Browsing by Author "Damian, Respicius Shumbusho"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Community empowerment and accountability in rural primary health care The case of Kasulu District in Tanzania
    (University of Dar es salaam, 2018) Damian, Respicius Shumbusho
    The study investigated the relationship between empowerment and community based accountability in rural primary Health Care. The focus was on empowerment attributes among community members existing legal and institutional frameworks, the management of the community health fund, and the role of health facility governance committees in kasulu district. The study employed a mixed method approach that included both quantitative and qualitative data collection and analysis methods. The study found that the majority had lower levels of empowerment (87.3 percent) and limited capability to demand and enforce accountability (73.1 percent). The feeling of having power to influence choices; trust in health workers, government officials, and community leaders: possession of skills related to finance and health care: and the capacity to obtain, analyse, and understand financial and health related information were significantly associated with the capability to enforce accountability. However, gender, education, employment status, and occupation were found to have significant influence on the variation in the capability. Married males in the young-adult age with average rural household income, employed and having higher education were more likely to have the capability to enforce accountability. Principal component analysis results revealed that building mutual trust, increasing power and confidence of community members, adequate availability and utility of relevant and simplified information, and improving skills related to financial and health service monitoring could enhance the capability to demand and enforce accountability. The findings also revealed the existence of a gap between the formal guidelines and actual operations of both the community health fund and health facility governance committees community-level participation in the community health fund is limited to mobilisation, contribution , and accessing contribution updates through notice board. Health facility governance committees have limited autonomy to make financial and purchase decisions. While the district council exercises more control over allocation and purchase decisions. Delay in decisions result in persistent stock-outs of medicine and medical items, which cause mistrust from communities and thus limit the readiness to contribute and monitor resources
  • Thumbnail Image
    Item
    Community empowerment and accountability in rural primary health care: the case of Kasulu district in Tanzania
    (University of Dar es Salaam, 2018) Damian, Respicius Shumbusho
    This study investigated the relationship between empowerment and community-based accountability in rural Primary Health Care. The focus was on empowerment attributes among community members, existing legal and institutional frameworks, the management of the Community Health Fund, and the role of Health Facility Governance Committees in Kasulu district. The study employed a mixed method approach that included both quantitative and qualitative data collection and analysis methods. The study found that the majority had lower levels of empowerment (87.3percent) and limited capability to demand and enforce accountability (73.1 percent). The feeling of having power to influence choices; trust in health workers, government officials, and community leaders; possession of skills related to finance and health care; and the capacity to obtain, analyses, and understand financial and health related information were significantly associated with the capability to enforce accountability. However, gender, education, employment status, and occupation were found to have significant influence on the variation in the capability. Married males in the young-adult age with average rural household income, employed and having higher education were more likely to have the capability to enforce accountability. Principal Component Analysis results revealed that building mutual trust, increasing power and confidence of community members, adequate availability and utility of relevant and simplified information, and improving skills related to financial and health service monitoring could enhance the capability to demand and enforce accountability. The findings also revealed the existence of a gap between the formal guidelines and actual operations of both the Community Health Fund and Health Facility Governance Committees. Community-level participation in the Community Health Fund is limited to mobilization. Contribution and accessing contribution updates through notice boards. Health Facility Governance Committees have limited autonomy to make financial and purchase decisions while the district council exercises more control over allocation and purchase decisions. Delays in decisions result in persistent stock-outs of medicine and medical items, which cause mistrust from communities and thus limit the readiness to contribute and monitor resources and service delivery. Essentially, limited confidence, legitimacy, and trust that Health Facility Governance Committees can address critical concerns of the communities undermine their efficacy as institutions for enhancing community-based accountability. The study concludes that community-based accountability interventions are more likely to be effective if they integrate promotion of agency among communities and improving the opportunity structure. Specifically, both enhancing the capacities of community-level actors to hold service providers and government officials accountable and creating institutional environments that facilitate community actors' control over the key financial and service delivery decisions and actions are imperative. Finally, a participatory approach to designing and implementing health policy interventions is critical for developing community ownership as a key prerequisite for successful community-based accountability. Among others, the study recommends strengthening capacities of community-level implementers, improving cooperation between the district council and community-level stakeholders, and interventional studies to assess the impact of trust, information, and financial skills on community-based accountability.
  • Thumbnail Image
    Item
    Community empowerment and accountability in rural primary health care: the case of Kasulu district in Tanzania.
    (University of Dar es Salaam, 2018) Damian, Respicius Shumbusho
    This study investigated the relationship between empowerment and community-based accountability in rural Primary Health Care. The focus was on empowerment attributes among community members, existing legal and institutional frameworks, the management of the Community Health Fund, and the role of Health Facility Governance Committees in Kasulu district. The study employed a mixed method approach that included both quantitative and qualitative data collection and analysis methods. The study found that the majority had lower levels of empowerment (87.3percent) and limited capability to demand and enforce accountability (73.1 percent). The feeling of having power to influence choices; trust in health workers, government officials, and community leaders; possession of skills related to finance and health care; and the capacity to obtain, analyse, and understand financial and health related information were significantly associated with the capability to enforce accountability. However, gender, education, employment status, and occupation were found to have significant influence on the variation in the capability. Married males in the young-adult age with average rural household income, employed and having higher education were more likely to have the capability to enforce accountability. Principal Component Analysis results revealed that building mutual trust, increasing power and confidence of community members, adequate availability and utility of relevant and simplified information, and improving skills related to financial and health service monitoring could enhance the capability to demand and enforce accountability. The findings also revealed the existence of a gap between the formal guidelines and actual operations of both the Community Health Fund and Health Facility Governance Committees. Community-level participation in the Community Health Fund is limited to mobilisation, contribution, and accessing contribution updates through notice boards. Health Facility Governance Committees have limited autonomy to make financial and purchase decisions while the district council exercises more control over allocation and purchase decisions. Delays in decisions result in persistent stock-outs of medicine and medical items, which cause mistrust from communities and thus limit the readiness to contribute and monitor resources and service delivery. Essentially, limited confidence, legitimacy, and trust that Health Facility Governance Committees can address critical concerns of the communities undermine their efficacy as institutions for enhancing community-based accountability. The study concludes that community-based accountability interventions are more likely to be effective if they integrate promotion of agency among communities and improving the opportunity structure. Specifically, both enhancing the capacities of community-level actors to hold service providers and government officials accountable and creating institutional environments that facilitate community actors’ control over the key financial and service delivery decisions and actions are imperative. Finally, a participatory approaches to designing and implementing health policy interventions is critical for developing community ownership as a key prerequisite for successful community-based accountability. Among others, the study recommends strengthening capacities of community-level implementers, improving cooperation between the district council and community-level stakeholders, and interventional studies to assess the impact of trust, information, and financial skills on community-based accountability.
  • No Thumbnail Available
    Item
    The paradox of voter turnout in the 2010 Tanzania general elections: a case of three constituencies
    (University of Dar es Salaam, 2012) Damian, Respicius Shumbusho
    This study examined the causes of low voter turnout in the Tanzania 2010 general elections. The focus was on the general causes of low voter turnout and the influence of voter education and voter mobilization by political parties on voter turnout. The study adopted a case study strategy where Karatu, Ubungo, and Igalula constituencies were purposely sampled. Data was generated by conducting structured interviews with 150 respondents from voters who had registered for the 2010 general elections and in-depth interviews with 32 stakeholders, including candidates, political party leaders, election officials and leaders of CSOs. The findings revealed that low voter turnout was caused by a combination of factors. These factors include voters’ concerns about economic hardship, low political efficacy among voters, the belief that individual vote can not make significant change, loss of confidence in the democratic value of elections, and the lack of significant competition within the elections. The findings also demonstrate that voter education was not effective enough in terms of influencing higher voter turnout due to the weakness in planning and implementation. The government left financing attention in hands of Development Partners. Political parties, instead of mobilizing voters to vote, concentrated on advertizing their policies and candidates as well as attacking their opponents. The role of achieving higher turnout to support them on Election Day was in most cases skipped. The study recommends that there should be a permanent government fund for voter education, a well planned and sustainable voter education programme, a review of election laws, establishment of a permanent fund for mobilizing finance for Voter Education. In addition, psephologists should conduct intensive studies on the effect of civic competency and the behavior of institutions such as political parties on voter turnout in Tanzania.