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The Tanzanian government has identified tourism as the most incentivising factor behind the sustainable conservation and economic development of heritage sites. To this end, the government has been transferring cultural heritage sites from the Antiquities Department to other government heritage agencies with a mandate of conservation and income generation through tourism. The intention is to increase the number of tourist destinations but so far, the experience has not been satisfactory. The purpose of this paper is to argue for sustainable management of archaeological sites in the Ngorongoro Conservation Area (NCA). The aim is to identify ways to mitigate the physical and anthropogenic challenges facing palaeoanthropological sites by assessing existing conservation policies and identifying modalities for sustainable use of cultural resources through tourism and other incentive mechanisms. Through an exploratory study approach, the paper aims to strengthen conservation and to reduce vulnerability to vandalism, thus enhancing sustainable management of cultural resources and community development. It contributes to improving the level of awareness of sustainable use of heritage resources to eradicate poverty. The legal regime for protection of cultural heritage in Tanzania comprises, among others, the Antiquities Act of 1964 (amended in 1979), as well as the National Museum of TanzaniaAct of 1980. These Acts provide bases for preservation and protection of sites and articles of palaeontological, archaeological, historical and cultural significance including movable and immovable relics. Besides these Acts, Tanzania has policies (Cultural Policy of 1997 and Cultural Heritage Policy of 2008) guiding the protection and management of heritage resources. These policies provide favourable circumstances for safeguarding intangible and tangible cultural resources, including the empowerment of local communities and other stakeholders. [ABSTRACT FROM AUTHOR]

Coastal areas across the globe are experiencing alarming levels of degradation, including in East Africa. In response, marine conservation efforts in the region are on the rise, many of which claim community empowerment as an essential goal. At the same time, research from geography and cognate disciplines has been working to detail the ways in which conservation practices in Africa can negatively impact communities living in and around protected areas. However, due in part to the much more recent history of coastal conservation, much of this important research is focused on land-based ecosystems. This paper adds to the burgeoning literature on coastal conservation efforts in the region by presenting findings from a case study of a World Bank-funded project in the Menai Bay Conservation Area (MBCA), in Zanzibar, Tanzania. This study combines interview-based fieldwork and a review of policy literature to conclude that while the project in MBCA maintains a strong rhetoric of community involvement, the goal of achieving community empowerment remains elusive. [ABSTRACT FROM PUBLISHER]

Violence against children (VAC) is both a global and local concern that has resulted in several child protection initiatives by formal and informal networks in East Africa. The dominant narrative on networking for VAC prevention and response significantly focuses on the functionality of formal networks and ignores grassroots networks. We conducted research to explore the functionality and corresponding impact of diverse networks that work to prevent and respond to VAC in Kenya, Tanzania, and Uganda. Study participants were VAC network leads at grassroots, subnational, and national levels, and network funders. Data were collected using interviews, document review, and focus group discussions. We found that scholarly literature illuminates the role of formal networks at the expense of grassroots networks, which are ignored and minoritized in literature. This may contribute to a disparity between the funding of grassroots and formal networks. Yet, grassroots network actors are VAC first responders and are instrumental in child protection work. We contend that it is vital to center grassroots networks in VAC policies, programs, and research in order to achieve sustainable connections between networks, communities, and funders, and to empower communities to protect children from abuse. [ABSTRACT FROM AUTHOR]

Gender analysis methodology is increasingly being considered as essential to health research because 'women's social, economic and political status undermine their ability to protect and promote their own physical, emotional and mental health, including their effective use of health information and services' {World Health Organization [Gender Analysis in Health: a review of selected tools. 2003; www.who.int/gender/documents/en/Gender.analysis.pdf (20 February 2008, date last accessed)]}. By examining gendered roles, responsibilities and norms through the lens of gender analysis, we can develop an in-depth understanding of social power differentials, and be better able to address gender inequalities and inequities within institutions and between men and women. When conducting gender analysis, tools and frameworks may help to aid community engagement and to provide a framework to ensure that relevant gendered nuances are assessed. The capacities and vulnerabilities approach (CVA) is one such gender analysis framework that critically considers gender and its associated roles, responsibilities and power dynamics in a particular community and seeks to meet a social need of that particular community. Although the original intent of the CVA was to guide humanitarian intervention and disaster preparedness, we adapted this framework to a different context, which focuses on identifying and addressing emerging problems and social issues in a particular community or area that affect their specific needs, such as an infectious disease outbreak or difficulty accessing health information and resources. We provide an example of our CVA adaptation, which served to facilitate a better understanding of how health-related disparities affect Maasai women in a remote, resource-poor setting in Northern Tanzania. [ABSTRACT FROM AUTHOR]

Background: Late initiation of treatment for illness secondary to the human immunodeficiency virus (HIV) remains a major challenge in developing countries. Despite the World Health Organization (WHO) recommendation that treatment be initiated early in disease management, health providers conducting quality improvement monitoring in one region of Tanzania noted that common management practice relies upon clinical signs of advanced disease alone for initiation of combination antiretroviral therapy (ART). Although Tanzanian National Treatment Guidelines followed standard WHO recommendations, few patients initiated ART based on laboratory parameters. As a potential barrier to optimal patient outcomes, further investigation of this inconsistency led to recognition of challenges reflecting patient, healthcare staff, and laboratory levels that might inhibit the use of CD4 cell counts as the entryway to care. Materials and Methods: Using a quality improvement approach, investigations were pursued for six discrete activities of HIV care delivery with before and after measures of selected indicators. With respect to patient engagement, meetings and informal educational sessions were held to promote understanding of the meaning of and need for CD4 testing. For clinic staff: (1) Qualitative interviews were conducted with providers to understand why laboratory data was not being used and (2) on-site interviews were conducted with laboratory personnel to review beliefs, methods, and practices related to measurement of CD4 cells testing. A large scale local campaign was mounted to (1) educate and empower patients to recognize a need for CD4 information in management of their own care; (2) re-educate and encourage providers to use measured, rather than clinical observation alone to initiate ART; and (3) understand and resolve clinical and laboratory challenges. Based upon findings from the interviews: (1) Meetings with hospital administrations were effected to resolve institutional barriers to using CD4 cell testing. Specific on-site training was initiated for both providers, with regard to use of CD4 cell counts, and nurses, with advanced training to initiate routine CD4 testing. These activities were well received because all staffwere able to review unlinked, site-based clinical data to appreciate gaps in a local care. Results: The number of CD4 samples obtained and recorded increased by 114% between May and October 2007 at targeted health facilities. ART enrollment increased by 62% between June and September 2007 without other significant change in care delivery. The median baseline CD4 at enrollment increased from 110 cells/mm3 in June to 150 cells/mm3 in September. Overall retention rate was 77% for 13,333 HIV patients enrolled in seven facilities. In September 2013, the cumulative 6-year overall retention rates are 77% for 53,040 patients enrolled in 42 health facilities in the region. Obstacles were addressed and community empowerment techniques used to stimulate change in established clinical behaviors. Conclusion: This "Know your CD4 campaign" initiative resulted in increased uptake of CD4 testing, treatment initiation and an unanticipated improvement in patient retention. With attention to patient, staff, and laboratory elements in resource-poor settings, decline in immune function and morbidity may be reduced and viral suppression prolonged. Empowering patients to be involved in their own care resulted in better overall adherence with HIV management. Local use of reviewed data can impact overall effectiveness of HIV care delivery. Simple quality improvement approaches impact sustainable change. [ABSTRACT FROM AUTHOR]

The article presents a synthesis of data from three village case studies focusing on how structural and cognitive social capital may have influenced the progression of the HIV epidemic in the Kagera region of Tanzania. Grounded theory was used to develop a theoretical model describing the possible links between structural and cognitive social capital and the impact on sexual health behaviours. Focus group discussions and key informant interviews were carried out to represent the range of experiences of existing social capital. Both structural and cognitive social capital were active avenues for community members to come together, empower each other, and develop norms, values, trust and reciprocal relations. This empowerment created an enabling environment in which members could adopt protective behaviours against HIV infection. On the one hand, we observed that involvement in formal and informal organisations resulted in a reduction of numbers of sexual partners, led people to demand abstinence from sexual relations until marriage, caused fewer opportunities for casual sex, and gave individuals the agency to demand the use of condoms. On the other hand, strict membership rules and regulations excluded some members, particularly excessive alcohol drinkers and debtors, from becoming members of the social groups, which increased their vulnerability in terms of exposure to HIV. Social gatherings (especially those organised during the night) were also found to increase youths' risk of HIV infection through instances of unsafe sex. We conclude that even though social capital may at times have negative effects on individuals' HIV-prevention efforts, this study provides initial evidence that social capital is largely protective through empowering vulnerable groups such as women and the poor to protect against HIV infection and by promoting protective sexual behaviours. [ABSTRACT FROM AUTHOR]

Objectives: We present an evaluation of the Community Capacity Building and Empowerment initiative, undertaken by the Community-Based Reproductive Health Project (CBRHP), designed to address high maternal morbidity and mortality.Methods: Qualitative data from group interviews and program data from CBRHP were used to assess progress in development and use of community level transport systems and support for the village health workers (VHWs).Results: Project activities increased community participation in maternal health. An increase was seen in knowledge of danger signs, birth planning, timely referrals, and transport of pregnant women to hospitals, as well as in support and retention of VHWs. More women with obstetrical problems are using the community-based transport system to get to hospitals.Conclusions: Community participation and support for VHW activities and the transport systems have led to better care for pregnant women and sustained links between the communities and health facilities, which may reduce maternal and infant morbidity and mortality. [ABSTRACT FROM AUTHOR]