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Does health insurance contribute to improving responsiveness of the health system?: The case of elderly in rural Tanzania
(Umeå University, 2022) Amani, Paul Joseph
Background: Financing healthcare in Tanzania has for years depended on out-of-pocket payments. This mechanism has been criticized as being inefficient, contributing to inequity and high cost as well as denying access to healthcare to those most in need, including the elderly in rural areas. Health insurance (HI) was recently introduced as an instrument to enable equitable access to healthcare and thus to improve the responsiveness of the health system. Even though health insurance is expected to bring benefits to those who are insured, there is a lack of specific studies in the country looking at the role of HI in facilitating the health system responsiveness among vulnerable populations of remote areas.
Aim: The aim of this thesis is to understand if and how health insurance contributes to improving the responsiveness of the healthcare system among the elderly in rural Tanzania.
Methods: Four interrelated sub-studies (2 quantitative and 2 qualitative) were conducted in Igunga and Nzega districts of Tabora region between July 2017 and December 2018. The first two sub-studies are based on a household survey using an adapted version of the World Health Organization’s Study on Global Ageing and Adult Health questionnaire. Elderly people aged 60 years and above who had used both outpatient and inpatient healthcare three and twelve months prior to the study, respectively, were interviewed. Whereas in sub-study 1 the focus was to investigate the role of health insurance status on facilitating access to healthcare, sub-study 2 assessed the relationship between health insurance and the health system responsiveness domains. In sub-study 3, interviews with healthcare providers were carried out to capture their perspective regarding the functioning of the health insurance. In the final sub-study 4, focus group discussions with elderly were conducted in order to explore their experience of healthcare, depending on their health insurance status. Crude and adjusted logistic and quantile regression models were applied to analyse the association between health insurance and access to healthcare (sub-study 1) and responsiveness (sub-study 2), respectively. For both sub-studies 3 and 4, qualitative content analysis was used to analyse the data.
Results: Sub-studies 1 and 2 involved a total of 1899 insured and uninsured elderly, while sub-studies 3 and 4 included 8 health providers and 78 elderlies respectively. Sub-study 1 showed that about 45% of the elderly were insured and HI ownership improved access and utilization of healthcare, both outpatient and inpatient services. In sub-study two, however, health insurance was associated with a lower responsiveness of the healthcare system. In general, all six domains: cleanliness, access, confidentiality, autonomy, communication, and prompt attention were rated high, but three were of concern: waiting time; cleanliness; and communication. Sub-study 3 uncovered several challenges coexisting alongside the provision of insurance benefits and thus contributing to a lower responsiveness. These included shortage of human resources and medical supplies, as well as operational issues related to delays in funding reimbursement. In sub-study 4, the elderly revealed that HI did not meet their expectations, it failed to promote equitable access, provided limited-service benefits and restricted use of services within residential areas.
Conclusion: While HI seems to increase the access to and use of healthcare services by the elderly in rural Tanzania, a lower responsiveness by the healthcare system among the insured elderly was reported. Long waiting times, limited-service benefits, restricted use of services within schemes, lack of health workforce in both numbers and skills as well as shortage of medical supplies were important explanations for the lower responsiveness. The results of this thesis, while supporting the national aim of expanding HI in rural areas, also exposed several weaknesses that require immediate attention. There is a need to, first, review the insurance policy to improve its implementation, expand the scope of services coverage, and where possible, to introduce cross-subsidization between the publicly owned schemes; additionally, improvements in the healthcare infrastructure, increasing the number of qualified health workforce and the availability of essential medicines and laboratory services, especially at the primary healthcare facilities, should be prioritized and further investments allocated.
The roles of tourism industry in socio-economic development of Zanzibar : A case study of Zanzibar town
(Mzumbe University, 2016) Moh’d, Issa S.
This study was done to examine the roles of tourism industry in socio-economic development of Zanzibar. Specifically, the study sought to identify contribution of tourism industry in socio-economic development of Zanzibar, to examine the strategies set by tourism stakeholders in promoting tourism industry in Zanzibar and to identify challenges of tourism industry in Zanzibar. The methods employed to obtain relevant information in this study were questionnaire, interview and documentary review. Before data collection took place, those primary tools (questionnaire and interview guide) were prepared and pilot tested for improving to get valid and reliable data. The qualitative data were analysed by using three qualitative techniques; these were comparison of data between sampling units, pattern matching of data and by using strong explanation building as proposed by Yin (1994). The quantitative data were analysed through tabulation, percentage and frequencies by the help of Microsoft excel. The result showed that the majority of the respondents agreed that tourism industry has great contribution to the socio-economic development of Zanzibar. These contributions include the following; generates employment opportunity, sources of income and foreign currency, expansion of market for small business and traditional goods, enabling understanding of different foreign languages, as well as encouraging intermarriages between locals and foreigners (tourists). Moreover, maintenance of cultural identity, environmental conservation and sanitation as well as promotion of interaction and hospitality are strategies set by tourism stakeholders in promoting tourism industry in Zanzibar. Furthermore, findings indicate that tourism industry in Zanzibar is faced by a lot of challenges that hinder the development of tourism industry in Zanzibar also the socio-economic development of Zanzibar. These include encroachment by foreigners, bureaucracy, political instability and presence of insecurity events. The study recommends that the government should use these set strategies properly to improve the tourism industry in Zanzibar. Also, all stakeholders must come together to perform their responsibilities to implement set strategies for promoting tourism industry in Zanzibar.
Factors influencing marketing of vegetables among small holder farmers: A study of tomato value chain in Ruvu Kibaha District
(Mzumbe University, 2020) Fredrick, Oliver
This study intended to look into factors influencing marketing of vegetables, looking into tomato value chain specifically to small holder farmers located at Ruvu Chini at Kibaha District council. The objectives were to investigating influences made by marketing information and transactional cost on the market of Tomatoes also challenges these farmers face and what is the role of government in vegetable farming. The research approach was both qualitative and quantitative. Data was collected through questionnaires and interview to a total of ninety three (93) respondents including smallholder farmer, agricultural officer and trade officers. Agricultural officers and trade officers were purposively selected while small holder farmers were conveniently selected. Data analysis was analyzed quantitatively through SPSS and qualitatively through discourse analysis. Ordinal regression was used to determine the relationship and influence of marketing information and transactional cost on ordinal outcome (vegetable marketing measured in scale of 1-3, where 1=Weak, 2=Moderate, 3= Strong) Findings revealed that, for every increase of transactional cost causes decrease in the marketing of tomatoes. Also access to market information positively influences vegetable marketing. The government main role is to enforce policies and creating good environment for farmers. However, farmers also declared that the government’s main role should be to protect smallholder farmers’ rights since the market of vegetables in Tanzania is a free market. Recommendations are that the government should enforce laws that empower small holder farmers of tomatoes like how it is done in other crops like cashew nuts and this can be done through strengthened collaboration with a public-private partnership with existing stakeholders.
The impact of composition of board of directors on organizational performance: A case of Fanikiwa Microfinance Company Limited
(Mzumbe University, 2013) Charles, Victoria
This study contributes to the literature by investigating the association between the overall performances of a microfinance institution in relation to the board structure and governance of the organization. How MFIs are governed is likely to affect their efficiency, outreach to the poor, sustainability, and impact on poverty alleviation. The research aimed at examining the extent to which board members’ influence over firms’ strategic issues mediates the effects of board composition on the performance of a microfinance institution. The study was conducted in Dar er Salaam, Tanzania. The sample of the population was 26 respondents 6 of which were directors. The study used questionnaires, interviews and documentary review. In data analysis Statistical Package for Social Sciences (SPSS) was used to analyze research findings. The researcher established that there cannot be development without proper leadership in any organisation, thus achieving the same requires a well formed and performing board of directors to form policies and strategies that determine the future of the company as well as explaining the basis of which performance and implementation can be assessed. Members of the board ought to diligently perform the roles of which they were appointed and to the best of their ability in enhancing the performance of the organization. The study recommended that the governing body of the company is a very important organ and plays a major part in enhancing the growth of the company. The same has to be empowered and encouraged in making proper decisions in the event the company and its employees are not in line with the intended company’s policies and strategies. In implementing such, proper and clear plans for the board activities should be put in place well in advance to enable the members to also plan ahead in ensuring their participation in the organization. On the same note companies need to put in place a board that is satisfactory in terms of the qualifications of the members and experience in the related field.
Factors leading imported furniture to be preferred over locally produced ones: A case of Ilala and Temeke municipal councils in Dar es salaam-Tanzania
(Mzumbe University, 2013) Chanjarika, Clement
The study to assess Factors Leading Imported Furniture to be preferred over Locally Produced Ones was conducted at Ilala and Temeke Municipal Councils in Dar Es Salaam-Tanzania. The objectives were to; compare the prices of locally produced furniture to imported ones; identify the quality in terms of durability and varieties of the local furniture and that one of imported; examine promotion and advertisement on local furniture compared to that one of imported furniture; find out the cost of timber, manufacturing power, transportation and other factors of producing furniture locally compared to the cost of importing them; explore the reasons as to why people prefer imported furniture compared to locally produced ones. A sample of 150 respondents were used, in collecting data the study used questionnaires, interview guide and observation, secondary data were also used. The study found that the high price of local furniture make them to be less preferred compared to imported ones. The cause of that high price is the high cost of raw materials such as the price of buying timber is considerably higher despite of timber to be available in Tanzania. Moreover it found that high manufacturing cost which lead to high price of the local furniture is not only caused by high cost of raw materials but also poor power supply, poor technology, poor infrastructure and unfavorable tax and levy. It also found that the quality in terms of durability of the local furniture is high compared to imported furniture, but low preference of the local furniture is due to high price, less varieties, less promotion and advertisement, unpleasant appearance and long waiting time from ordering to deliverance of the local furniture. The study recommended that; Tanzania furniture manufacturers should not seek to compete at low price while the costs of production including the cost of timber, electric power, transportation are high, they should focus on means of reducing such kind of production costs. The controlling measures/way forward and recommendations on the high local production cost (high price), less varieties, less promotion and advertisement and others are evidently exposed on the study.