Institute of Development Studies

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    Redefining Occupational Health for Tanzania
    (Taylor & Francis Group, 1986) Kamuzora, Peter
    Occupational health was defined twenty years ago by the joint ILO/WHO committee on occupational health as 'the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations.' This definition has shaped not only the concept but also the organisation and delivery of occupational health services in Africa. Most approaches to workers' health problems are enmeshed in the medical model that strictly limits its operations to medical service delivery to prevent accidents and diseases in formal and defined occupations, most of which fall into the category of wage employment. All workers outside this category — for example, peasants — are not covered by the ILO/WHO definition.
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    The Politics of Implementing Intersectoral Policies for Primary Health Care Development: Experience and Lessons from Tanzania
    (1995) Kamuzora, Peter
    The paper reviews the initiatives made by the Government of Tanzania to develop intersectoral collaboration for the implementation of Primary Health Care(PHC). It explains why there has been little in those directions. A number of shortcomings were identified during the different phases of PHC implementation, these include: misconception of PHC by the MoH as PHC was paradoxically initiated in the MoH (national level) as a vertical programme alongside other vertical programmes which were not coordinated, formation of the PHC coordinating committees alongside development committees existing at village, district and regional levels gave rise to unnecessary multiplication of committees at these levels: a tendency by the MoH to refrain from implementing its past decisions such as dropping the formation of a National Health Council to guide the PHC-oriented policy formulation process at national level; weakening the national level coordinating mechanism by lack of political legitimacy it deserves; and inadequate legal mechanisms proposed in the 1983 PHC guidelines to back up PHC implementation which were made in reference to only the village level PHC committee. Experience of implementing PHC in Tanzania highlights the point that intersectoral collaboration is not simply a technical issue but as influenced by socio-political factors. This article has raised a number of issues which have to be noted in order to improve intersectoral collaboration in Tanzania. First, is the need to place PHC on Tanzania's political agenda. This may taken time but it is a necessary exercise to undertake. Second, effective mechanisms to foster policy coordination at national level should be developed. Third, intersectoral coordination processes at national level should guide similar processes at subnational levels. Fourth, is always to be aware of an counteract the problems presented by the medical model in health programmes implementation processes.
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    Entrepreneurship Development in Africa : some reflections from Tanzania
    (DUP Ltd, 1996) Rugumamu, Severine M.; Mutagwaba, B. B.
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    Lethal Aid: The Illusion of Socialism and Self-Reliance in Tanzania
    (Africa World Press, 1997) Rugumamu, Severine M.
    Despite massive infusions of financial and technical assistamce from the northern hemisphere, Africa is worse off today -- economically, societally, and environmentally -- than it was 30 years ago. But were economic development, poverty alleviation, and democracy ever actually the objectives of either donor or recipient states in the first place? To what extent was the limitless potential of the self-reliance strategy foreclosed by the corrupting power of foreign aid? As much as military power, propaganda, or diplomacy, "aid" -- realistically and essentially -- is one of the economic instruments of statecraft and, as such, has historically been used as a policy tool for various attempts at influence. While policies and strategies on both sides of the aid process may give primacy of place to development, actual practice almost invariably reveals the opposite, as donor and recipient alike employ aid resources to pursue their respective national, class, or even regime interests. Through the Tanzanian experience of "Big Brother's" helping hand, the author of this book examines the true role of foreign aid in the development process and exposes certain widely-held myths about that role.
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    Foreign Aid, Grassroots Participation and Poverty Alleviation In Tanzania: The Hesawa Fiasco
    (1999) Rugumamu, Severine M.
    The study set to examine foreign aid effectiveness in the poverty alleviation in rural Tanzania. More specifically, it sought to investigate the impact of the Health through Sanitation and Water (HESAWA) program among the rural population of Mwanza and Kagera Regions. Twelve villages were studied. HESAWA is an aid-supported program through SIDA and Sweden. The Government of Tanzania contributes marginally through annual budgetary allocations. Although the program's core objectives did not directly target poverty alleviation, its very emphasis on economic growth and social development among the rural poor presupposes poverty alleviation as an indirect final objective. Moreover, from the early 1990s, the objectives of international development cooperation by various donors largely shifted in favour of the war on poverty reduction. Thanks are largely to the conclusion of the Cold War and the end of the double standards behaviour among Western donor governments. In a similar policy shift, HESAWA's overall mandate was enlarged and focused more pointedly on the poverty reduction issues.
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    Foreign Aid and the Poverty Menace in Tanzania : An overview of recent experiences
    (OSSREA, 2000) Rugumamu, Severine M.; Mutagwaba, Benjamin
    Most of the aid-poverty debate in the development studies literature is dominated by two diametrically opposed positions. On the one hand, there are those who argue that foreign aid can contribute markedly towards poverty reduction in the South. On the other hand, there is growing evidence to suggest that, in fact, there is little or no correlation between aid inflows to the South and GDP growth rates, let alone poverty reduction. The evidence so far available on Tanzania provides virtually no causal relationship between the amount of aid received and economic growth or poverty alleviation. If the amount of foreign aid received had any relationship with poverty reduction in Tanzania, then it should have long been eliminated. One of the major reasons why foreign aid failed to alleviate poverty in Tanzania was because the real needs and aspirations of the poor were ignored by those who purported to be helping them. There were hidden interests on both sides of the aid process, evidenced in aid-tying on the part of donors, the high proportion of concessional loans and the importance of the technical assistance personnel component in foreign aid packages, and concern with regime survival on the part of the recipient government. A wider focus on the way in which domestic and international political economy imperatives interact to produce a specific outcome is essential to an understanding of the failure of aid to reduce poverty in Tanzania.
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    Africa’s Debt Bondage: A Case for Total Cancellation
    (2001) Rugumamu, Severine M.
    From the early 1980s to the present, Africa’s external debt burden has become increasingly onerous and unmanageable. The continent’s inability to service its debt is vividly reflected not only by a massive build-up of arrears but most importantly, by the number and frequency of rescheduling. Although most concerned parties agree on the urgent need for creative and innovative approaches to resolve Africa’s debt crisis, opinions differ considerably as to what exactly needs to be done. Recent partial and often disjointed debt relief measures that have been tried to manage the debt crisis have been found largely inadequate. It is hereby proposed that debt should be cancelled for highly indebted poor countries. This is precisely because debt repayment is economically exhausting as it continues to block future development; it is politically destabilising as it threatens social harmony; and, it is ethically unacceptable as it hurts the poorest of the poor.
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    Conflict Management in Africa: Diagnosis of Current Practices and Future Prospects
    (2002) Rugumamu, Severine M.
    In the realm of peace and security in Africa, the 1990s witnessed dramatic and profound changes throughout the continent. With the conclusion of the Cold War, some of the major tensions between East and West over African battleground were markedly eased. South Africa and Namibia installed democratically elected governments. Relative peace and stability was established in Mozambique after three decades of confrontation between warring parties. Several dozens of African countries held democratic elections. Unquestionably, all these are positive and significant signs toward peace, stability and development. However, while many parts of the world moved toward greater stability and political and economic cooperation, Africa remained one of the cauldrons of instability. Political insecurity and violent conflicts became increasingly persistent realities of the development scene in Africa. Internal conflicts with deep historical roots flared in many countries on the continent. Ironically, while the international community paid less and less attention to African security affairs, the continent's institutional and organizational capacity to manage its pervasive conflicts was not developing at the same pace as conflict escalations. Against such a backdrop, peace and peace making in Africa emerges as one of the critical issues of great importance in global politics.
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    Globalization, Democracy and Development in Africa: Challenges and Prospects
    (Taylor & Francis, Ltd, 2004-08) Assefa, Taye; Rugumamu, Severine M.; Ahmed, Abdel G. M
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    Globalization Demystified: Africa’s Possible Development Futures
    (Dar es Salaam University Press (DUP), 2005) Rugumamu, Severine M.
    This succinct and balanced monograph critically examines Africa's integration - or lack thereof - into the global capitalist system. From historical and interdisciplinary perspectives, it considers how encounters between structurally unequal economies and institutions have shaped the continent's past and exacerbated the exploitation and abject poverty suffered by the majority. Rugumamu analyses how Africa's continued marginalisation stems from the expanding and increasingly divergent international trading and investment systems, and disparities in technological progress. He counters orthodox neo-liberal arguments and unquestioned assumptions of failure to integrate into the world economy. Instead the author asserts that Africa has been asymmetrically integrated into the world economy from the beginnings of modern history, and that the march of global capitalism is further undermining the continent's ability to negotiate a more beneficial position. The author proposes alternatives of collective self-determination, democratically negotiated to empower the under- represented sections of society; but warns that such steps would require new modes of political and economic organisation and structural changes to established patterns.
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    Factors Influencing Implementation of the Community Health Fund in Tanzania
    (2006) Kamuzora, Peter; Gilson, Lucy
    Although prepayment schemes are being hailed internationally as part of a solution to health care financing problems in low-income countries, literature has raised problems with such schemes. This paper reports the findings of a study that examined the factors influencing low enrolment in Tanzania’s health prepayment schemes (Community Health Fund). The paper argues that district managers had a direct influence over the factors explaining low enrolment and identified in other studies (inability to pay membership contributions, low quality of care, lack of trust in scheme managers and failure to see the rationale to insure). District managers’ actions appeared, in turn, to be at least partly a response to the manner of this policy’s implementation. In order better to achieve the objectives of prepayment schemes, it is important to focus attention on policy implementers, who are capable of re-shaping policy during its implementation, with consequences for policy outcomes.
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    Applying Policy Analysis in Tackling Health-equity Related Implementation Gaps
    (2006-01) Gilson, Lucy; Erasmus, Ermin; Kamuzora, Peter; Mathews, Verona; Ngulube, T. J; Scott, Vera
    In international health policy debates the problems experienced in implementing new policies and interventions are generally seen as resulting from the weak use of available evidence and the failure to hold health workers accountable for their actions. Both of these causes are then sometimes linked to the lack of political will to improve implementation. This paper presents an alternative perspective that takes fuller account of the ways in which the exercise of power shapes implementation experiences.
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    The Effects of Breastfeeding and Its Co-Variates on Infant and Child Mortality: Some Evidence from Dodoma Region, Tanzania
    (2007) Niboye, Elliott P.
    Mortality control in most developing countries is still at low levels because of high infant and child mortality rates. The infant and child mortality rates for Tanzania are still high despite the observed declining trend in developing countries in the twentieth century. The efficacy of mass campaigns against general or specific diseases and extension of health services is not convincing; hence the importance of emphasising the natural behaviours and means such as breastfeeding that confers protection to infants and children from health scourges. This paper is a result of a study carried out in some selected localities in Dodoma Region, Tanzania. The major findings were that on average, most women in the study area breastfed for two years. Some socio-economic and biological variables such as education, residence, maternal age, parity, and birth interval were found to be strongly correlated with both breastfeeding and under-five mortality. However, the variables have a strong effect on mortality of the under-fives than breastfeeding. Furthermore, it was found that breastfeeding for long duration is beneficial to young children, especially infants. Nevertheless, its positive effects are elevated in a multivariate perspective. Factors that increase mortality risks not only increase the importance of breastfeeding for children's survival, but also increase the age up to which its benefits continue to be important. In retrospect, this suggests that any policy intervention designed to promote breastfeeding should concern itself primarily with how children of the most deprived subgroups are fed, and should stress continuation of breastfeeding to higher ages for those same subgroups