Adult services tanzania-Use of health care services in two rural communities in Tanzania.

This study was undertaken to investigate the pattern of utilization of medical and dental health care services in rural Tanzania. Two hundred adults, 91 men and women aged 20 or over, were interviewed. Nearly all subjects reported using modern dental and medical health care services. Home remedy was the only indigenous method of treatment used for dental problems while for medical problems a traditional healer was the most commonly used indigenous alternative. It seems that the pattern of utilization of health care services differs for medical and dental problems.

Adult services tanzania

Adult services tanzania

Adult services tanzania

Once the learners are Adult services tanzania and the course starts, the facilitator identifies those who lack reading, writing and arithmetic skills. The transcripts Submissive wife lactating spanked then translated into English by the same person who transcribed the recordings and were again checked for accuracy by GM and TK. Challenges of children with cancer and their mothers: a qualitative research. There is more than one literacy circle in each learning centre. According to the programme evaluation conducted inthe literacy rates in four piloted areas increased by 13 Adult services tanzania cent Mushi,which resulted in a gradual expansion of the programme. Hanemann Ed. Skip to main content. Cancer in children: key facts. A literacy circle can have up to 30 learners, led by one facilitator. Furthermore, equipment should be available when needed, as servifes by a female young adult:.

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Significant cultural variation exists in beliefs about depression terminology, symptomatology, and treatments but data from sub-Saharan Africa are minimal.

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The United Republic of Tanzania was established in , when mainland Tanzania and the Island of Zanzibar gained independence from British colonial rule and sultanate rule, respectively. Since independence, the country has focused on improving economic growth and reducing poverty, introducing a number of policies and strategies in order to achieve its aims.

In , the government adopted a long-term strategy for the United Republic of Tanzania, the National Development Vision , with the ultimate aim of transforming Tanzania into a middle-income country, with high living standards, equity and a well-educated society.

In addition, gender inequality remains a major challenge to the country's socio-economic development. Many studies have shown that gender inequality is one of the underlying causes of poverty, as most women do not have equal rights when it comes to assets, employment and access to education EFA national report, One of the main objectives of the National Development Vision is to create a well-educated, learning society imbued with an ambition to develop.

Tanzania established various education plans and strategies, which are also intended to contribute to meeting the Education for All EFA goals. The main focus has been on early childhood care and education, equitable access to all levels of education, vocational education, teacher education and adult, non-formal and continuing education.

In , the government made primary education compulsory and free, which increased access and participation at this level of education. Enrolment rose from 4. Unfortunately, the country has not been able to achieve EFA Goal 4, the achievement of a 50 per cent improvement in levels of adult literacy by , especially for women, and equitable access to basic and continuing education for all adults.

A national literacy census, conducted in , revealed that adult literacy rates were on the decrease. In response, in , the government launched the Integrated Community Based Adult Education programme. The programme was designed, in part, to address the shortcoming of previous adult education programmes, which included: top-down approaches to planning, teacher-centred methodologies and fixed curricula which were not relevant to learners' needs.

The Integrated Community Based Adult Education ICBAE programme started as a four-year pilot project designed to develop learner-centred and community-based learning approaches in literacy and post-literacy classes for adults and out-of-school youth in Tanzania.

According to the programme evaluation conducted in , the literacy rates in four piloted areas increased by 13 per cent Mushi, , which resulted in a gradual expansion of the programme. Currently, the ICBAE programme operates across Tanzanian, striving to ensure equitable access to quality literacy and post-literacy classes for young people and adults.

Learners are empowered to discuss and analyse key issues in their communities and the programme assists them in starting mini projects income-generating activities which will bring about social and economic change.

Learners do not receive a certificate on the completion of the programme, but with the literacy, vocational and life skills they have acquired, they are able to rely on their own knowledge and continue with income-generating activities, which enable them to support themselves and their families.

A literacy class. Aims and Objectives The central objective of the Integrated Community Based Adult Education programme is to promote equitable access to quality basic education while increasing participation and enabling young people and adults to acquire literacy skills and reach a sustainable proficiency level. Other aims and objectives of the programme are to:.

The programme is implemented across all 25 regions of the Tanzanian mainland. Learning centres are located in primary schools and the learning cycle lasts 18 months. Once learners enrol, they are organized into groups, which are known as literacy circles. There is more than one literacy circle in each learning centre. A literacy circle can have up to 30 learners, led by one facilitator. The language of instruction is Kiswahili.

Learners meet three times per week, usually in the evenings once the children have finished school and gone home. Facilitators have manuals which contain relevant topics in agriculture and micro-economics, health and hygiene, and socio-politics. However, the curriculum is very flexible, allowing learners to focus more on the topics which are most relevant to them or which interest them the most.

Learners do not receive textbooks. Instead, using the REFLECT approach, each literacy circle addresses key issues in their communities, designs learning activities, participates in problem-solving, and plans income-generating activities. Learners at different levels of literacy are enrolled in the same literacy circle and work together and learn from each other.

Learners who need additional help with their literacy skills spend more time with the facilitator, and, as there are no textbooks, facilitators use manuals and newspapers to teach literacy. Based on their interest, and the financial and natural resources available to them, they plan an income-generating activity to improve their livelihoods. After completing the six-month course, learners spend the remaining months of the learning cycle doing practical work related to the income-generating activity of their choice.

The literacy circle facilitators are not employed during this stage. Instead, learners are guided by agricultural trainers, employees of the Ministry of Agriculture known as extension officers, who provide learners with information and demonstrations of how to put existing and newly acquired knowledge into practice and in income-generating activities. In addition, learners who already have advanced knowledge and experience of a certain activity have the opportunity to act as assistants in class, supporting peers to perform better.

They form groups, choose an income-generating activity that interests them and work together on the activity to generate income. They agree as a group how they will divide their profits. Learners receive the loan as a group. For example, a group of women from one literacy circle decided that they wanted to make school uniforms. With the help of the facilitator, they found a local tailor who taught them how to sew.

They applied for the loan, and, once they received it, were able to purchase a sewing machine to support their income-generating activity. The facilitator also teaches learners the basics of book-keeping. When an activity starts generating income, the learners repay the loan at an interest rate of one per cent.

Literacy is very important to the successful planning and implementation of an income-generating activity as it allows learners to undertake simple accounting and book-keeping. The teachers who facilitate the literacy circles are employed as paid volunteers. They are paid by the Tanzanian Government through local government authorities.

As facilitators, they involve learners and encourage them to participate, share knowledge and experience, and contribute to the development of the class curriculum. Each facilitator is supervised by the head teacher of the primary school at which the literacy circle is based. Head teachers also provide support to the facilitators.

In some cases, elementary school teachers are chosen as literacy circle facilitators because of their experience in teaching literacy skills. They were originally expected to attend four weeks of training on the methodology; however, since , funding has not been available to conduct the training, as adult education and literacy are not among the strategic priorities of local authorities.

Enrolment of Learners The ICBAE programme is aimed at young people and adults who learn about the programme from other community members.

Income-generating activities and the Revolving Loan Fund are incentives for learners to join the programme. When people see learners from the ICBAE programme launching their income-generating activities, selling their products and earning money, they too are encouraged to join.

Once the learners are enrolled and the course starts, the facilitator identifies those who lack reading, writing and arithmetic skills. Content covers knowledge and skills relevant to the acquisition of the literacy, life and vocational skills necessary for conducting the chosen income-generating activities.

The main topics and themes include:. Learners with very low levels of literacy skills are offered some additional time, under the supervision of the facilitators, to learn and practice reading and writing. To teach literacy and numeracy, facilitators use different materials, such as alphabet books, newspapers, and ICBAE manuals which cover the above mentioned topics of Agriculture and Micro-Economics, Health and Hygiene and Socio-Political Education.

The materials are also distributed to the learners. At the beginning of the class, teacher picks some key words and sentences related to the topic and writes them on the board. Learners practice reading and writing these key words and sentences. The curriculum of the programme is very flexible and it is based on the needs assessment conducted to determine the needs of the learners.

Needs assessment analysis is conducted through semi-structured interviews with learners, either at the beginning or during the course. A facilitator showing what his group of learners has prepared in Bukoba, Karagwe, Northern, Tanzania. The methodology promotes a process of participatory learning that empowers people to critically examine their environment, identify their problems, discuss and analyse them, and come up with practical solutions for sustainable development.

The primary teaching materials are facilitators' manuals which cover topics relevant to learners and their context, such as agriculture and micro-economics, health and hygiene, and socio-political education. In line with the REFLECT methodology, facilitators conduct teaching and learning activities using participatory rural appraisal PRA tools, which encourage learners to develop their own learning aids and activities.

In course sessions, learners decide what they want to learn, and what actions they will carry out in order for learning to take place.

Under the supervision of the facilitator, learners create maps, charts and Venn diagrams, while also developing activities, such as drama, story-telling and songs. Using participatory tools in literacy circles helps to:.

Learners are given the chance to approach certain activities more practically. The learners draw the tree on the ground. The roots represent the income while on the leaves they indicate all activities for which they need money, for example, paying school fees.

Those who are planning to pay for school fees raise their hands and the total number is written on the respective leaf. Literacy class in session, in Kiroka, Morogoro, Eastern Tanzania. The field visits are conducted by national adult education officers, district adult education coordinators and ward education coordinators. In addition, discussions are held with learners in order to gather feedback as to the quality of implementation.

Follow-up home visits are conducted with graduates from the programme. During these visits, graduates are asked how, if at all, they make use of the knowledge and skills they acquired during the course, in improving their daily lives, and supporting and providing for their families.

This is also assessed through observation: for example, if a learner was engaged in tree planting activity, does he or she take care of their own garden, and has he or she managed to develop a small business or find work after the programme?

This is a way of evaluating the outcomes explicitly adopted by the programme, since learners' progress since graduating should indicate the extent to which the programme has influenced their lives.

In terms of literacy, learners' progress is measured through tasks and activities given to them by the facilitator. There are no standardized tests, as yet. Since its inception, the programme has increased access to basic adult education, offering educational opportunities to approximately 14,, young people and adult learners.

The programme has achieved a high percentage of female enrolment, at around 55 per cent. With regards to literacy skill levels, between and , around 3,, learners with initially very low level of literacy skills managed to acquire literacy skills which helped them in conducting their income-generating activities.

As noted above, this is essential as they need to be able to carry out basic book-keeping in order to show income, expenditure and profit. Over the same period, around 6,, learners acquired knowledge and skills in various income-generating activities.

Using the income they have earned through these income-generating activities, learners have been able to improve their lives through the more balanced diet they can now afford, by paying school fees for their children and by living in more financially stable households. But now I can. I can record what I am earning and my expenditure.

Also, the example of the different activities of the learners motivates other illiterate adults to join the classes as they can learn in a wcy that suits their needs while also developing the skills to produce through income-generating activities. I can read books, newspapers and write letters to my friends.

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Adult services tanzania

Adult services tanzania

Adult services tanzania

Adult services tanzania

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Metrics details. Cancer is one of the leading causes of morbidity and mortality worldwide. Seventy percent of deaths of cancer occur in low or middle-income countries, where the resources to provide cancer treatment and care are minimal. Tanzania currently has very inadequate facilities for cancer treatment as there are only five sites, some with limited services; two are in Dar es Salaam and one each in Mwanza, Kilimanjaro and Mbeya that offer cancer treatment. Despite cancer being a prevalent problem in Tanzania, there is a significant shortage of information on the experiences of young people who receive cancer treatment and care.

The aim of this study was to explore cancer-related concerns and needs of care and support among young adults and children who are receiving cancer treatment in Dar es Salaam, Tanzania. Identified concerns included physical effects, emotional effects, financial impacts, poor early care, and poor treatment.

Identified needs included the need for improved care in hospital by the staff, need for community support, financial needs, needs for improved cancer care and treatment in the hospitals, and the need for increased education about cancer. Resilience was identified, particularly around hope or faith, having hope to be healed, and receiving good care from staff. Young adults and children receiving cancer treatment in Tanzania have many needs and concerns.

Improvements with regard to the care provided in hospital by the staff, the cancer care and treatment in the hospital, and population-wide education about cancer are necessary to address the identified needs and concerns. Cancer is a common health threat all over the world. According to the World Health Organization, cancer is one of the leading causes of morbidity and mortality worldwide [ 1 ].

In , there were approximately 9. The cancer burden in these countries can be reduced through early detection and effective treatment management yet challenges remain in many low and middle-income countries. Currently in Tanzania, cancer services are offered in five centres: two are in Dar es Salaam [ 4 , 5 ] one in Mwanza [ 6 ], one in Kilimanjaro [ 7 ] and one in Mbeya [ 8 ]. However, they are inadequate to cover the need for cancer treatment as only one site located in Dar es Salaam offers a wide range of services including diagnostic, chemotherapy and radiotherapy, while the rest offer only limited services [ 5 ].

In , there were approximately 21, reported deaths from cancer in Tanzania and 35, new diagnoses across all ages [ 9 ]. While the World Health Organization estimates that the overall incidence of childhood cancers is approximately , children per year [ 10 ], there is a paucity of data on the incidence of childhood cancer diagnosis in Tanzania and sub-Saharan Africa more broadly [ 11 ].

Once Tanzanian patients have been diagnosed with cancer, they are eligible for free treatment, but patients must pay for screening out of pocket [ 9 ], which can potentially lead to cancer-related deaths to go undiagnosed and unreported. In addition to the challenges related to diagnosis and treatment, children and young adults with cancer experience stressful physical and emotional suffering that could significantly affect their well-being including lack of self-esteem, physical incapacity, and poor educational progress [ 12 ].

While on treatment, children experience pain, nausea and vomiting, fatigue, weakness, loss of hair, loss of limb function and attention deficit problems, all of which amplify fear, anxiety and depression [ 13 , 14 ]. Moreover, stressors related to cancer in children and young adults can affect the whole family and lead to separation of siblings, family loss of emotional control, disruption of family routines, fear, extended family conflicts, and impact on financial strains [ 12 , 13 ].

Healthcare providers are not always trained in psychosocial support as a component of quality cancer care, and thereby fail to manage the psychosocial symptoms that patients present with, despite the call for improved training in healthcare providers [ 15 ].

If psychosocial needs of children and young adults with cancer are not met, it is likely that negative effects of cancer including fear of death, depression, lower pain tolerance and disability, among others, will increase [ 12 ]. This may lead to unnecessary, repeated, or frequent hospitalization or intrusive procedures and lower quality of life [ 16 , 17 ]. Despite cancer being a prevalent problem in Tanzania, there is currently a paucity of knowledge on the experiences of Tanzanian children and young adults who receive cancer treatment and care.

While only a few studies have examined the psychosocial situation of Tanzanian cancer patients [ 18 , 19 , 20 ], some of which are over a decade old, none of these focused on concerns or needs of care and support for children and young adults,. Consequently, the lack of information makes it difficult for stakeholders, including the government, partners, and the community, to provide appropriate care and support [ 21 , 22 ].

This study aims at reducing this knowledge gap. The aim was to explore cancer-related concerns and needs of care and support among young adults and children who are receiving cancer treatment in Dar es Salaam, Tanzania. Using an explorative, qualitative design, focus group discussions FGDs were held to explore cancer-related concerns and needs of care and support among young adults and children. Focus group methodology was chosen based on its ability to facilitate semi-structured conversation between participants to explore individual and collective experiences [ 23 ].

Young adults were recruited from Ocean Road Cancer Institute ORCI , a hospital in Dar es Salaam, Tanzania where the majority of Tanzanian adults with cancer receive care and treatment, accommodating approximately patients [ 5 ]. The centre accommodates approximately 50 children [ 4 ]. Six FGDs were held with 22 participants comprising of two groups of young adults and four groups of children respectively, split by sex. An interview-guide was developed and piloted with the guide modified based on the initial feedback from the participants see Table 1 for the questions.

The questions were open-ended and explorative, developed with the aim to explore an understudied subject. Given that there is a lack of knowledge about the situation for young cancer patients in Tanzania, questions around topics that would be useful to inform about cancer care for the population and ways to improve that could be posed to young adults as well as children were developed. The same questions were posed to all participants and the moderator was allowed to clarify the content of questions if needed.

However the questions did not appear to be difficult for any participant, including the younger ones and clarifications were not needed. The inclusion criteria included speaking Kiswahili fluently and being in sufficient physical condition to participate, as recommended by the nurses in-charge of the respective wards. The same nurses were responsible for recruiting young adults and children to the FGDs. During FGDs, participants sat comfortably at a round table to facilitate interaction with the moderator and observer present who sat among participants.

For the children, one guardian per child provided written consent for the child to participate with the child providing written assent. At the beginning of the FGDs, participants were reminded of the voluntary nature of participation and that they should feel free to withdraw at any time. A moderator GM led the discussion while an observer research assistant took notes. The recordings from the FGDs were transcribed verbatim by a transcriber fluent in Kiswahili and English.

The transcripts were verified for accuracy against the interview recordings by the co-authors GM and TK who are fluent in Kiswahili and English. The transcripts were then translated into English by the same person who transcribed the recordings and were again checked for accuracy by GM and TK.

Data were analyzed using content analysis whereby the entire transcribed text was read and notes of what was said in the FGDs were made in the margins, identifying codes [ 24 , 25 ]. The codes were collected and reviewed, with similar codes grouped together in themes.

The transcripts were read again to ensure that all codes had been identified and that data that fit under a certain theme were labeled as necessary [ 24 ]. Young adults were on average Five themes emerged related to concerns experienced, including physical effects of cancer, emotional effects of cancer, financial impacts, poor early cancer care, and poor cancer treatment. Another female child expressed:. Now, even when my relatives wash dishes, I feel like I cannot do it.

Other aspects related to the physical impact of cancer included being physically sick vomiting or experiencing negative side effects of medication.

Cancer treatment not only had physical effects but also emotional effects. Participants expressed concerns around the impact on their family, a male child said:.

For it is a long process, perhaps many arrangements at home fail. For what it was, we as children with cancer have difficulty learning, which is a problem. The parents as well find it difficult to bring you [to the hospital] and then you look at the income itself, the rest of the brothers need to attend the hospital. Over three years, it becomes a problem.

I was stigmatized…because those suffering from blood cancer are thin, similar to people suffering from HIV…so we Tanzanians, many are doctors by eyes so when he sees without testing you, he starts to spread rumors in the street, that a particular person is a victim [of HIV].

The issue of infertility due to operation of the uterus was a concern for female young adults. One male young adult said:. You are prescribed [chemotherapy] drugs which cost eight hundred thousand [TSH] or three hundred thousand, but you don't have the ability to purchase those drugs.

You have to go around and seek for those drugs, and if you don't find, you have to go home. And then your condition becomes worse. It was nearly two million for 24 injections until I would finish the drugs. I have been given eight injections only. Now, other injections remain but I have no money and now we were supposed to get money to finish up.

Treatment for cancer in Tanzania is supposed to be covered by the government once a patient is diagnosed. However, the male young adults mentioned that treatment is supposed to be free, but it is not:. When I first came here, I was told the treatment is free, the medicine is free, food is free, and you don't even pay for hospitalization.

In contrary, when I came here, the second day when I was seen by the doctor, I was prescribed and told to go outside to buy medicine. You find that my dose costs five hundred and fifty thousand [TSH] for each dose, and I have to take it twelve times, so there is a small possibility of me getting them all. Patients reported ethical concerns related to the care provided by the healthcare staff.

A new commission to trap people who give bribes that may help to reduce the problem. They were just treating; they give you medicine only. A male child explained his story about diagnosis as:. When we came [to the hospital], they sent us to the ward of children with sickle cell. They investigated, and the results showed no sickle cell. But they gave me medication and after the drugs, the swelling of my lymph nodes went down, so they let me go back home.

When I went home, I stayed one week, and it started again. We came back here again, they examined me and found no sickle cell Participants expressed that there was a delay in initiation and continuing treatment as well as a delay in diagnosis and results, that treatment was provided far from home, that treatment was not available close to home and that they had had to transfer to referral hospital.

A female young adult said:. At the hospital, they said 'we are not sure about this disease, but we shall give you these drugs. I started taking them, but the swelling remained; so the second month, we returned to the hospital.

They said, we can't do the investigation here, so they referred me to Ocean Road. A final concern participants mentioned was the poor cancer care available once they were diagnosed and receiving treatment. Patients who are arriving at the hospital are told to go buy medicine. I suffer much pain and the pain becomes worse at night. Participants expressed receiving poor care at the hospital and that staff communicated poorly regarding treatment and care. Sometimes you find sand in your food.

Sometimes the beans are half cooked. Female young adults mentioned not having lights at their toilets and outside the toilets.

Adult services tanzania

Adult services tanzania

Adult services tanzania