Strengthening national capacities for researching on Social Determinants of Health (SDH) towards informing and addressing health inequities in Tanzania

Abstract

BackgroundTanzania’s socio-economic development is challenged by sharp inequities between and within urban and rural areas, and among different socio-economic groups. This paper discusses the importance of strengthening SDH research, knowledge, relevant capacities and responsive systems towards addressing health inequities in Tanzania.MethodsBased on a conceptual framework for building SDH research capacity, a mapping of existing research systems was undertaken between February and June 2012. It involved a review of national policies, strategies and published SDH-related research outputs from 2005 onwards, and 34 in-depth interviews with a range of stakeholders in Tanzania.ResultsThe conceptualization of SDH varies considerably among stakeholders and their professional background, but with some consensus that it is linked to “inequities” being a consequence of poverty, poor planning, limited attention to basic humanity and citizenship rights, weak governance structures and inefficient use of available resources. Commonly perceived SDH factors include age, income, education, beliefs, cultural norms, gender, occupation, nutritional status, access to health care, access to safe water and sanitation and child bearing practices. SDH research is in its infancy but gaining momentum. In the absence of a specific “SDH portfolio”, SDH research is scattered and hidden within disease specific, poverty-related research and research on universal health coverage. Research is mainly externally funded, which has implications on the focus of context specific SDH research, national priorities and transfer to policy. This create mismatch with population and research capacity needs.ConclusionMost research analysis in the country fails to consider the context specific structural determinants of health and inequities towards a broader understanding of existing vulnerabilities. The challenge is on promoting a culture of critical inter-disciplinary research and analysis that is central to SDH research. Establishing a system to promote collaboration across sectors and strengthen collective capacities for individuals and institutions researching in SDH will augment existing SDH research initiatives and better inform appropriate intersectoral policies towards addressing prevailing health inequities across the country.

Inequalities in global health inequalities research: A 50-year bibliometric analysis (1966-2015)

“…These respective asymmetries in the global scientific output and collaborations appear to mirror the geopolitical hierarchies and the subsequent dependencies and conditionalities that are known to have been created over time; it is surely no coincidence that the countries known for being international funding sources and also the countries at the core of these global research collaborations [ 76 – 78 ] and those known to be more 'dependent' on external research funding are on the periphery. In many lower income countries, the majority of research is externally funded, which may play a role in fostering and influencing the types of domestic vs. international research collaborations that are built, as well as potentially creating donor-driven research agendas that may influence policy agendas, and decisions on national research priorities, which may not necessarily correspond to local population needs [ 29 , 30 , 38 , 79 ].…”

Stakeholders’ opinions and questions regarding the anticipated malaria vaccine in Tanzania

“…As found in this study, religion and ethnicity may play a significant role towards inequity in immunization coverage. Health inequity is known to be a set back to the wider health development, and this could be addressed by examining the wider social and structural aspects that increase vulnerability to diseases [ 30 – 33 ]. Evidence in Nigeria indicates that the community tailored interventions have proven to be effective in increasing the utilization of polio vaccination [ 34 ].…”

Mothering, Albinism and Human Rights: The Disproportionate Impact of Health-Related Stigma in Tanzania

“…As a result, the health outcomes of a person and population are related to the structural determinants and conditions of daily life that comprise the SDH and are responsible for the majority of health inequities between and within countries (UN Economic and Social Council (UNECOSOC) 2000). Mtenga et al (2016) studied how strengthening SDH was important for addressing health inequities in Tanzania, as there are significant discrepancies within urban and rural areas with a direct impact on access to health care. They found that the majority of research in Tanzania fails to consider the context-specific structural determinants of health and inequities that provide a broader understanding of existing vulnerabilities.…”

“…A second way in which health systems differentially impacted these mothers and their children was in a lack of direct access to the health services required by persons with albinism that leads to health inequities (Mtenga et al 2016). Decreased access, particularly to skin and vision clinics, was pronounced in rural settings and for those living in poverty.…”

“…Tanzania is described as a country where spiritualized cosmologies infuse political, economic, and private spheres of life, and where the religions of its colonizers-Christianity and Islam-are increasingly indigenized (Imafidon 2018;Olupona 2014). Tanzania achieved independence in 1961 through relatively peaceful processes but its development is undermined by persistent poverty and sharp inequalities, including urban and rural differences and gender imbalances (Mtenga et al 2016). Patriarchal norms suppress many women in Tanzania, especially those impacted by little-known disabilities such as those related to the condition of albinism (Nyangweso and Olupona 2020;UNGA 2016).…”