published_or_final_version / abstract / Education / Doctoral / Doctor of Philosophy

The worldwide maternal mortality rate is excessive. Developing countries such as Tanzania experience the highest maternal mortality rates. The continued exploration of issues to create ease of access for women to quality maternal health care is a significant concern. A central strategy for reducing maternal mortality is that every birth be attended by a skilled birth attendant, therefore special attention was placed on motivations and factors that might lead to an increased utilization of health facilities. This qualitative study assessed the perceptions of local population concerning maternal health services and their recommendations for improved quality of care. The study was conducted in the Karatu District of Tanzania and gathered data through 66 in-depth interviews with participants from 20 villages. The following components were identified as essential for perceived quality care: medical professionals that demonstrate a caring attitude and share information about procedures; a supportive and nurturing environment during labor and delivery; meaningful and informative maternal health education for the entire community; promotion of men’s involvement as an essential part of the system of maternal health; knowledgeable, skilled medical staff with supplies and equipment needed for a safe delivery. By providing these elements, the community will gain trust in health facilities and staff. The alignment the maternal health services offered to the perceived expectation of quality care will create an environment for increased attendance at health facilities by the local population.

ABSTRACT Introduction Under-five mortality is still a major cause of concern in Sub Saharan Africa and among the highest in the world. This is also exacerbated by the high prevalence and episodes of malaria in this age group, which accounts for 90% of all under-five deaths estimated in the region annually. The effect of detecting clustering of all cause and cause specific mortality and underlying factors is crucial for timely public health interventions. This is especially important for health authorities in Tanzania where under-five malaria attributable deaths accounts for 45% of the annual estimated mortality of 100, 000. Study objectives To estimate under-five mortality and analyze clustering of all cause and malaria specific mortality among under five children in Ifakara Demographic Surveillance System from 2002-2005. Methods Data from the Ifakara Health Research and Development Centre (IHRDC) were obtained for all under-five children who lived in 25 villages in the DSS from 2002 – 2005. Analyses for all cause and malaria cause specific under-five mortality were done using data collected from the DSS and verbal autopsy systems. Annual all cause and malaria specific mortality rates were calculated by dividing number of deaths and person years observed. Clustering of deaths for all cause and cause specific (malaria) in the 25 villages were analyzed using SaTScanTM version 7.0 software. A Poisson model was used to detect clusters with high rates in space and in space-time. Household assets and characteristics were used to construct a wealth index using Principal component analysis (PCA) in StataTM version9. The index was used to group households into five equal groups from poorest to least poor. Results Overall infants’ mortality was sixty-three times higher (326 per 1,000 person years) compared to children (5.1 per 1,000 person years) and with mortality rates between girls and boys were very similar, (15.8 and 14.8 per 1,000 person years). Year of death and place of death (village) were found to be significantly associated with malaria deaths. However, socio-economic status of parents in households where deaths occurred was not associated to malaria deaths in the DSS. A number of statistically significant clusters of all cause and cause specific malaria deaths were identified in several locations in the DSS. The located clusters imply that villages within the clusters have an elevated risk of under-five deaths. A space-time cluster of four villages with radius of 15.91 km was discovered with the highest risk (RR 2.71; P-value 0.020) of malaria deaths in 2004. Conclusion These findings demonstrate that there is non-random clustering of both all cause and malaria cause specific mortality in the study area. The high infant mortality results also suggest a careful examination of the data collection procedures in the DSS and require further studies to understand this pattern of mortality among the under-five population. Appropriate health interventions aimed at reducing burden of malaria should be strengthened in this part of rural Tanzania. There is need to replicate this study to other areas in the country.

The traditional monopoly of politics and international relations on theorizing power, authority and legitimacy has eroded in the late modern era. The complexity of these domains has been compounded in a strongly interconnected, post-Westphalian world, where sovereignty and statehood are increasingly negotiated, where centres of power and authority have shifted and where new configurations of governance have come to the fore. The conventional conceptual toolbox of inter-national relations has been slow to adapt, and so the need to embrace insights from other disciplines never greater. The study of legitimacy in particular has been hamstrung by conventional drawings of both sovereignty and authority. Public authority, in the Weberian idealist sense, is the legitimated exercise of power. The study of power has broadened considerably in this timeframe; legitimacy, or rather the practice of legitimation, must mirror power's analytical expansion. Even where the need to broaden our conceptualization of legitimation has been conceded, its empirical content has remained woefully thin. The question of how political actors legitimate their authority to act thus remains under-theorized and under-researched. This thesis contributes to contemporary debates regarding power, legitimation and authority in two key respects. The first is in theorizing legitimation as practice: the everyday 'socially meaningful patterns of action' (Adler & Pouliot 2011, p3) that render power authoritative. This practice-based approach, benefitting in particular from the legacies of Foucault and Bourdieu, moves firmly away from accounts of legitimacy as 'inputs' and 'outputs' towards a more processual account. The second is in locating these everyday practices beyond formalized institutions, undertaken by a range of actors in a range of forums. The increasingly blurred 'non-state' operates in the margins between global and local; national/international; public/private and indeed state/non-state, whilst nonetheless sustaining a claim to publicness. These 'twilight' institutions (Lund 2006a) include the non-government organizations in Tanzania on which this thesis is focussed. It draws on extensive critical ethnography in locating everyday governmental and non-governmental legitimation practice, whilst linking the local to the global. This is not solely about facilitating the travel of international relations to its hitherto geographical and theoretical margins, but to return with rigour to the centrality of legitimation as experienced in 'most of the world' (Chatterjee 2004). It asks, in short, how NGOs, as non-state actors, legitimate their authority to act in the everyday, within today's interconnected world.

This thesis deals with problems and prospects for local government in Tanzania. In the opening chapter theoretical issues relating to local government in developing countries are raised. These are followed by a historical account of the development of local government institutions in Tanzania, from pre-colonial times to the present day. After this, the thesis identifies current problems of local government performance paying special attention to local government authorities' effectiveness in collecting their own revenues, their responsiveness to public needs, and staff satisfaction with council leadership. Various explanations of poor performance of local government authorities in Tanzania are then reviewed and evaluated. While acknowledging the lack of autonomy from central government and the ill-planned re-introduction of councils in 1982 as causes of poor performance, this thesis attributes some of the performance problems to the traditional managerial philosophy, the reliance on rigid bureaucratic structures and associated management practices, and to inappropriate managerial skills of the elected and non-elected officials of councils. In conclusion the thesis elaborates suggestions for action to improve the performance of local government in Tanzania.

<p><strong>Aim </strong>The aim of this study is to investigate the activity participants’ opinions on Kilimanjaro Aids Control Associations’ (KACA) work in combating HIV/AIDS in Moshi, Tanzania, and to examine what they have learnt from participating KACA’s activities. The authors also examined whether the participants thought the activity has influenced on their behaviour.</p><p><strong>Method </strong>The study is an explorative qualitative study with semi-structured interviews. The respondents (20) were purposively selected in order to get balanced representation.</p><p><strong>Results </strong>The majority of respondents were very grateful after being in contact with KACA. According to some of the respondents, KACA supplies needy people with financial as well as mental support. Many of the respondents have been passing on their new knowledge about HIV/AIDS to others, and claimed that they have changed their behaviour.</p><p><strong>Conclusion </strong>Our findings were that the majority of our respondents had positive experiences about KACA’s role in combating HIV/AIDS in the Kilimanjaro area. Almost every respondent claimed they had got new knowledge about HIV/AIDS. The new knowledge led to reduced risk taking behaviour, which we believe can reduce the spread of HIV. Since this study contains 20 respondents, the results can not be generalized.</p>

One of the most challenging questions that a political comparativist can grapple with in todays world is: Why do some countries and their systems of governance fail while others succeed? As a student of comparative politics, I have been grappling with a similar question for some time now: What is wrong with development initiatives in Africa? This is the major question motivating my research. In this dissertation, I apply a new institutional approach to an exploration and analysis of the fundamental institutional issues of the current local governance system in Tanzania. Specifically, this study investigates and reflects on the relationship between institutions and governance in local political settings and analyzes the impacts of institutional factors on good governance, particularly at the local level, in Tanzania. Of particular importance in this study is the precise analysis that I provide of contemporary governing practices in Tanzania since the inception of the Local Government Reform Program (LGRP) in 2000. This is used to compare current governing practices to the conceptions of how they were expected work after the end of the program in June 2008. I used documentary research to identify fundamental issues in local governance in Tanzania. From this checklist, a selected few of the problems, ones that are common to all local government authorities (LGAs), were chosen as the foci of the research. Then, in order to explore the relationship between the selected problems and the institutional framework, a case study of four LGAs in Tanzania was employed. I have argued in this dissertation that Tanzanias development outcomes (good governance and reduction of systemic poverty) are greatly influenced by the countrys institutions of governance. However, my research findings show that the role of institutions that are deemed necessary for the achievement of local development goals and good governance in Tanzania has become severely simplified if not forgotten. Drawing on the discussions and findings of each chapter in this dissertation, I came to the conclusion that when the system of governance is malfunctioning, then something must be wrong with its institutional mechanisms. This is what I have described in this study as alternative thinking on governance.

Aim The aim of this study is to investigate the activity participants’ opinions on Kilimanjaro Aids Control Associations’ (KACA) work in combating HIV/AIDS in Moshi, Tanzania, and to examine what they have learnt from participating KACA’s activities. The authors also examined whether the participants thought the activity has influenced on their behaviour. Method The study is an explorative qualitative study with semi-structured interviews. The respondents (20) were purposively selected in order to get balanced representation. Results The majority of respondents were very grateful after being in contact with KACA. According to some of the respondents, KACA supplies needy people with financial as well as mental support. Many of the respondents have been passing on their new knowledge about HIV/AIDS to others, and claimed that they have changed their behaviour. Conclusion Our findings were that the majority of our respondents had positive experiences about KACA’s role in combating HIV/AIDS in the Kilimanjaro area. Almost every respondent claimed they had got new knowledge about HIV/AIDS. The new knowledge led to reduced risk taking behaviour, which we believe can reduce the spread of HIV. Since this study contains 20 respondents, the results can not be generalized.

Tanzania har länge strävat efter att uppnå så kallad universal grundskoleutbildning, men haft blandad framgång, år 2001 genomfördes ett nationstäckande projekt för att försöka uppnå detta (BEMP). Som en del av projektet avskaffades skolavgiften i landets statliga grundskolor vilket förväntas öka närvaron i skolorna. I denna uppsats kommer en utbildningsmodell användas för att analysera hur situationen har utvecklats från år 1994 till 2004 samt effekterna av projektet. En aning förvånande så visade det sig att närvarograden har sjunkit mellan de undersökta åren. Slutsatsen som kan dras av det är att skolavgiften endast utgör en liten del av kostnaden som förknippas med grundskoleutbildningen och att det krävs fer åtgärder än att endast ta bort ekonomiska inträdeshinder för att uppnå universal grundskoleutbildning.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2010.