BackgroundTanzania is experiencing acute shortages of Health Workers (HWs), a situation which has forced health managers, especially in the underserved districts, to hastily cope with health workers’ shortages by adopting task shifting. This has however been due to limited options for dealing with the crisis of health personnel. There are on-going discussions in the country on whether to scale up task shifting as one of the strategies for addressing health personnel crisis. However, these discussions are not backed up by rigorous scientific evidence. The aim of this paper is two-fold. Firstly, to describe the current situation of implementing task shifting in the context of acute shortages of health workers and, secondly, to provide a descriptive account of the potential opportunities or benefits and the likely challenges which might ensue as a result of implementing task shifting.MethodsWe employed in-depth interviews with informants at the district level and supplemented the information with additional interviews with informants at the national level. Interviews focussed on the informants’ practical experiences of implementing task shifting in their respective health facilities (district level) and their opinions regarding opportunities and challenges which might be associated with implementation of task shifting practices. At the national level, the main focus was on policy issues related to management of health personnel in the context of implementation of task shifting, in addition to seeking their opinions and perceptions regarding opportunities and challenges of implementing task shifting if formally adopted.ResultsTask shifting has been in practice for many years in Tanzania and has been perceived as an inevitable coping mechanism due to limited options for addressing health personnel shortages in the country. Majority of informants had the concern that quality of services is likely to be affected if appropriate policy infrastructures are not in place before formalising tasks shifting. There was also a perception that implementation of task shifting has ensured access to services especially in underserved remote areas. Professional discontent and challenges related to the management of health personnel policies were also perceived as important issues to consider when implementing task shifting practices. Additional resources for additional training and supervisory tasks were also considered important in the implementation of task shifting in order to make it deliver much the same way as it is for conventional modalities of delivering care.ConclusionsTask shifting implementation occurs as an ad hoc coping mechanism to the existing shortages of health workers in many undeserved areas of the country, not just in the study site whose findings are reported in this paper. It is recommended that the most important thing to do now is not to determine whether task shifting is possible or effective but to define the limits of task shifting so as to reach a consensus on where it can have the strongest and most susta...

Abstract:In Tanzania, reproductive health and HIV services are coordinated by the Ministry of Health and Social Welfare in two separate units namely Reproductive and Child Health Section and the National AIDS Control Programme. The importance of integrating the two services that are vertically run is expected to improve access to and uptake of key essential services and extend coverage to underserved and vulnerable populations and thus minimizing missed opportunities. Experts around the world recognize the central role of Sexual and Reproductive Health (SRH) services in preventing HIV infection. Evidence suggests that improving access to contraception for women to prevent pregnancy is an important and cost-effective way to prevent HIV-positive births. Integrating SRH and HIV services therefore verifies its importance for improving maternal and child health as well as leading to prevention of HIV infection. The primary objective of this review was to gain an understanding of the current linkages between SRH and HIV within Tanzania's policies, programmes, systems and services. Policy documents, guidelines, national laws, and published reports on SRH and HIV were reviewed. The majority of the reviewed documents mentioned fundamentals of integration between SRH and HIV. Majority of policies and guidelines both in family planning (FP) and HIV documents mandate bi-directional linkages. This review suggests that there are linkages between the two services and can be operationalised together. However, policies and guidelines only specify services to be integrated without due consideration of resources and structural orientation for linked services._____________________________________________________________________________

HIV/AIDS-related stigma, and its associated discrimination, is known to negatively affect all aspects of HIV prevention, care and treatment. Studies have revealed the extent to which individuals are stigmatized and discriminated against the health care system. However, there has been limited information on stigma manifestations and reduction interventions. The main objective of the study was to determine the magnitude and factors influencing HIV/AIDS-related stigma and discrimination with a specific focus on the manifestations and reduction interventions. In-depth interviews, exit interviews and focus group discussions were deployed in the study. Results have shown that HIV/AIDS is increasingly conceptualized as a continuum between prevention and care, effects of stigma and discrimination are from both health facilities and communities. While religious leaders isolate people living with HIV/AIDS (PLWHAs) and consider them as most promiscuous, health workers also have strong negative attitudes and feelings and as a result PLWHAs refrain from counselling and testing services. A stigmatizing social environment was found to pose barriers to all strategies and/or interventions that are aimed at reducing this situation. Because of stigma and discrimination, people living with HIV/AIDS receive inadequate treatment, as such they decline to divulge their status to partners or change their behaviour avoiding depressing reactions. Basing on that therefore, adequate outreach services at both community and health facility levels be established and line up in the fight against stigma and discrimination facing people living with HIV/AIDS.

Background: Insecticide-treated nets (ITNs) are highly effective in reducing morbidity and mortality from malaria. However, it is widely accepted that ITNsif not re-treatedlose their effectiveness with time and eventually need to be replaced. This study sought to determine the social, ethical, and cultural issues related to the lifecycle of ITNs, which includes net ownership, usage, maintenance, reuse, recycling, disposal, and replacement. Methods: In this qualitative study, conducted in the districts of Mtwara Rural, Kilombero, and Muheza, Tanzania, we collected information about bed nets, including usage habits, types, treatment status, materials used, brands, acquisition sources, and perceptions thereof. We conducted 23 key informant interviews and 20 focus group discussions with village leaders, other influential people in the community, and district health-care personnel. Results: ITNs were deemed acceptable and used by most community members in the participating communities. Alternative uses and disposal practices of used bed nets were also common among community members; however, participants had limited knowledge regarding the health and environmental risks associated with these practices. Most participants did not perceive bed net recycling as a sustainable option. Recycling was considered feasible, however, if effective infrastructure for collection and disposal could be established. Poverty was identified as a major driving force towards alternative uses of bed nets. Financial constraints also meant that not all household members were able to sleep under bed nets; pregnant mothers, children under 5 years old, and the elderly were prioritised. Conclusion: Our findings may inform the National Malaria Control Programme and other stakeholders as they develop country-specific and environmentally friendly bed net replacement strategies. Appropriate strategies will help ensure sustained protection of vulnerable populations against malaria, while considering local social, ethical, and cultural issues related to the recovery of bed nets. Insecticide-Treated Net Lifecycle Management in Tanzania www.eahealth.org

Background: Despite the ongoing efforts to promote HIV testing, the majority of adults in Tanzania remain untested, and many remain unwilling to know their HIV status. Understanding the underlying reasons for this unwillingness to test and know one's status will support the development of targeted interventions to promote the uptake of HIV testing. This paper explores the willingness of and barriers faced by self-perceived healthy individuals to test for HIV in selected districts of Tanzania. Methods: A cross-sectional survey was conducted in urban and rural wards between October 2011 and March 2012. Structured questionnaires with closed-and open-ended questions were administered to heads of randomly selected households. Information collected included socioeconomic, demographics, rural/urban backgrounds and the perceived reasons which hinder household heads/members to access and utilise HIV-testing services. Regression analysis was conducted to assess the relationship between the same factors and participants' willingness to go for an HIV test in the near future. Results: There were 1,429 respondents from randomly selected households interviewed, and out of these, 57.1% were women, and 42.9% were men. The mean age of all respondents was 33.6 years; men were slightly older (mean age, 37 years) than women (mean age, 34 years). Almost one-third (n=433, 30.3%) of the respondents reported having ever tested for HIV, of whom 294 (61.8%) were women, and 139 (38.2%) were men. Being educated to at least the primary school level, being an urban resident, and being female increased the probability of HIV testing by 1.7% (P<.001), 1.3% (P<.005) and 0.2% (P<.005) respectively. Further, for each year, one's age increased the probability of positive future intentions to test for HIV increased by 0.4 % (P<.005). Education, residence and marital status were not significantly associated with future willingness to test. Fear of being stigmatised and discriminated was observed to be one of the important barriers for HIV testing among those who had never tested and those who were unwilling to test in the future. Conclusion: In urban areas, knowledge of the benefits of HIV testing is higher than in rural areas. Overall stigma remains the most salient barrier to HIV testing and interventions that address this, and other structural drivers for stigma need to be addressed in order for people's willingness to test to increase. Finally, health systems need to be strengthened to further encourage testing and be ready to provide quality and non-discriminatory services once people's willingness to test becomes apparent.