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In the Nordic countries, unions are represented in company boards and can infl uence companies’ policies toward labor abroad. Th is article focuses on the Norwegian national oil company Equinor and its support of unionization of its employees in Tanzania. Th is was inspired by the Nordic tradition of social dialogue between corporations and strong, independent unions. Corporation managers and union representatives tend to refer to this social dialogue as “the Norwegian model,” but this is a narrow conceptualization of the model that disregards the role of the state. I argue that while it is benefi cial for the Tanzanian workers to be organized, it is probably also “good for business” to have unionized workers who have adopted the Nordic collaborative model, rather than a more radical union model.

BackgroundThe success of payment for performance (P4P) schemes relies on their ability to generate sustainable changes in the behaviour of healthcare providers. This paper examines short-term and longer-term effects of P4P in Tanzania and the reasons for these changes.MethodsWe conducted a controlled before and after study and an embedded process evaluation. Three rounds of facility, patient and household survey data (at baseline, after 13 months and at 36 months) measured programme effects in seven intervention districts and four comparison districts. We used linear difference-in-difference regression analysis to determine programme effects, and differential effects over time. Four rounds of qualitative data examined evolution in programme design, implementation and mechanisms of change.ResultsProgramme effects on the rate of institutional deliveries and antimalarial treatment during antenatal care reduced overtime, with stock out rates of antimalarials increasing over time to baseline levels. P4P led to sustained improvements in kindness during deliveries, with a wider set of improvements in patient experience of care in the longer term. A change in programme management and funding delayed incentive payments affecting performance on some indicators. The verification system became more integrated within routine systems over time, reducing the time burden on managers and health workers. Ongoing financial autonomy and supervision sustained motivational effects in those aspects of care giving not reliant on funding.ConclusionOur study adds to limited and mixed evidence documenting how P4P effects evolve over time. Our findings highlight the importance of undertaking ongoing assessment of effects over time.

Multinational corporations have been criticised for their rhetorical support to - as opposed to substantive engagement with - gender equality in their corporate social responsibility (CSR) activities in poor countries. Many host countries have started regularizing CSR in recent years, and there is great variation between countries and different sectors when it comes to the gendered dimensions of social investments. This article focuses on the factors that influence CSR in the petroleum sector, using Equinor in Tanzania as a case study. We argue that national regulations in host countries, perceptions of risk, as well as the need to gain ‘a social license to operate’ from host communities, means that the gendered dimensions of CSR in the petroleum sector differ in important ways from other sectors. The study also shows that company ownership by a state that profiles itself as a champion in gender equality does not in itself lead to gender sensitive social investments. The main ‘beneficiaries’ of Equinor’s social investments in Tanzania are men, but this fact is disguised by using a gender neutral language in CSR reporting.

This theme section brings the state back into anthropological studies of corporate social responsibility through the lens of Norwegian energy corporations working abroad. Th ese transnational corporations (TNCs) are expected by the government to act responsibly when “going global.” Yet, we have observed that abroad, Norwegian corporations backed by state capital largely operate like any other TNCs. We argue that the driver for the adaptation to global capitalism is not coming from the embracing of neoliberal policies in Norway, but is rather inherent to the ways internationalization of the Norwegian economy is unfolding. To the extent that the Norwegian state has an impact on the corporations’ international endeavors, it relates primarily to the imperative of managing Norway’s reputation as a humanitarian superpower.

Background In malaria endemic countries of sub-Saharan Africa, many children develop severe anaemia due to previous and current malaria infections. After blood transfusions and antimalarial treatment at the hospital they are usually discharged without any follow-up. In the post-discharge period, these children may contract new malaria infections and develop rebound severe anaemia. A randomised placebo-controlled trial in Malawi showed 31% reduction in malaria- and anaemia-related deaths or hospital readmissions among children under 5 years of age given antimalarial drugs for 3 months post-discharge. Thus, post-discharge malaria chemoprevention (PMC) may provide substantial protection against malaria and anaemia in young children living in areas of high malaria transmission. A delivery implementation trial is currently being conducted in Malawi to determine the optimal strategy for PMC delivery. In the trial, PMC is delivered through community- or facility-based methods with or without the use of reminders via phone text message or visit from a Health Surveillance Assistant. This paper describes the acceptance of PMC among caregivers. Methods From October to December 2016, 30 in-depth interviews and 5 focus group discussions were conducted with caregivers of children who recently completed the last treatment course in the trial. Views on the feasibility of various delivery methods and reminder strategies were collected. The interviews were transcribed verbatim, translated to English, and coded using the software programme NVivo. Results Community-based delivery was perceived as more favourable than facility-based delivery due to easy home access to drugs and fewer financial concerns. Many caregivers reported lack of visits from Health Surveillance Assistants and preferred text message reminders sent directly to their phones rather than waiting on these visits. Positive attitudes towards active use of health cards for remembering treatment dates were especially evident. Additionally, caregivers shared positive experiences from participation in the programme and described dihydroartemisinin-piperaquine as a safe and effective antimalarial drug that improved the health and well-being of their children. Conclusions Post-discharge malaria chemoprevention given to children under the age of 5 previously treated for severe anaemia is highly accepted among caregivers. Caregivers prefer community-based delivery with use of health cards as their primary tool of reference. Trial registration NCT02721420 (February 13, 2016).

Background Severe malarial anaemia is one of the leading causes of paediatric hospital admissions in Malawi. Post-discharge malaria chemoprevention (PMC) is the intermittent administration of full treatment courses of antimalarial to children recovering from severe anaemia and findings suggest that this intervention significantly reduces readmissions and deaths in these children. Community delivery of health interventions utilizing community health workers (CHWs) has been successful in some programmes and not very positive in others. In Malawi, there is an on-going cluster randomised trial that aims to find the optimum strategy for delivery of dihydroartemesinin-piperaquine (DHP) for PMC in children with severe anaemia. Our qualitative study aimed to explore the feasibility of utilizing CHWs also known as health surveillance assistants (HSAs) to remind caregivers to administer PMC medication in the existing Malawian health system. Methods Between December 2016 and March 2018, 20 individual in-depth-interviews (IDIs) and 2 focus group discussions (FGDs) were conducted with 39 HSAs who had the responsibility of conducting home visits to remind caregivers of children who were prescribed PMC medication in the trial. All interviews were conducted in the local language, transcribed verbatim, and translated into English. The transcripts were uploaded to NVIVO 11 and analysed using the thematic framework analysis method. Results Although intrinsic motivation was reportedly high, adherence to the required number of home visits was very poor with only 10 HSAs reporting full adherence. Positive factors for adherence were the knowledge and perception of the effectiveness of PMC and the recognition from the community as well as health system. Poor training, lack of supervision, high workload, as well as technical and structural difficulties; were reported barriers to adherence by the HSAs. Conclusions Post-discharge malaria chemoprevention with DHP is perceived as a positive approach to manage children recovering from severe anaemia by HSAs in Malawi. However, adherence to home visit reminders was very poor and the involvement of HSAs in a scale up of this intervention may pose a challenge in the existing Malawian health system. Trial registration ClinicalTrials.gov identifier NCT02721420. The trial was registered on 26 March 2016. Electronic supplementary material The online version of this article (10.1186/s12913-018-3791-5) contains supplementary material, which is available to authorized users.

Many resource-rich African countries have recently drafted local content policies for their petroleum sector. Using Tanzania as an example, this paper argues that previous experiences in the extractive industries are a central factor for public sentiments and debates on resource nationalism and local content in the petroleum sector. The paper focuses on the shifting local content polices in the mining sector over the last two decades and presents some of the initiatives that mining companies have taken to increase the local content. The 2010 Mining Act has weak and unbinding requirements on local content. National statistics show that there has been no increase in the local purchase of goods and services and that the percentage of expats in the sector has been relatively stable over the years. As in other African countries, local content is subject to elite capture and patronage, but support to cooperatives is one way of involving local communities in a positive manner. Discontent with the contribution of mining to the national economy entailed a heated debate on local content policies for the petroleum sector, but the legislations that were put in place in 2015 ended up being relatively ‘soft’, due to the fear of losing investors.

Understanding the role of large energy corporations in society is a crucial, yet challenging task for the social\ud science of energy. Ethnographic methods hold potential for plying into corporations’ own self-representations,\ud to reveal the relations of power and politics that determine flows of energy and extractive capital at the global\ud and local level. Ethnography help us move beyond structural analyses, to locate the agents and processes at work\ud within economies of energy production, and identify tensions and dynamics both within the corporation and at\ud the interface with society. We argue that a multi-method and reflexive approach can help social scientists reflect\ud on frictions in corporate encounters, and more importantly that attention to frictions is in fact a gateway to gain\ud new insights about the field. In our research project about Norwegian energy companies and their corporate social\ud responsibility work when ‘going global’, applying a multi-method made us question dominant assumptions\ud within anthropology of what constitutes “access”. We discuss how multiple approaches to “access”, which takes\ud into account the positionality of the researcher, fluidity of research fields along with attention to power dynamics\ud can shape the sort of knowledge that is produced when studying energy companies.

Children initially hospitalized with severe anaemia in Africa are at high risk of readmission or death within 6 months after discharge. No intervention strategy specifically protects children during the post-discharge period. Recent evidence from Malawi shows that 3 months of post-discharge malaria chemoprevention (PMC) with monthly treatment with artemether-lumefantrine in children with severe malarial anaemia prevented 31% of deaths and readmissions. While a confirmatory multi-centre trial for PMC with dihydroartemisinin-piperaquine is on going in Kenya and Uganda, there is a need to design and evaluate an effective delivery strategy for this promising intervention. This is a cluster-randomized trial with 5 arms, each representing a unique PMC delivery strategy. Convalescent children aged less than 5 years and weighing more than 5 kg admitted with severe anaemia and clinically stable are included. All eligible children will receive dihydroartemisinin-piperaquine at 2, 6 and 10 weeks after discharge either: 1) in the community without an SMS reminder; 2) in the community with an SMS reminder; 3) in the community with a community health worker reminder; 4) at the hospital with an SMS reminder; or 5) at the hospital without an SMS reminder. For community-based strategies (1, 2 and 3), mothers will be given all the PMC doses at the time of discharge while for hospital-based strategies (4 and 5) mothers will be required to visit the hospital each month. Each arm will consist of 25 clusters with an average of 3 children per cluster giving approximately 75 children and will be followed up for 15 weeks. The primary outcome measure is uptake of complete courses of PMC drugs. The proposed study will help to identify the most effective, cost-effective, acceptable and feasible strategy for delivering malaria chemoprevention for post-discharge management of severe anaemia in under-five children in the Malawian context. This information is important for policy decision in the quest for new strategies for malaria control in children in similar contexts. ClinicalTrials.gov: NCT02721420 . Protocol registered on 29 March 2016.The study was not retrospectively registered but there was a delay between date of submission and the date it first became available on the registry.

Payment for Performance (P4P) aims to improve provider motivation to perform better, but little is known about the effects of P4P on accountability mechanisms. We examined the effect of P4P in Tanzania on internal and external accountability mechanisms. We carried out 93 individual in-depth interviews, 9 group interviews and 19 Focus Group Discussions in five intervention districts in three rounds of data collection between 2011 and 2013. We carried out surveys in 150 health facilities across Pwani region and four control districts, and interviewed 200 health workers, before the scheme was introduced and 13 months later. We examined the effects of P4P on internal accountability mechanisms including management changes, supervision, and priority setting, and external accountability mechanisms including provider responsiveness to patients, and engagement with Health Facility Governing Committees. P4P had some positive effects on internal accountability, with increased timeliness of supervision and the provision of feedback during supervision, but a lack of effect on supervision intensity. P4P reduced the interruption of service delivery due to broken equipment as well as drug stock-outs due to increased financial autonomy and responsiveness from managers. Management practices became less hierarchical, with less emphasis on bureaucratic procedures. Effects on external accountability were mixed, health workers treated pregnant women more kindly, but outreach activities did not increase. Facilities were more likely to have committees but their role was largely limited. P4P resulted in improvements in internal accountability measures through improved relations and communication between stakeholders that were incentivised at different levels of the system and enhanced provider autonomy over funds. P4P had more limited effects on external accountability, though attitudes towards patients appeared to improve, community engagement through health facility governing committees remained limited. Implementers should examine the lines of accountability when setting incentives and deciding who to incentivise in P4P schemes.

Scandinavian countries lead most rankings on gender equality and women’s rights. Anthropologists who work in development are continuously confronted with perceptions and practises countering the type of universal rights in question. This chapter examines the ways that anthropologists engage with sensitive issues of gender rights in development cooperation. With reference to the issue of gay rights in Tanzania and polygamy in Mozambique, it is argued that the role of applied anthropology should be to produce research-based knowledge on the situation of poor and vulnerable men and women—who are the ultimate target of all Scandinavian aid programs. Research of this type must give equal emphasis to relevance and scientific rigor and be methodologically innovative in order to relate to time and resource constraints and reach central decision-makers.

The Integrated Management of Childhood Illness (IMCI) has been introduced to reduce child morbidity and mortality in countries with a poor health infrastructure. Previous studies have documented a poor adherence to clinical guidelines, but little is known about the reasons for non-adherence. This mixed-method study measures adherence to IMCI case-assessment guidelines and identifies the reasons for weak adherence. In 2007, adherence was measured through direct observation of 933 outpatient consultations performed by 103 trained clinicians in 82 health facilities in nine districts in rural Tanzania, while clinicians' knowledge of the guidelines was assessed through clinical vignettes. Other potential reasons for a weak adherence were assessed through both a health worker- and health facility survey, as well as by a qualitative follow-up study in 2009 in which in-depth interviews were conducted with 40 clinicians in 30 health facilities located in two of the same districts. Clinicians performed 28.4% of the relevant IMCI assessment tasks. The level of knowledge was considerably higher than actual performance, suggesting that lack of knowledge is not the only constraint for improved performance. Other important reasons for weak performance seem to be 1) lack of motivation to adhere to IMCI guidelines, stemming partly from a weak belief in the importance of following the guidelines and partly from weak intrinsic motivation, and 2) a physical and/or cognitive "overload", resulting in lack of capacity to concentrate fully on each and every case and a resort to simpler rules of thumb. Poor remunerations contribute to several of these factors.

Corporate community involvement contributes capital or resources in various forms to a community. However, such involvement may also influence local institutions that determine how well these resources are used, that is, the extent to which they are used to promote the public good rather than being subject to private capture. For community involvement to have a beneficial effect on local development, corporations need to consider their impact on local institutions. Presented in this article are two case studies from Tanzania that illustrate how community involvement activities of two mining firms have resulted in misappropriation of and conflict over corporate community involvement funds. It is argued that corporations need an analytical approach that integrates a differentiated stakeholder approach with institutional theory to contribute to local development in poor communities.

Following advice from the World Bank, and hoping for economic growth and independence from donors, a number of African countries have opened up opportunities for large-scale mining by foreign investors over the last decade and a half. Tanzania, one of the ‘new’ mining countries, is now among the largest gold producers in Africa, but investor-friendly contracts have resulted in extremely low government revenues from mining, totalling less than 5 percent of what the country receives in development aid. In response to widespread discontent, and acknowledging the plight of affected communities, the government amended the 1998 Mining Act in 2010. However, improved legal provisions may have limited effect if the present governance challenges are not resolved. The article demonstrates that the legal provisions meant to protect the rights of affected people are not followed, and that poorly functioning local democracy is particularly dangerous for pastoralists who are ‘represented’ by local authorities often dominated by non-pastoralist immigrants. Compensation to smallholder farmers is either non-existent or too low – or the compensation money is embezzled by the authorities entrusted to distribute it.

Local democracy and the involvement of local communities in the provision of social services are central issues in the local government reforms that are presently being implemented in many developing countries. At the same time, institutions that run parallel to local authorities, such as social funds and various user-committees, are established to improve accountability and participation. By focusing on actual political processes rather than administrative, legal and fiscal aspects of decentralisation, this article traces the breakdown of two development projects in Tanzania to the existence of parallel structures. It suggests that user-committees and social funds should be integrated in local authority structures to avoid fragmentation of participation and to enhance local democracy.

Background: Despite limited evidence of its effectiveness, performance-based payments (P4P) are seen by leading policymakers as a potential solution to the slow progress in reaching Millennium Development Goal 5: improved maternal health. This paper offers insights into two of the aspects that are lacking in the current literature on P4P, namely what strategies health workers employ to reach set targets, and how the intervention plays out when implemented by local government as part of a national programme that does not receive donor funding. Methods: A total of 28 in-depth interviews (IDIs) with 25 individuals were conducted in Mvomero district over a period of 15 months in 2010 and 2011, both before and after P4P payments. Seven facilities, including six dispensaries and one health centre, were covered. Informants included 17 nurses, three clinical officers, two medical attendants, one lab technician and two district health administrators. Results: Health workers reported a number of strategies to increase the number of deliveries at their facility, including health education and cooperation with traditional health providers. The staff at all facilities also reported that they had told the women that they would be sanctioned if they gave birth at home, such as being fined or denied clinical cards and/or vaccinations for their babies. There is a great uncertainty in relation to the potential health impacts of the behavioural changes that have come with P4P, as the reported strategies may increase the numbers, but not necessarily the quality. Contrary to the design of the P4P programme, payments were not based on performance. We argue that this was due in part to a lack of resources within the District Administration, and in part as a result of egalitarian fairness principles. Conclusions: Our results suggest that particular attention should be paid to adverse effects when using external rewards for improved health outcomes, and secondly, that P4P may take on a different form when implemented by local implementers without the assistance of professional P4P specialists. publishedVersion