Papers by Richard Sambaiga
Research Square (Research Square), Mar 28, 2024
Poor quality of care within Tanzania's primary health system contributes to thousands of preventa... more Poor quality of care within Tanzania's primary health system contributes to thousands of preventable maternal and child deaths, and unwanted pregnancies each year. A key contributor is lack of coordination between three primary healthcare actors: public sector Community Health Workers (CHWs) and health facilities, and private sector Accredited Drug Dispensing Outlets (ADDOs). The Afya-Tek program aims to improve the continuity of care amongst these actors in Kibaha district, through a mobile-application based digital referral system that focuses on improving maternal, child and adolescent health. The digital system called Afya-Tek was co-created with users and bene ciaries, and utilises open-source technology in-line with existing government systems. The system guides healthcare actors with individualised decision support during client visits and recommends accurate next steps (education, treatment, or referral). From July 2020 to June 2023, a total of 241,000 individuals were enrolled in the Afya-Tek program covering 7,557 pregnant women, 6,582 postpartum women, 45,900 children, and 25,700 adolescents. CHWs have conducted a total of 626,000 home visits to provide health services, including screening clients for danger signs. This has resulted in 38,100 referrals to health facilities and 24,300 linkages to ADDOs. At the ADDO level, 48,552 clients self-presented; 33% of children with pneumonia symptoms received Amoxicillin; 34% of children with diarrhoea symptoms received ORS and zinc; and 4,203 referrals were made to nearest health facilities. Adolescents preferred services at ADDOs as a result of increased perceived privacy and con dentiality. In total, 89% of all referrals were attended by health facilities. As the rst digital health program in Tanzania to demonstrate the linkage among public and private sector primary healthcare actors, Afya-Tek holds promise to improve maternal, child and adolescent health as well as for scale-up and sustainability, through incorporation of other disease conditions and integration with government's Uni ed Community System (UCS). Lack of strengthened continuum of care at community level for maternal, child and adolescent in Tanzania is partly due to fragmented service provision at the primary healthcare level; lack of guidance to aid decision-making processes; and limited use of data. What this study adds: The Afya-Tek program showcases an innovative digitally enabled system which strengthens the linkages between private sector Accredited Drug Dispensing Outlets (ADDOs) and public sector community health workers and health facilities. The Afya-Tek program improves the continuum of care at community level and prompt access to care for mothers and children through digital decision support tools, patient referral and tracking. The involvement of the private sector ADDOs shows promise in improving adolescent health due to delivering private, con dential and client centred services. How this study might affect research, practice or policy: Afya-Tek's participatory approach in co-creation of the digital system and implementation processes has been critical to ensure system usability and ownership on the ground. As the rst digital health system in Tanzania to link public and private sectors, it works within a framework of Public Private Partnership and contributes to effective linkage, for a scaled-up improvement and sustainability of primary healthcare.
Tanzania Journal of Sociology
Since the 1990s there have been serious concerns about the quality of formal knowledge1 in Tanzan... more Since the 1990s there have been serious concerns about the quality of formal knowledge1 in Tanzania. The centre of the concerns has been the relationship between formal knowledge and development. Most of the studies agree that, under-development in Tanzania is highly influenced by the poor quality of formal knowledge. Though this has been the case, little is known about the distortions of knowledge in materialist terms. As it is argued by various scholars, poor quality of formal knowledge has been associated with a poor learning environment, lack of teaching staff and other basic equipment. While these are important, this study aimed at explaining how systems of knowledge production and dissemination distort the quality of knowledge in Tanzania. By situating Tanzania in the context of European imperialism, it was observed that knowledge production and dissemination systems have been destroyed since colonial times, and the content of knowledge has been sporadically distorted to respo...
The Pan African medical journal, Dec 31, 2022
BMC Health Services Research
Background: Healthcare outcomes in child, adolescent and maternal in Tanzania are poor, and mostl... more Background: Healthcare outcomes in child, adolescent and maternal in Tanzania are poor, and mostly characterised by fragmentary service provision. In order to address this weakness, digital technologies are sought to be integrated in the milieu of health as they present vast opportunities especially in the ability to improve health information management and coordination. Prior to the design and implementation of the Afya-Tek digital intervention, formative research was carried out to ensure that the solution meets the needs of the users. The formative research aimed to examine: the burden of disease and related health seeking behaviour; workflow procedures and challenges experiencing healthcare actors; adolescent health and health seeking behaviour; and lastly examine technological literacy and perceptions on the use of digital technologies in healthcare delivery. This paper therefore, presents findings from the formative research. Methods: The study employed exploratory design gro...
African Sun Media eBooks, Mar 3, 2022
This chapter investigates embodiment through the social relational model of disability by central... more This chapter investigates embodiment through the social relational model of disability by centralising pain. The analysis focuses on the impairment effects and disablism of menstrual pain and counteracts the coloniality of knowledge through the epistemological standpoint of 63 young Tanzanian females with disabilities. The results show that menstrual pain impacts both their public and private lives by adding a layer of oppression to disability experience. The findings demonstrate that pain denial is a pathway for young females to navigate amidst the potentiality of full social personhood. The chapter makes novel suggestions to global and public health professionals, academia and the state regarding approaches for validating the menstrual pain of persons with disabilities.
The African Review
The arrival of Motorcycle taxis (bodaboda) in the public transport sector in African and beyond h... more The arrival of Motorcycle taxis (bodaboda) in the public transport sector in African and beyond have had far reaching opportunities and challenges in other realms of public affairs especially the economy and security. This paper examines the paradoxical nature of Bodaboda Youth in terms of their role in either promoting or/and preventing violent extremism in Tanzania. It seeks a nuanced understanding of the security dimensions of the bodaboda phenomenon with a focus on what the influx of bodaboda means for violent extremism (VE) and prevention of violent extremism (PVE) in Tanzania and elsewhere in Africa. Drawing on empirical evidence from Tanzania, and inspired by sound actor oriented perspectives, the article, defends the contention that Bodaboda Youth can actively and creatively participate VE operatives and PVE practices. Analytically, the paper challenges dominant discourses, which have tended to present a rather one-sided and reductionist view that represent youth as perpetra...
Environment and Planning E: Nature and Space, 2021
This paper provides an account of everyday discursive and material practises deployed by marginal... more This paper provides an account of everyday discursive and material practises deployed by marginalised forest-dependent groups in the course of resisting the implementation of Reduced Emission from Deforestation and forest degradation (REDD + ) and conservation regulations. Available literature have documented extensively that REDD + market-based models across the Global South, and Tanzania in particular, have led to increasing inequality, injustices, and exclusions. Nevertheless, there is little attention to exploring how different social actors that are unequally positioned resist exclusions. The paper explores selected case studies of marginalised forest-dependent groups in Lindi, Southern Tanzania, who creatively work to negotiate unequal power relations through a range of encounters around REDD+. Our analysis shows unequal social, spatial, and environmental ramifications of market-based conservation policies and strategies that have led to different kinds of material and discurs...
The African Review, 2018
Africa has recently been declared the most “youthful” continent in the world because over two-thi... more Africa has recently been declared the most “youthful” continent in the world because over two-thirds of Africa’s population is under the age of 35 years. For Africa, this is not just a demographic feature but a turning point in terms of nations’ socio-economic and political configurations and dynamics. Youths in Africa do not only constitute the majority population, but they are also at the centre of societal interactions and transformations (Honwana and De Boeck 2005). Put it differently, the youth in Africa are located at the core of the continent’s opportunities, challenges and crises of the 21st Century (Burges 2005). Despite efforts to invest in the youth, both formal and non-formal institutions have tended to pay inadequate attention to the development and empowerment of the youths in Africa. Instead, this generational category has often been linked with violence, economic vulnerability, political exclusion and other forms of vulnerability. In that respect, to be young in Afri...
This study explores what sexuality means for individual adolescents, by examining how an why adol... more This study explores what sexuality means for individual adolescents, by examining how an why adolescents go about engaging with multiple social and cultural prescriptions or ideals relation to their sexual lives. Grounded in the refined conceptualization of agency, the study approaches adolescents as “agents” in themselves and their sexual or reproductive practices “social actions”. Based on ethnographic methods, the study focuses on sexual and reproductive experiences of adolescents in Mtwara Town, Southern Tanzania. Central to th analysis is the understanding of sexual and reproductive actions from the adolescents’ viewpoints. Findings show that sexual practices during adolescence in Mtwara Town constitute contested social phenomena as they are simultaneously disapproved and endorsed by different social actors and institutions. In their quest for social well-being, adolescents inter-subjectively engage with multiple, competing and often contradictory sexual norms an expectations a...
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Papers by Richard Sambaiga