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Browsing by Author "Semali, Innocent A."

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Assessment of parental perception of malaria vaccine in Tanzania
(Malaria journal, 2015) Semali, Innocent A.
Background Clinical trials of the RTS,S malaria vaccine have completed Phase III and the vaccine is on track for registration. Before making decisions about implementation, it is essential to prepare the ground for introducing the vaccine by assessing awareness and willingness to use malaria vaccines and to provide policy makers with evidence-based information on the best strategies to engage communities to manage the introduction of malaria vaccine in Tanzania. Methods In November 2011, as part of a large cross-sectional study of all 23 regions of Tanzania (mainland Tanzania and Zanzibar) was conducted during Tanzanian Integrated Measles Campaign (IMC) survey. In this study, the variables of interests were awareness and willingness to use a malaria vaccine. The main outcome measure was willingness to use a malaria vaccine. Logistic regression was used to examine the influence of predictive factors. Results A representative sample of 5502 (out of 6210) women, aged 18 years or older and with children under 11 months old, was selected to participate, using random sampling probability. Awareness of the forthcoming malaria vaccine, 11.8 % of participants in mainland Tanzania responded affirmatively, compared to 3.4 % in Zanzibar (p value <0.0001). 94.5 % of all respondents were willing to vaccinate their children against malaria, with a slight difference between mainland Tanzania (94.3 %) and Zanzibar (96.8 %) (p value = 0.0167). Conclusions Although mothers had low awareness and high willingness to use malaria vaccine, still availability of malaria vaccine RTS,S will compliment other existing malaria interventions and it will be implemented through the Immunization, Vaccines and Biologicals (IVB) programme (formerly EPI). The information generated from this study can aid policy makers in planning and setting priorities for introducing and implementing the malaria vaccine.
Associations and healers: Attitudes towards collaboration in Tanzania. In The professionalisation of African medicine
(Routledge, 2018) Semali, Innocent A.
The establishment of an effective organisation or association of healers may be considered as one step towards the professionalisation of traditional healers. In Tanzania there is no law which prohibits or governs the practice of traditional medicine. In Tanzania there have been a number of efforts to promote traditional medicine. The association (UWATA) attracted many traditional healers within the urban set-up, some of whom were not traditional healers but quacks, while others were opportunists. Many people have urged the incorporation or collaboration of traditional medicine with modern health care. In general, traditional healers have been eager to form associations but faced with leadership problems. Umoja wa Waganga Tanzania or Traditional Healers' Union of Tanzania managed to open a number of treatment centres in the country. Its members were always coming forward to display their talents to cure, and they organised several treatment sessions in a number of areas throughout the country.
Cervical cancer prevention in Tanzania: Health services and health policy influences on a preventable cancer
(Research gate, 2010) Semali, Innocent A.
Background: Cervical cancer is the leading cause of cancer death among women in Tanzania. Fewer than 20% of women in Tanzania present for care when cervical cancer disease is in its early, preventable stages. Development of structural factors related to health policy and health services may alleviate disease mortality and morbidity. Methods: Fifty stakeholders from government, nongovernmental, and healthcare organizations including the Tanzanian Ministry of Health (MOH) completed semi-structured face-to-face interviews to determine existing health services for cervical cancer, and capacity for implementation of a community-based program to promote screenings. Each interview lasted approximately two hours and was comprised of individuals and teams of stakeholders. Qualitative data analyses were performed using NVivo software. Results: Qualitative themes were related to political will, health services infrastructure, and partnership building. Political will and public/private collaboration exists for the development of a program to facilitate screenings for cervical cancer. The MOH committed to improve health services by increasing capacity for cervical cancer screen and treat protocols. Additionally, a public/private team will develop a strategic plan for cervical cancer control and prevention to define specific health policies and screening recommendations. Conclusion: Increasing the capacity for cervical cancer screenings will improve reproductive health services for women. Additionally, the development of cervical cancer screening policies may decrease deaths and presentation of late stage disease. Cervical cancer prevention is a public health imperative for women in low resource settings. It is a preventable cancer and therefore a major social justice issue affecting women, their families and communities.
Cholera outbreak in Homa Bay County, Kenya, 2015
(The Pan African medical journal, 2015) Semali, Innocent A.
Cholera is among the re-emerging diseases in Kenya. Beginning in December 2014, a persistent outbreak occurred involving 29 out of the 47 countries. Homa Bay County in Western Kenya was among the first counties to report cholera cases from January to April 2015. This case study is based on an outbreak investigation conducted by FELTP residents in Homa Bay County in February 2015. It simulates an outbreak investigation including laboratory confirmation, active case finding, descriptive epidemiology and implementation of control measures. This case study is designed for the training of basic level field epidemiology trainees or any other health care workers working in public health-related fields. It can be administered in 2-3 hours. Used as adjunct training material, the case study provides the trainees with competencies in investigating an outbreak in preparation for the actual real-life experience of such outbreaks.
Community vaccine perceptions and its role on vaccination uptake among children aged 12-23 months in the Ileje District, Tanzania: a cross section study
(The Pan African medical journal, 2016) Semali, Innocent A.
Introduction: Underutilization of vaccines still remains a challenge in many regions across the world. Ileje district is one of the districts in Tanzania with consistently low pentavalent vaccine uptake (69%) and with drop out of 15%. We determined the vaccination completion with regard to Oral Polio virus, Measles, Bacillus Calmette-Guérin, and pentavalent vaccines and its association with community perceptions on vaccines. Methods: We conducted a cross sectional study in Ileje district from October to December 2013. We sampled 380 mothers using a multistage random sampling technique. We analysed data using EPI INFO. We summarized descriptive variables using mean and standard deviation and categorical variables using proportions. We conducted bivariate and multivariate logistic regression to identify factors influencing vaccination uptake, statistical significance was assessed at 95% confidence interval. Results: Mean age of the mothers was 27 years (SD 6.5 years) while that of their children was 16 months (SD 3.6 months). Fully vaccinated children were 71.1% and partially vaccinated were 28.9%, 99.2% were vaccinated with BCG vaccine and 73.4% were vaccinated with all OPV vaccine. Predictors of vaccination completion included negative perception on the vaccine provider-client relationship (AOR 1.86, 95%CI1.03-3.35), Perceived satisfaction with vaccination services (AOR 2.63, 95%CI 1.1 - 6.3). Others include child being born in the health facility (AOR 13.8 95% CI 8.04-25.8) and younger age of a child (AOR 0.51, 95%CI 0.29-0.9). Conclusion: improving quality of vaccination services, promoting health education and sensitizing community on health facility delivery will improve child vaccination completion in the district
Complications of ventriculoperitoneal shunts in children in Dar es Salaam
(East and Central African Journal of Surgery, 2005) Semali, Innocent A.
Background: From the few reports available, VP shunt surgery in sub- Saharan Africa is associated with significant complications. This study was aimed at establishing the pattern, causes and frequency of complications of VPS in Tanzania. Methods: Sixty five of the 102 children with hydrocephalus treated with ventriculoperitoneal shunts between January 1996 and January 1999 were studied prospectively. The first follow-up was at 2 weeks postoperative when the wounds were evaluated and occipitofrontal circumference measured. Further follow-ups were at 4 weeks and at three months. Collaborating staff of the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) thereafter regularly followed up the children at home. Results: The male to female ratio was 1.8 to 1. Forty-seven of the children (72%) were less than 12 months old but no patient was under 1 month of age at operation. The mean occipitofrontal circumference was 50.7cm. Shunt blockage was the commonest complication (32.3%) followed by infection (24.6%). The combined complication rate of shunt infection and wound infection was 46.1%. Shunt-related mortality was 13 (20.0%). There was no statistically significant correlation between the occipitofrontal circumference and type of complication or mortality. The mean age among the patients showing disconnection was 21.3 months compared to a mean age of 8.1 months for those not having this complication (P-value=0.04) Conclusion: The complication rates were higher than those in Western series but compared well with findings from sub Saharan Africa other studies.
Controlling pesticide poisoning at community level in Lake Eyasi Basin, Karatu District, Tanzania
(European Journal of Oncology, 2011) Semali, Innocent A.
Efforts to increase food production and bring about economic empowerment should not adversely affect public health and the environment. Strategies geared towards increasing farmers’ capacity to farm sustainably and productively can greatly enhance both public health and profits. In rural communities in Tanzania, poor pesticide management and hazardous practices are common due to a lack of capacity, economic empowerment, and untrained and uninformed farmers. To improve the health of the Lake Eyasi Basin community, we embarked on a project that aimed at empowering farmers to monitor pesticides health impacts on themselves and the community in general through a community-based surveillance and make decisions that will contribute to the sustainable reduction of the risks of pesticides. The outcome of a three months implementation (April – June 2010) of the project will be shared in this paper.
Decentralizing EPI Services and Prospects for Increasing Coverage: The Case of Tanzania
(The International journal of health planning and management, 2005) Semali, Innocent A.
Primary health Care (PHC) strategies were adopted widely in 1978 after the Alma Ata declaration to improve accessibility to health services and the health of the people. Of the strategies of PHC was the decentralization of health services to lower levels in order to enhance participation and responsiveness of the health system to local problems. While PHC was being promoted vertical programmes such as the expanded programme on immunization (EPI) were also being promoted and achieved substantial benefits. However, almost 25 years later many countries have not been able to achieve these health goals. This study addressed the question: Can we make the process of health care decentralization more likely to support health system and EPI goals? This study analysed the experience of EPI decentralization at national, regional and district levels. Several stakeholders were identified who were supportive and others who were non‐supportive of the process. Community support to EPI measured by using willingness to pay (WTP) for kerosene (to keep vaccines cool) was low. It was significantly (p < 0.05) associated with whether providers in the nearest health facility properly attended the target population and whether the providers in the facility were available when needed. There was a substantial stakeholder support and opposition to the process of decentralization at the district level. Community support was not high possibly due to the perceived non‐availability of the service providers and their lack of awareness of the population they serve. It was proposed that reforms should give priority to the involvement of communities and peripheral health facility providers in the process. Copyright © 2005 John Wiley & Sons, Ltd.
Decolonizing global health education rethinking institutional partnerships and approaches
(Academic Medicine, 2021) Semali, Innocent A.
Global health often entails partnerships between institutions in low- and middle-income countries (LMICs) that were previously colonized and high-income countries (HICs) that were colonizers. Little attention has been paid to the legacy of former colonial relationships and the influence they have on global health initiatives. There have been recent calls for the decolonization of global health education and the re-examination of assumptions and practices underpinning global health partnerships. Medicine’s role in colonialism cannot be ignored and requires critical review. There is a growing awareness of how knowledge generated in HICs defines practices and informs thinking to the detriment of knowledge systems in LMICs countries. Additionally, research partnerships often benefit the better resourced partner. In this article, the authors offer a brief analysis of the intersections between colonialism, medicine, and global health education and explore the lingering impact of colonialist legacies on current global health programs and partnerships. They describe how “decolonized” perspectives have not gained sufficient traction and how inequitable power dynamics and neocolonialist assumptions continue to dominate. They discuss 5 approaches, and highlight resources, that challenge colonial paradigms in the global health arena. Furthermore, they argue for the inclusion of more transformative learning approaches to promote change in attitudes and practice. They call for critical reflection and concomitant action to shift colonial paradigms toward more equitable partnerships in global education.
Deprivation and the equitable allocation of health care resources to decentralized districts in Tanzania.
(Elimu Tiba Tafiti, 2005) Semali, Innocent A.
There is growing concern internationally that limited public sector resources for health care should be allocated equitably. But how can this be done? Resources can be allocated equitably by using a resource allocation formula that includes measures of the relative need for health services in individual geographic areas (such as districts) in a particular country. One indicator of need that is receiving increased attention is deprivation. This study estimated deprivation levels in each district using data from the 2000 Census. Deprivation in Tanzania was found to be largely related to three factors: • the percentage of households without a toilet; • the percentage of children not enrolled in primary school; and • the percentage of the population that is illiterate. There is a marked variation in deprivation between various districts in Tanzania. Tanzania recently adopted a needs-based formula, which includes a poverty measure, to allocate resources to districts. This paper presents an analysis of the allocation of health care resources in Tanzania. It is part of a series of studies undertaken in different African countries under the auspices of the theme work on fair financing in the regional network for Equity in Health in east and southern Africa (EQUINET. More extensive details on needs-based resource allocation formulae, deprivation and the methods used in these studies can be found in McIntyre et al. (2000), also available on the EQUINET website www.equinetafrica.org. This paper analyses equity in current resource allocation in Tanzania, and compares these allocations to equity target allocations, using an index of deprivation. The results revealed that districts currently receiving relatively high allocations according the current poverty-based formula would receive slightly lower budgets if the deprivation index was used in the resource allocation formula. Those with very low allocations would receive slightly more if the deprivation index was used to guide resource allocation. However, the resource allocation differences between the poverty-based and deprivation-based formulae were small. This suggests that Tanzania has already made good progress in addressing equity in resource allocation between districts
Developing political will and building partnerships to support a community-based health promotion program for breast and cervical cancer control and prevention in Dar Es Salaam, Tanzania
(ResearchGate, 2010) Semali, Innocent A.
Abstract Background: Tanzania has one the highest age-adjusted incidence rates of cervical cancer. The incidence of breast cancer is increasing although somewhat hard to estimate since there is no population level cancer registry. There is a paucity of research regarding population level scale up of breast and cervical cancer prevention in Tanzania. Methods: Data for this cross-sectional qualitative study included face-to-face interviews and a focus group discussion. Nineteen stakeholders from the Tanzanian Ministry of Health completed interviews. The Community Health Management Team of the Kinondoni District participated in a focus group discussion (n=10). Both face-to-face interviews and the focus group discussion were conducted to determine political will and feasibility of developing a community-based breast and cervical cancer control and prevention program. Results: Qualitative themes elucidated political will for the development of a community-based cervical cancer program, the need to improve health infrastructure and capacity to promote screening and treatment protocols, and development of public/private partnerships for cancer control. Stakeholders expressed a need to focus on cervical cancer prevention due to the high disease burden, the existing treatment capacity, and lack of pathologist and access to mammography. Conclusions: There is political will and strong support for public/private partnerships to develop a community-based pilot program for cervical cancer control and prevention. However, the immediate priority is on the health services infrastructure. Population level scale up of screen and treat protocols in Dar Es Salaam are limited at this timepilot programs may provide an alternative approach and help increase capacity for services.
Equity and utilization of preventive health care service. the case of immunization comletion among children 12-23 months in Kagera region Tanzania.
(East African journal of public health, 2009) Semali, Innocent A.
Objective: The aim of this study was to determine factors associated with completion of immunization as an input in to strategies to raise the immunization coverage in Tanzania. Methods: This study used a panel data collected over four survey rounds at a minimum of six months apart to determine the causes of failure to complete immunization in Tanzania. The data were collected during between 1991 and 1994 in Kagera region Tanzania among children 12-23 months old. Data analysis was done using Statistical Analysis Software (SAS) version 9.1. Pooled logistic regression was used to determine the likelihood odds ratio of completing immunization. Results: The study observed 550 children contributing 1541 children observation rounds across all panels. Immunization coverage was 87.7 percent and factors that significantly (p<0.05) increasing completion of immunization were having more than three under five children, high mother's education, being urban, road passable through out the year and high economic status. If head of household was a female compared to male it significantly reduced the odds of completing immunization. Conclusions: Strategies to improve immunization coverage have to give priority to households headed by a female, poor and those with poor access to health care. Copyright of East African Journal of Public Health is the property of East African Public Health Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. For access to this entire article and additional high quality information, please check with your college/university library, local public library, or affiliated institution.
Equity in health sector sesponses to HIV/AIDS in Tanzania
(EQUINET Discussion Paper, 2003) Semali, Innocent A.
This paper presents an analysis of the manner in which economic and health inequalities in Tanzania influence equity in access to health care and responses to HIV/AIDS. It is estimated that globally there are 42 million people suffering from AIDS of whom 29.4 million are found in Sub- Saharan Africa. HIV/AIDS was first described in 1983 in Tanzania, and has since spread dramatically. The prevalence in Tanzania has been found to vary between 1.6% of the population in rural areas to 28.6% in urban areas. HIV/AIDS has had an impact on all sectors of the society. It has been the leading cause of adult death with a proportional mortality ratio from AIDS ranging from 30.2 percent to 44.5 percent. The number of tuberculosis patients has increased substantially. The morbidity and mortality from AIDS has negatively affected schooling, agricultural and economic sectors in Tanzania. Industrialized countries have been able to use their ample resources to control and treat HIV/AIDS. However the overwhelming poverty in Sub-Saharan Africa countries has left a massive social deficit that has undermined efforts to manage the AIDS epidemic. Hence even while the United Nations has made a global commitment to the Millennium Development Goals (MDG), including addressing HIV/AIDS and poverty, the poverty burden and weakness on economic and social institutions threatens the achievement of these goals. Like other developing countries with high HIV/AIDS burdens, Tanzania faces significant challenges in meeting its UNGASS commitments on the goals. The paper explores these challenges and the responses to them. The paper draws from secondary data sources and interviews. The evidence indicates that poor economic performance in Tanzania has compromised its ability to address HIV/AIDS. While the most critical constraint is an absolute shortfall of resources, there are several equity issues that arise within the health sector. Within Tanzania, there is a significant variation in resource availability for health by geographical area. The health service referral system has performed poorly, leaving the primary health care services poorly supported and financed, even though these are the services most relevant to support of community prevention Home Based Care (HBC) initiatives. Government and Donors have made efforts to increase financial resources to these levels, but this is threatened by capacity shortfalls at district level, in both human and material resources. At the same time the clients to lack the information and means to make more effective use of services. Such factors threaten equity in access to new antiretroviral treatments for HIV/AIDS and the implementation of HIV/AIDS control activities, despite political commitments and the comprehensive policy intentions. Strategies are needed to address these equity gaps. Such strategies should address the absolute and relative resource shortfalls to rural areas, to certain districts and to district and primary care levels of health systems. Health sector reforms that have placed significant emphasis on district roles and powers, need to also address the capacities to 4use these roles and thus to ensure equitable access to ART. Financing reforms and new funding mechanisms need to ensure that they provide for the risk pooling and comprehensive cover that is needed if health services are to reach poor people as a vehicle for equitable access to ART. There are lessons from experience in Tanzania for new programmes, including for the Global Health Fund. The experience of donor participation in primary health care indicates that while donor funds can provide necessary resources, specific attention needs to be paid to measures for ensuring integration into national health systems and for ensuring the sustainability and continuity of those programmes supported by donor funding. This demands an increased share of financing from government funds and greater attention to supporting overall health systems capacities within specific programmes.
Factors affecting the utilisation of improved ventilated latrines among communities in Mtwara Rural District, Tanzania
(The Pan African medical journal, 2012) Semali, Innocent A.
Introduction The Tanzania government, working in partnership with other stakeholders implemented a community-based project aimed at increasing access to clean and safe water basic sanitation and promotion of personal hygiene in Mtwara Rural District. Mid-term evaluation revealed that progress had been made towards improved ventilated latrines; however, there was no adequate information on utilisation of these latrines and associated factors. This study was therefore conducted to establish the factors influencing the utilisation of these latrines. Methods A cross-sectional study was conducted among 375 randomly selected households using a pre-tested questionnaire to determine whether the households owned improved ventilated latrines and how they utilised them. Resuls About half (50.5%) of the households had an improved ventilated latrine and households with earnings of more than 50,000 Tanzanian Shillings were two times more likely to own an improved latrine than those that earned less (AOR 2.1, 95% CI=1.1-4.0, p= 0.034). The likelihood of owning an improved latrine was reduced by more than 60 percent for female-headed households (AOR=0.38; 95% CI=0.20-0.71; p=0.002). Furthermore, it was established that all members of a household were more likely to use a latrine if it was an improved ventilated latrine (AOR=2.4; 95% CI=1.1-5.1; p= 0.024). Conclusion Findings suggest adoption of strategies to improve the wellbeing of households and deploying those who had acquired improved ventilated latrines as resource persons to help train others. Furthermore, efforts are needed to increase access to soft loans for disadvantaged members and increasing community participation
Factors associated with HIV testing and receiving results during antenatal care in Tanzania
(African Population Studies, 2014) Semali, Innocent A.
Mother to child transmission of HIV (MTCT) control goal is achievable when all pregnant mothers test for HIV and collect the results enabling timely eligibility and access to anti-retroviral therapy (ART). This study aimed to determine factors associated with uptake of HIV testing during antenatal care in Tanzania. Using 2011-2012 Tanzania HIV and Malaria Indicator Survey data, 3555 women who attended antenatal clinic and delivered in the last two years were analyzed. One was considered HIV tested if she took HIV test and collected results. Bivariate and multivariate analysis was done using STATA version 12. High proportion (76%) tested for HIV during antenatal care, factors significantly associated (p<0.05) with testing included receiving information on HIV testing during antenatal care, age, education and wealth. Proportion taking HIV test was high, prevention of MTCT (PMTCT) strategies should focus on increasing information on testing during antenatal care (ANC), targeting the young, less educated and poor.
Factors influencing utilisation of cervical cancer screening services among HIV positive women attending care and treatment centres in Kinondoni municipality, Dar es Salaam, Tanzania
(African Health Sciences, 2024-07-11) Mashalla, Yohana J.; Kabalimu, Titus K.; Semali, Innocent A.
Background: Cervical cancer is among the leading causes of cancer-related deaths among HIV+ve women. Objective: To determine factors influencing utilisation of cervical cancer screening among HIV+ve women attending Cancer Treatment and Care in Kinondoni Municipality, Dar es Salaam. Methods: Cross-sectional study among HIV+ve women was carried out between September and October 2021; collected using a standardised questionnaire. Descriptive statistics, bivariate and multivariate analyses were used to determine cervical cancer extent and association of predictors of cervical cancer screening. Results: 230 HIV+ve women aged 21–60 years were interviewed. Only 47% had screened for cervical cancer. Low knowledge of HIV+ve as risk significantly associated with less likelihood to screen for cervical cancer [AOR 0.49, 95% CI (0.253-0.957, P = 0.037)]. Parity of 3 or more was twice likely to screen for cervical cancer [AOR 2.124, 95% CI (1.012-4.456, P = 0.046)]; and housewives were 2.5 more likely to screen for cervical cancer [AOR 2.594, 95% CI (1.149-5.853, P = 0.002)]. Lack of knowledge on preventive measures was less associated with likelihood to screen [AOR 0.114, 95% CI (0.013-0.972, P = 0.047)]. Conclusion: Lack of knowledge on HIV+ve and prevention, age and parity are likely to influence utilisation of cervical cancer screening services.
Food insecurity and coping strategies among people living with HIV in Dar es Salaam, Tanzania
(Tanzania Journal of Health Research, 2011) Semali, Innocent A.
Food insecurity and malnutrition seriously impedes efforts to control HIV/AIDS in resource poor countries. This study was carried out to assess food security, and coping strategies among people living with HIV/AIDS (PLHIV) attending Care and Treatment Centre (CTC) in Dar es Salaam, Tanzania. A structured questionnaire was used to interview randomly selected adults (≥18 years) who were HIV positive who have just been eligible for anti-retroviral treatment (ART) in a CTC or one who has started ART but not more than four weeks has elapsed. A total of 446 (females=67.9%; males= 32.1%) people living with HIV/AIDS attending CTC were interviewed. About three quarters (73.1%) of the respondents were 25-44 years old and most (43.9%) were married. Two thirds (66.7%) of the respondents had primary school education. Seventy percent reported to have a regular income and 63.7% with a monthly income of less than US$ 154. More than half (52.2%) of the respondents were food insecure. Food insecurity was similar in both males (54.6%) and females (51.2%). However, food insecurity was least (48.2%) among those who were single and highest (57.7%) among those cohabiting. Low level of food insecurity was associated with having completed primary education (Adjusted OR=0.27; 95%CI, 0.09–0.82) and high income (>US$154) (OR=0.10; 95%CI, 0.01–0.67). Reporting two or less meals increased the likelihood of food insecurity (OR=4.2; 95% CI1.7-9.8). Low frequency of meals was significantly more prevalent (18.6%) among those ≥45 years than among 35–44 years old respondents (6.7%) (P=0.04). Borrowing money (55.8%) and taking less preferred foods (53.3%) were the most common coping strategies. In conclusion, food insecurity is a significant problem among people living with HIV in Dar es Salaam which might significantly affect compliance to care and support. The study suggests that counselling of PLHIV before anti-retroviral treatment programmes should devise special strategies targeting those with low education, low income and low frequency of meals.
Health reform cycles in Tanzania: 1924–1994
(Tanzania Journal of Development Studies, 2007) Semali, Innocent A.
This paper analyses health reforms in Tanzania since 1924 to 1993 to determine how each paradigm influenced the next by using the recent World Health Organization (WHO) framework of health system. Published and gray documents were reviewed and analyzed for the four discrete attempts at reforming the health sector, focusing on the district health system decentralization. The findings revealed that for each wave, there was a review of the health system, making information from preceding efforts to be available to the subsequent reforms. After independence the political party in power played a major role in ensuring availability of information and its utilization. Predominant information in each wave showed that the health system was underfinanced, there was poor performance of PHC strategies, non-integration of DMO and poor health workers income. Health reforms should focus on health system finance, integrated district health system, health workers welfare and community participation.
Health sector reform and decentralization in Tanzania: the case of the expanded programme on immunization at district level
(World Health Population, 2005) Semali, Innocent A.
What was the immediate stakeholders’ response to decentralization of Expanded Program on Immunization at district level in Tanzania? Analysis of quantitative and qualitative data from a range of stakeholders was done. The immediate response included reduced cooperation, delayed financial disbursement, reduced supervisions and low EPI coverage (52.8 percent). It was concluded that there was a need to increase awareness of decentralization and management capacity at district level tofacilitate positive alignment of the stakeholders.
Health sector reforms and decentralization in Tanzania: the case of expanded program on immunization at national level
(East African journal of public health, 2004) Semali, Innocent A.
Following successful establishment of Expanded Program on Immunization (EPI) in the 1970's as vertical program, the burden of disease for many of the vaccine preventable diseases was pushed to low levels. The current round of health reforms in Tanzania calls for decentralization and integration of vertical programs. This has the potential to assist or erode generally good performance of EPI. Reforms on the programme have been undertaken in Tanzania since 1996, and have included 1) integration of the procurement, storage, and distribution of vaccine and related equipment into the operations of a quasi-autonomous drug procurement agency. 2) government financing of procurement of the oral polio vaccine, cold chain kerosene, and 3) the integration of kerosene and vaccine distribution, supervision and monitoring to district health system. Our analysis shows that the integration of the procurement and distribution of vaccines into the operations of the drug procurement agency, and privatization of the distribution of the cold chain kerosene initially stalled EPI reforms for several reasons and had an adverse effect on EPI decentralization and coverage. The major cause of the problems was opposition from the EPI providers at district level who had to accept decreased income consequent to the reforms. We conclude that greater involvement of all stakeholders in the planning of the programme, would have presented an opportunity for forecasting the opposition and developing mitigating strategies.

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