Tanzania: A Case Study, Final Report, World Bank, Washington D.C., May 31, 2011.
Health Focus (2006) in World Bank, Mayor's Task Force: Urban Poverty & Climate Change in Dar es Salaam, Tanzania: A Case Study,
Final Report, World Bank, Washington D.C., May 31, 2011.
Moore S et al. Undated. Health promotion for impoverished rural and refugee populations in Tanzania focusing on malaria control, sanitation and water supply. (LSHTM, Concern Worldwide, IHI, Durham University collaboration). www.ihi.or.tz
Ndalahwa Faustin Madulu et al., “Population, Health, and Environment Integration and Cross-‐Sectoral Collaboration in East Africa: Tanzania Country-‐Level Assessment” (2007), available from popref@prb.org
Sheuya SA. 2008. Improving the Health and Lives of People living in Slums. Ann. N.Y.Acad.Sci. 1136: 298-‐306. (contact:sheuya@yahoo.com, Ardhi University, Dar es Salaam, Tanzania).
Stansfeld S & Candy B. 2006. Psychosocial work environment and mental health – a meta-‐analytic review. Scandinavian Journal of Work and Environmental Health, 32:443-‐462.
TAWASANET. 2008. Water: more for some….or some for more?
Watkiss et al (2011) in World Bank, Mayor's Task Force: Urban Poverty & Climate Change in Dar es Salaam, Tanzania: A Case Study,
Final Report, World Bank, Washington D.C., may 31, 2011.
HEALTH SYSTEM RESEARCH
Equity and Efficiency in Service Delivery: Human Resources. Background Analytical Note for the Annual Review of the General Budget
Support 2008.
Kida, Tausi, The Systemic Interaction of Health Care Market and Urban Poverty in Tanzania, Ph.D. Dissertation, International Institute of S
of Erasmus University Rotterdam, The Hague, The Netherlands, 2009.
Kuwawenaruwa A & Borghi J. June 2012. Health insurance cover is increasing among the Tanzanian population but wealthier groups are more likely to benefit. Ifakara Health Institute Spotlight, Issue 11.
Prosper H, Macha J and Borghi J. March 2010. Despite challenges, IMCI scale-‐up is possible. IHI Spotlight, Issue 4. SHIELD Information Sheet. 2010. Who pays for Health Care in Tanzania? IHI Spotlight.
SHIELD Information Sheet 2010. Who benefits from Health Care in Tanzania? IHI Spotlight.
SIKIKA. 2011. Medicines and medical supplies availability report. Using absorbent gauze availability survey as an entry
as an entry point. A case of 71 districts and 30 health facilities across Mainland Tanzania. 10th-‐20th May, 2011. Dar es Salaam:
SIKIKA (www.sikika.or.tz )
Performance based incentives implemented in East Africa (research project IHI, synthesis of available literature and secondary analysis of available data)
GOVERNANCE AND ACCOUNTABILITY
Croke K. August 2011. Politics, Child Mortality, and Health Systems Development in Tanzania and Uganda. 1995-‐2009. Draft Version. Johns Hopkins University, School of Advanced International Studies, kevinjcroke@gmail.com )
Fjeldstad O-‐H, Katera L & Ngalewa E. April 2008. Citizens demand tougher action on corruption in Tanzania. REPOA Brief No. 11.
Fjeldstaf O-‐H, Katera L & Ngalewa E. November 2008. Disparities exist in citizen's perceptions of service delivery by local government authorities in Tanzania. REPOA Brief No. 13.
HakiElimu. December 2006. Is Government Managing Money Well. Findings from Recent Audit Reports. Report written by Ruth Carlitz. www.hakielimy.org
Hoogeveen J & Ruhinduka R. 2009. Poverty reduction in Tanzania since 2001: Good intentions, few results. Paper commissioned by the
Research and Analysis Working Group, Tanzania. (unpublished)
Katera L & Semboja J. 2008. Budget allocation and tracking expenditure in Tanzania: the case of health and education sectors. In: Pressend, M & Ruiters, M. (eds). Dilemmas of poverty and development – a proposed policy framework for the Southern African Develop
Community. Midland. The Institute of Global Dialogue.
Tidemand P & Msami J (forthcoming). Local government reforms and their impact on local governance and service delivery: Empirical evidence of trends in Tanzania Mainland 2000-‐2008.
Twaweza. October 2008. Twaweza fostering an ecosystem of change throughout East Africa through imagination, citizen agency and public accountability! www.twaweza.or.tz.
VULNERABILITY, SOCIAL PROTECTION & POVERTY ANALYSIS
Aikaeli J. 2010. Determinants of rural income in Tanzania: an Empirical Approach. REPOA Research Report 10/4.
Amury Z & Aneth K, Coping strategies used by street children in the event of illness, Research Report 10/1, 2005, REPOA, Dar es Salaam. Gwatkin DR, Rutstein S, Johnson K, Suliman E, Wagstaff A & Amouzou Agbessi. April 2007. Socio-‐economic differences in
health, nutrition and population. HNP, The World Bank.
Khan et al. March 2006. Geographic aspects of poverty and health in Tanzania. Does living in a poor area matter? Health Policy and
Planning 21(2): 110-‐112.
Kijakazi O Mashoto, Anne N Astrom, Marit S Skeie and Joyce R Masalu. 2010. Social demographic disparity in oral health among the poor: a cross sectional study of early adolescents in Kilwa District, Tanzania BMC. Open access.
Leach V. 2007. Children and vulnerability in Tanzania. A brief synthesis. REPOA Special Paper 07.25. Dar es Salaam: REPOA. Lindeboom W, Leach V, Mamdani M & Kilama B. 2006. Vulnerable children in Tanzania and where they are. An unpublished report,
REPOA.
Maarifa ni Ufungo. 2008. Cost sharing in education in Kilimanjaro III: How the gaps are widening. Kilimanjaro: Maarifa ni Ufungo.
Mahmud MK, Hotchkiss DR, Berruti ASA, Hutchinson PL. 2005. Geographic aspects of poverty and health in Tanzania: does living in a poor area matter? . Oxford University Press.
Mbelle. A.V.Y. 2007. Macro Economic Policies and Poverty Reduction initiatives in Tanzania: What Needs to be done? ESRF Publication. McAlpine, Kate, Robert Henley, Mario Mueller and Stefan Vetter, ‘A Survey of Street Children in Northern Tanzania: How Abuse or
Support Factors May Influence Migration to the Street, Community Mental Health Journal, Volume 46, Number 1, 26-‐32, 2010, DOI:
10.1007/s10597-‐009-‐9196-‐5.
Mboghoina T & Osberg L. 2010. Social Protection of the Elderly in Tanzania: current status and future possibilities. REPOA Special
Paper 10/5.
Mhina, Edward Hiza, Youth Policies and Violence Prevention in the Great Lakes Region: A Study on Tanzania-Towards Youth Inclusive Policies and Prevention of Violence in Tanzania, A study conducted for United Nations Educational, Scientific and Cultural Organisation, UNESCO, Dar es Salaam, 2011.
Ministry of Labour, Employment and Youth Development in collaboration with HelpAge International, Dar es Salaam,
Tanzania. May 2010. Achieving income security in old age for all Tanzanians: a study into the feasibility of universal social pension.
Ministry of Foreign Affairs of Denmark, DANIDA. 2008. Gender equality in health. www.um.dk
Minot N, Simler K, Benson T, Kilama B, Luvanda E and Makbel A. January 2006. Poverty and malnutrition in Tanzania: New approaches for examining trends and spatial patterns. International Food Policy Research Institute: Washington, DC.
or www.repoa.or.tz )
Mashoto et al. 2010. Social demographic disparity in oral health among the poor: a cross sectional study of early adolescents in Kilwa
District, Tanzania.
Mkombozi, Census report 2005: A comparative analysis of Tanzania's most vulnerable children, Mkombozi, Moshi and Arusha, 2005. Mkombozi, Census report 2006: The rhetoric and reality of Tanzania's street children, Mkombozi, Moshi and Arusha, 2006.
Mkombozi, Census Report 2010: Empowering children, engaging families, and engaging communities, Mkombozi, Moshi and Arusha,
2010.
Mkombozi, 'Perceptions' Survey: Survey of Community members' perceptions of children who are living/working in the street, Mkombozi, Moshi and Arusha, 2010.
Mwanakombo Mkanga, Impact of Development-‐Induced Displacement on Households Livelihoods: Experience of people from Kurasini
Dar es Salaam – Tanzania, MSc Thesis, 2010.
National Bureau of Statistics (NBS), Key Findings; Child Work and Child Labour in Tanzania: The Integrated Labour Force Survey (2006), NBS, Dar es Salaam.
NBS and UNICEF (2011), Children with disabilities in Tanzania: Prevalence and experiences, Report based on the Tanzanian Disability
Survey of 2008,' Final Report, NBS and UNICEF, Dar es Salaam, June 2011.
RAWG, MKUKUTA Monitoring System & Ministry of Finance and Economic Affairs. 2012. Poverty and Human Development Report
2011.
RAWG. 2009. Poverty and Human Development Report 2009. Dar es Salaam: Mkuki na Nyota Publishers
RAWG. 2008. Views of the People 2007: Tanzanians give their opinions on growth and poverty reduction, their quality of life and social well-‐being, and governance and accountability. Dar es Salaam: REPOA.
RAWG. 2008. Tanzanian children's perceptions of education and their role in society: Views of the Children 2007. Dar es Salaam: REPOA.
RAWG. 2006. Status Report 2006: Progress towards the goals for growth, social well-‐being and governance in Tanzania. Dar es Salaam: REPOA.
RAWG. 2007. Poverty and Human Development Report 2007. Dar es Salaam: Mkuki na Nyota Publishers
RAWG. 2005. Poverty and Human Development Report 2005. Dar es Salaam: Mkuki na Nyota Publishers
Save the Children, UK, Singida District Council (Tanzania), Sustainable Environment Management Action. 2006. Poverty and
Vulnerability in Singida Rural District. Household Economy Analysis. Report written by Claire Chastre
Smithson P. 2006. Fair's fair. Health inequities and equity in Tanzania. Dar es Salaam: Women's Dignity Project and Ifakara Centre for
Health Research and Development.
Smithson P. October 2011. Tanzania Demographic and Health Survey 2010. What has changed? Ifakara Health Institute, Spotlight, Issue
9.
Tanzania Gender Network Programme (TGNP). 2009. Will the 2009/10 budget work for marginalised women? Gender, Democracy and
Development Digest. Issue No 1.
Tanzania Gender Network Programme (TGNP). 2009. “Who cares for us?” Time Use Study of Unpaid Care Work in Tanzania. Dar es
Salaam: TGNP
TAWASANET. 2008. Water: more for some….or some for more?
UNICEF, Tanzania. 2009. Childhood Poverty in Tanzania: Deprivations and Disparities in Child Well-‐Being. A Joint Report by REPOA, NBS and UNICEF.
UNICEF, Tanzania. 2012. Cities and Children. The Challenge of Urbanisation in Tanzania. Dar es Salaam, Tanzania.
URT, RAWG. Poverty and Human Development Report (2003, 2005, 2007, 2009, 2012). Dar es Salaam: Mkuki na Nyota Publishers. URT. 2011. Stopping Violence Against Children. The Tanzania Violence against Children Study and the National Response, UNICEF,
Ministry of Community Development, Gender and Children, Dar es Salaam.
National mechanisms in place for the ethics review of research:
The ethics review bodies are a good means for assessing the soundness, feasibility and ethics of the proposed research and methodology, prior to its implementation. There are two national level ethics review bodies: the National Research Ethics Committee that is coordinated by the Research Ethics Department within NIMR, and COSTECH. There are another seven individual national research institutions.
Research protocols may be reviewed at the institutional level by the Institutional Ethics Review Committee. For institutions that do not have such committees in place, research protocols may be presented directly to and reviewed by the relevant national ethics committees. All research protocols involving foreign researchers (or internationally sponsored research, invasive procedures such as vaccine/ drug related research, human subjects (including research with and of communities)) have to be submitted to the National Research Ethics Committee for a second phase of the review process –all health related research to NIMR, and all non-‐health related research to COSTECH.
Even though ethics review bodies and ‘National Guidelines on Research Ethics' in Tanzania are in place, not all research carried out within the country is ethically cleared. For example, not all national institutions undertaking or promoting research enforce an ethical review process (i.e. do not always require proposed research to be ethically cleared before implementation), unless of course it is a requirement by their collaborating partner, or their funder. Having said this, some institutions do have stringent ethical requirements in place, and often research protocols may require clearance by national bodies as well as those of their collaborating partners. According to NIMR, the presence of the National Research Ethics Committee and the review process in general has to some extent helped ensure that aside from protecting
research participants from any potential harm, the proposed research addresses national priorities, builds national research capabilities and is conducted in accordance with the national and international accepted standards. Also, even though there are no specific committees in place, nationally or institutionally, for reviewing research specifically on SDH and health inequity, existing Committees can ensure representation of reviewers who are best qualified to comment and provide technical inputs to specific subject areas.
An ethics review process costs – in terms of time and money. A full approval process (through institutional and national bodies) can take from a minimum of two to three months and beyond, pending on the complexity of the research, the soundness of proposed methodologies and availability of relevant reviewers. For example, research originating at IHI (alone or with one of its collaborators) is first presented to the Scientific Committee within IHI that usually provides useful feedback on the overall methodology and proposed analytical plan, including the level of priority that should be given to the proposed area of research, institutionally and nationally. This Committee usually tries to meet once a month or every other month. Once relevant comments are incorporated, a revised protocol is then shared with the Institutional Ethics Review Committee members that usually meets as required – phase two of the review process that may call for another revision of the research protocol before it is submitted to the NIMR National Review Committee (if need be) that is supposed to meet once a month, though this may not always be possible. The National body may well have questions and comments for further clarification that will need to be addressed before it once again reviews and approves the proposed research. Finally, as noted earlier, some external collaborators may have their own stringent ethical review requirements which can incur additional costs (also their requirements might not always be in sync with national ethical process and at times resulting in a conflict of interest).
To hasten the ethics approval process and make it more cost-‐efficient (or affordable), interviewed researchers reported a dire need to establish ethics committees at the respective academic institutions that can review the entire process (i.e. without having to go through
‘national' bodies). Such committees' have to be approved and endorsed by the National Committee: the NIMR Act No. 23 of 1979 (an amendment of NIMR ACT of 1977) stipulates the criteria, conditions and fulfillments of establishing ethics committees. On the other hand, according to one senior researcher, “the real research ethics story is the way in which 'ethics' have been abandoned as research has become commercialised, personalised, privatised…”
Institutional mechanisms for monitoring of research:
Research and advocacy institutions generally have a range of processes in place that provide a forum for periodic technical support as well as mentoring of ongoing research, ranging from monitoring institution specific indicators (generally linked to their five year strategic plans) and periodic progress reports to national dissemination forums. For example, REPOA has several mechanisms for monitoring ongoing research within the institution -‐ the annual strategic plan that defines the institutional research priorities over a period of time (usually five years), periodic progress reports to the funders, periodic reviews by and feedback from REPOA's technical committee of senior researchers and policy makers from a several institutions, dissemination of research findings or methodological issues through ‘open' and
‘closed' seminars, as well as the annual research workshop that solicits feedback from a cross section of researchers, advocates, activists and policy makers from across the country.
The choice of indicators to inform institutions of their annual ‘outputs' are usually related to number of research outputs (e.g. number of completed research projects in a specified time period, number of reports submitted, number of conference presentations, number of publications in peer reviewed journals, number of dissemination forums, etc.) in specific thematic areas of interest. While these ‘numbers' are a useful insight into the range and magnitude of ongoing activities, they are not necessarily a good indication of the quality of research being implemented, except perhaps for the published papers being accepted in well-‐ known peer reviewed journals.
National mechanisms for monitoring of research:
Nationally, the MKUKUTA Monitoring Master Plan provides a framework for deeper and broader monitoring of the range of issues covered by MKUKUTA (URT 2006). The monitoring system provides an analysis of changes in relation to goals and operational targets of MKUKUTA and these then inform decisions about national planning, budgeting, and public expenditure management. A total of 80 national level outcome oriented indicators provide the basic skeleton of evidence of changes in growth, well-‐being and governance during MKUKUTA implementation. They track changes and help to assess whether Tanzania is achieving the goals set in its MKUKUTA Strategy. Indicators are complemented by analytical research (the PHDR) which provides evidence about the causes and consequences of change. Availability of data and the potential to determine trends were two key factors in determining the categories and levels of disaggregation of each indicator. The national-‐level MKUKUTA indicator set is complemented by larger sector specific indicator sets (and as far as possible national indicators are drawn from sector indicator sets). Sectoral indicators assist in monitoring implementation of sector plans and priorities. And specific departments and Commissions within sectors have their own list of monitoring indicators linked to their current priorities. So for example, TACAIDS whose support to research and implementation of interventions revolves around issues related to HIV/AIDS, monitoring indicators include the number of MARPS reached with counseling or supporting groups, number of condoms distributed, number of people who have used VCT services, number of people (men/women/children/) on treatment, etc. Again, while these indicators provide some insight into access to essential services and numbers served, they do not say much about the quality of service provision.
The health M&E system consists of routine systems (Health Management Information System
{HMIS}, demographic and disease surveillance) and the MoHSW is in charge of this; and non-‐ routine systems (household surveys, research) that is done by other government or research entities. Tanzania can provide information of reasonable quality on health status of population, on diseases, and on health service provision. There are however, weaknesses in the collection of HMIS routine data which is not always complete or reliable, and often delayed. Vital registration does not have good coverage (and this information is required for planning health services). Other reporting systems in the context of MKUKUTA operate parallel to the HMIS. Operational research is under-‐funded. Data are not always analysed, organised or presented in a user-‐friendly way. Interpretation is limited.
A key concern expressed by several respondents is the focus on ‘averages', on meeting the MDG targets, and the absence of indicators that identify the extent of inequality in the country. Most respondents noted the dire need to develop and adopt clear measurable indicators of progress on reducing inequalities; as well as incorporating more of the
‘qualitative' indicators to better understand ‘quality' aspects as well as perceptions of the beneficiaries.
SDH-Net
