Browsing by Author "Mboera, Leonard"

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    Challenges to Fair Decision-Making Processes in The Context of Health Care Services: A Qualitative Assessment from Tanzania
    (2012-06) Shayo, Elizabeth; Norheim, Ole F.; Mboera, Leonard; Byskov, Jens; Maluka, Stephen; Kamuzora, Peter; Blystad, Astrid
    Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people's needs. In Tanzania, the policy of decentralization and the health sector reform place an emphasis on community participation in making decisions in health care. However, aspects that can influence an individual's opportunity to be listened to and to contribute to discussion have been researched to a very limited extent in low-income settings. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. The study was carried out in the Mbarali District of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. Existing challenges related to individuals' influence of decision making processes in health care need to be addressed if greater participation is desired. There is a need for increased advocacy and a strengthening of responsive practices with an emphasis on the right of all individuals to participate in decision-making processes. This simultaneously implies an emphasis on assuring the distribution of information, training and education so that individuals can participate fully in informed decision making.
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    Ecologists Can Enable Communities to Implement Malaria Vector Control in Africa
    (BioMed Central, 2006) Mukabana, Richard W.; Kannady, Khadija; Kiama, Michael G.; Ijumba, Jasper N.; Mathenge, Evan M.; Kiche, Ibrahim; Nkwengulila, Gamba; Mboera, Leonard; Mtasiwa, Deo; Yamagata, Yoichi; Schayk, Ingeborg van; Knols, Bart G. J.; Lindsay, Steven W.; Castro, Marcia C.; Mshinda, Hassan; Tanner, Marcel; Fillinger, Ulrike; Killeen, Gerry F.
    Integrated vector management (IVM) for malaria control requires ecological skills that are very scarce and rarely applied in Africa today. Partnerships between communities and academic ecologists can address this capacity deficit, modernize the evidence base for such approaches and enable future scale up. Community-based IVM programmes were initiated in two contrasting settings. On Rusinga Island, Western Kenya, community outreach to a marginalized rural community was achieved by University of Nairobi through a community-based organization. In Dar es Salaam, Tanzania, Ilala Municipality established an IVM programme at grassroots level, which was subsequently upgraded and expanded into a pilot scale Urban Malaria Control Programme with support from national academic institutes. Both programmes now access relevant expertise, funding and policy makers while the academic partners benefit from direct experience of community-based implementation and operational research opportunities. The communities now access up-to-date malaria-related knowledge and skills for translation into local action. Similarly, the academic partners have acquired better understanding of community needs and how to address the Until sufficient evidence is provided, community-based IVM remains an operational research activity. Researchers can never directly support every community in Africa so community-based IVM strategies and tactics will need to be incorporated into undergraduate teaching programmes to generate sufficient numbers of practitioners for national scale programmes. Academic ecologists at African institutions are uniquely positioned to enable the application of practical environmental and entomological skills for malaria control by communities at grassroots level and should be supported to fulfil this neglected role.
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    Factors Affecting Utilization of Evidence Based Health Information System for Effective Supply Chain of Essential Medicine in Tanzania: A Case Study from Mbeya Region
    (JHIDC, 2011) Kagaruki, Gibson; Kimaro, Honest C.; Mboera, Leonard
    Background: Essential Medicines (EMs) are medicines that satisfy the priority health care of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness. While Health Information System (HIS) is a system that integrates data collection, processing, reporting and use of the information necessary for improving health service effectiveness and efficiency through better management at all levels of health services. Method: A cross sectional study was conducted from April to June 2009 in Mbeya Region and at the national level to assess the factors affecting utilization of evidence based health information system for effective supply chain of EMs in Tanzania so as to develop strategies for valuable procurement at the facility and national levels. Quantitative data was collected from 33 health facilities (HFs) and qualitative data was collected from two focus group discussions and 23 different key informants from different levels of the EMs supply chain. Results: This study revealed the following main factors that affect utilisation and management of information system (IS): lack of strong IS at Medical Store Department and Ministry of Health and Social Welfare to manage the organization, suppliers and clients needs; lack of compliance to the national ordering and deliveries guideline and procedures; inadequate funds; low capacity in implementing integrated logistic system; lack of national representative data during annual budgeting and forecasting of EMs requirements; and political interests. Conclusion: In this study the supply chain of EMs at the HFs and central levels in Tanzania is not evidence-based. For effective utilization of HIS in the supply chain of EMs there is need to strengthen the capacity in the management and utilisation of HIS at facility, district and national levels.