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1. Can Transparency and Accountability Programs Improve Health? Experimental Evidence from Indonesia and Tanzania

Author:
Jean Arkedis, Jessica Creighton, Archon Fung, Stephen Kosack, Dan Levy, and Courtney Tolmie
Publication Date:
05-2019
Content Type:
Working Paper
Institution:
The John F. Kennedy School of Government at Harvard University
Abstract:
We assess the impact of a transparency and accountability program designed to improve maternal and newborn health (MNH) outcomes in Indonesia and Tanzania. Co-designed with local partner organizations to be community-led and non-prescriptive, the program sought to encourage community participation to address local barriers in access to high quality care for pregnant women and infants. We evaluate the impact of this program through randomized controlled trials (RCTs), involving 100 treatment and 100 control communities in each country. We find that on average, this program did not have a statistically significant impact on the use or content of maternal and newborn health services, nor the sense of civic efficacy or civic participation among recent mothers in the communities who were offered it. These findings hold in both countries and in a set of prespecified subgroups. To identify reasons for the lack of impacts, we use a mixed-method approach combining interviews, observations, surveys, focus groups, and ethnographic studies that together provide an in-depth assessment of the complex causal paths linking participation in the program to improvements in MNH outcomes. Although participation in program meetings was substantial and sustained in most communities, and most attempted at least some of what they had planned, only a minority achieved tangible improvements and fewer still saw more than one such success. Our assessment is that the main explanation for the lack of impact is that few communities were able to traverse the complex causal paths from planning actions to accomplishing tangible improvements in their access to quality health care.
Topic:
Health, Health Care Policy, Children, and Randomized Controlled Trials
Political Geography:
Africa, Indonesia, Tanzania, and Southeast Asia

2. Decentralized Local Health Services in Tanzania: Are Health Resources Reaching Primary Health Facilities, or Are They Getting Stuck at the District Level?

Author:
Jameson Boex, Luke Fuller, and Ammar A. Malik
Publication Date:
04-2015
Content Type:
Research Paper
Institution:
Urban Institute
Abstract:
This study analyzes local health finances in Tanzania by considering the extent to which public health resources in Tanzania flow from the district government level to primary health facilities, or whether these resources get stuck at the district level. Our analysis of health expenditures in six rural Local Government Authorities suggests that less than half of local health funding reaches the front-line dispensaries that provide the vast majority of local health services. The structure of the local health system appears to favor top-down interventions and control, rather than empowering local facilities to improve local health outcomes.
Topic:
Health, Health Care Policy, International Development, and Cities
Political Geography:
Africa and Tanzania

3. Journal of Public and International Affairs 2013

Author:
Greg Rosalsky, Sarah Schleck, Nathaniel D. F. Allen, Ezra Levin, Alex Penwill, Farzan Sabet, Daniel Tam-Claiborne, Albert Trithart, Mark Walker, Ben Grubb, and Gloria Twesigye
Publication Date:
05-2013
Content Type:
Journal Article
Journal:
Woodrow Wilson School Journal of Public and International Affairs
Institution:
Woodrow Wilson School of Public and International Affairs, Princeton University
Abstract:
The nine articles in this volume were chosen from over 150 submissions through a blind-selection process in Princeton. After individually reading a large number of submissions, attending editors first voted for their favorite papers via secret ballot, and we then facilitated an open debate to winnow down these choices to the cream of the crop. In the intervening months before publication, editors in Princeton from relevant policy areas worked with the authors to fact-check their work and fine-tune their arguments. While their geographic foci and policy subjects are multifarious, all the authors in this edition share a passion for changing the world through better policy. Whether it is women’s health issues in Tanzania, banking regulation in the European Union, diplomacy with Iran over its nuclear ambitions, or immigration policy in the United States, the authors implore global policymakers to change course in order to remedy contemporary problems in public affairs. This dedication to making the world a better place through public policy, in addition to demonstrating first-rate scholarship, make us proud to showcase these articles.
Topic:
Health, Nuclear Weapons, Politics, Foreign Aid, Governance, Nuclear Power, Democracy, Economy, Arms Trade, and Microcredit
Political Geography:
Africa, China, Iran, Tanzania, Honduras, Mali, Niger, and United States of America

4. The Spice Industry in Tanzania: General Profile, Supply Chain Structure, and Food Standards Compliance Issues

Author:
Evelyne Lazaro and Adam Akyoo
Publication Date:
03-2007
Content Type:
Working Paper
Institution:
Danish Institute for International Studies
Abstract:
The fall in the agricultural sector's contribution to Tanzanian export earnings since the early 1990s has increased attention toward new crops with the potential of supplementing the country's traditional export crops. Particular attention has been focused upon identifying crops enjoying price stability, high demand elasticity and low substitutability. Spices fall into this category. Consequently there have been efforts by public agencies and private exporters, both on the mainland and on Zanzibar, to promote the crop. However, access to high value export markets raises issues of supply chain dynamics and conformity with international standards. This paper focuses upon the recent history of the spice industry in Tanzania with reference to these issues. The main conclusions are that Certified Organic standards are the only international standards complied with, and that a very loosely coordinated chain exists alongside a more coordinated one. Macro- and micro-institutional weaknesses need attention if the full potential of the sub-sector is to be realized.
Topic:
Economics, Health, and Industrial Policy
Political Geography:
Africa, Zanzibar, and Tanzania

5. Does the Private Sector Care About AIDS?

Author:
Vijaya Ramachandran, Manju Kedia Shah, and Ginger Turner
Publication Date:
01-2006
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
This paper analyzes the determinants of firms' decision to provide HIV/AIDS prevention activities. Using data from 860 firms and 4,955 workers in Uganda, Tanzania, and Kenya, it shows that larger firms, and firms with higher skilled workers tend to invest more in AIDS prevention. Firms where more than 50 percent of workers are unionized are also more likely to do more prevention activity. Finally, these characteristics are also significant in determining whether or not a firm carries out pre-employment health checks of its workers. The results shed light on the likelihood of private sector intervention and the gaps that will require public sector assistance.
Topic:
Health, Human Welfare, Humanitarian Aid, and Non-Governmental Organization
Political Geography:
Uganda, Kenya, and Tanzania