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Background Lower-middle-income countries (LMICs) have a common goal to achieve universal health coverage (UHC) through voluntary health insurance schemes. This is important to improve access to healthcare services and ensure financial protection for all by reducing out-of-pocket expenditures. This study aimed to examine the role of risk preferences on enrollment status (currently insured, previously insured, and never insured) into a Tanzanian voluntary health insurance scheme targeted at the informal sector. Methods Data were collected from households in a random sample of 722 respondents. The risk preference measure was based on a hypothetical lottery game which applies the BJKS instrument. This instrument measures income risk where the respondents are to choose between a certain income and a lottery. Both multinomial and simple logistic regression models have been used to analyze the relationship between risk aversion and enrollment status. Results On average, the respondents have a high degree of risk aversion, and the insured are more risk averse than the uninsured (previously insured and never insured). There is a weak tendency for the wealthiest, measured by household income or total household expenditure, to be somewhat more risk averse than the less wealthy. Logistic and multinomial logistic regressions show that risk aversion is strongly associated with enrollment status. A higher degree of risk aversion significantly increases the probability of being insured, relative to being previously insured, and relative to being never insured. Conclusion Risk aversion matters in a decision to enroll into the iCHF scheme. Strengthening the benefit package for the scheme, might increase the enrollment rate and hence improve access to healthcare services for people in rural areas and those employed in the informal sector.

Background Based on the latest UNAIDS report on the global AIDS epidemic; about 34 million people worldwide are estimated to live with HIV and about 69% of them are found in Sub-Saharan Africa. In Tanzania, people living with HIV/AIDS are estimated to be 1.6 million, of which, 1.3 million belong to the age of 15 years and above. Broad Objective The study aimed to assess the general knowledge of HIV/AIDS among secondary school students in Misungwi district. Methods A cross-sectional study design was employed involving 330 students. Information concerning knowledge on causes, risk factors, transmission routes, signs and symptoms as well as preventive measures of HIV/AIDS was collected using a self-assessment structured questionnaire. Data were analyzed using STATA. Mean and standard deviation summarized the numerical variables. Categorical variables were summarized using frequency and proportions. A linear regression model was used to determine the relationships between knowledge score and exposure variables. Multivariable were used to control for confounders. Significance level was set at 5%. Results Majority of students had the age of 16–18 years old. Male were 64% of the sample. The study found age, sex and level of classes had an influence the knowledge on symptoms, risk factors and general knowledge about HIV/AIDS. Age appeared to influence HIV symptoms, risk factors and general knowledge (p

Introduction: In the early 1990s, many countries in the world adopted health sector reforms that focused on strengthening the primary health care system through strong community participation. However, most of the primary health care systems in many countries including Tanzania have remained weak. Most of the vulnerable groups like the elderly have been neglected in the priority setting process. The study aimed to analyse the prospects and challenges of the implementation of the prioritization process for elderly health care services under a decentralised health system.Methods: The study adopted an exploratory case study design that used Key Informant Interviews (KIIs) and focus group discussions (FGDs). The study was conducted in Nzega and Igunga districts in Tabora Region of western Tanzania. The study employed 24 key informants from the two districts. Data were analyzed using the content analysis approach. Results: The study found prospers of the Local Government Authorities (LGAs) that LGAs can conduct a priority-setting process that involves different stakeholders. Different procedures are used for prioritizing the elderly at LGAs including the issue of dealing with their complaints, identifying the elderly and providing identities (IDs) for exemption purposes. In addition, the priority setting process is done on a teamwork basis and uses different guidelines which are prepared by the central government to help the process of priority setting at LGAs. However, there were some challenges facing LGAs, these included; difficulties during elderly identification, there being no specific law that protects elderly matters, exemption/waivers being not clear and insufficient resources to implement the planned activities at the LGAs. Conclusion: The LGAs are important and have the chance to improve the health care services of the elderly. However, due to the encountered challenges, the government should enact a law that will protect the elderly’s interests and that will give the direction of the exemption policy. Also, having a specific per cent of the LGAs revenue for the elderly matters and improving the identification process by having a database at the LGAs level.

Background: Several countries including Tanzania, have established voluntary non-profit insurance schemes, commonly known as community-based health insurance schemes (CBHIs), that typically target rural populations and the informal sector. This paper considers the importance of household perceptions towards a CBHIs in Tanzania and their role in explaining the enrolment decision of households. Methods: This is a cross-sectional household survey that involves 722 households located in Bahi and Chamwino districts in Dodoma region. A three-stage sampling procedure was used, and the data were analyzed using both factor analysis (FA) and principal component analysis (PCA). Statistical tests such as Bartlett’s test of sphericity, Kaiser-Meyer-Olkin (KMO) for sampling adequacy, and the Cronbach’s alpha to measure internal consistency and scale reliability were performed to examine the suitability of the data for PCA and FA. Finally, multivariate logistic regressions were run to determine the associations between the identified factors and the insurance enrolment status. Results: PCA identified 7 perception factors while FA identified 4 factors. The quality of healthcare services, preferences (social beliefs), and accessibility to insurance scheme administration (convenience) were the common most important factors identified by the two methods. Multivariate logistic regressions showed that the factors identified from the two methods differed somewhat in importance when considered as independent predictors of the enrollment status. The most important perception factors in terms of strength of association (odds ratio) and statistical significance were accessibility to insurance scheme administration (convenience), preferences (beliefs), and the quality of health care services. Age and income were the only demographic characteristics that were significant. Conclusion: Household perceptions influence households’ decisions to enroll in CBHIs. Policymakers should recognize and consider the role of perceptions when designing policies that aim to increase the enrolment into CBHIs.

Background: There have been claims amongst nutrition stakeholders in Tanzania that the food basket regions, are the regions most affected by stunting among children. However, this study could not find evidence that combines food production and stunting levels, to substantiate this claim. Therefore, this study aims to compare data on stunting, food production and consumption within administrative regions of the Tanzania mainland. Methods: The study used an ecological study design to show the relationship between stunting, poverty, food production and consumption across administrative regions in Tanzania. The study used data from three national wide surveys: 2017/2018 Household Budget Survey (HBS), Tanzania National Nutrition Survey (TNNS) 2018 and Agriculture Statistics for Food Security report 2018/2019. Results: The study showed that there is a positive relationship between the prevalence of stunting and food production (r=0.43, p=0.03), while there is a negative relationship between stunting and the level of both the average monthly household consumption expenditure (r = -0.48, p = 0.01) and average monthly household food consumption expenditure (r = -0.509, p = 0.01). It was further found that some regions which have higher levels of stunting such as Njombe, have the lowest level of basic need poverty. Conclusion: The study found a positive relationship between food production and the prevalence of stunting using data across regions in mainland Tanzania. This is an indication that regional food security may not entail nutrition security, hence a call for more advocacy on nutrition-sensitive agriculture.