Afya Maoni Wezesha: Using Citizen e-health Feedback to Improve Health Services in Tanzania

ESRF, in collaboration with Columbia University, Muhimbili University, and Wezesha, is implementing the Afya Maoni project, funded by JPAL. This project aims to evaluate the impact of a digital SMS-based client feedback platform “Afya Maoni” on healthcare outcomes. Specifically, it seeks to assess how the platform influences changes in behavior and knowledge, improves the quality of care, and enhances overall citizen health outcomes.

The evaluation focuses on three levels: citizens and communities, healthcare workers, and government officials. The intended impact includes reducing mortality rates (e.g., maternal and child) and morbidity rates (e.g., HIV, TB, and malaria). To achieve this, the study employs a randomized controlled trial (RCT) methodology to rigorously evaluate the effects of the e-health feedback platform on healthcare service quality, the satisfaction of both community members and healthcare workers, and health outcomes.

The project is being implemented in 950 health facilities across 85 districts and their catchment areas, providing a comprehensive assessment of the platform’s potential to transform healthcare delivery and outcomes.

Dignity at Work: Improving Employer-Worker Relations in Informal Labor Market

This project focuses on addressing the challenges faced by domestic workers by identifying key issues and testing effective, practical solutions to enhance their quality of life. Recognizing that dignity and respect are among the core values domestic workers prioritize, the study aims to promote these as workplace norms within the informal labor market.

The research builds on the IDInsight Dignity Initiative by adapting and redesigning a dignity-focused workshop tailored specifically for employers of domestic workers. This workshop is designed to encourage employers to reflect on the critical importance of dignity and respect in their interactions with domestic workers. The project aims to foster positive changes in employers’ beliefs and preferences, strengthen employer-domestic worker relationships, improve working conditions, and reduce labor turnover within this informal labor sector. By addressing these challenges, the initiative seeks to establish dignity and respect as foundational workplace norms, ultimately enhancing the well-being of domestic workers.

This initiative is a collaborative effort involving reputable institutions, including the University of Zurich, the Norwegian School of Economics, UC Irvine, an edutainment company, and CVM Tanzania. The research team is currently working with the edutainment organization to contextualize the training materials, conduct pilot tests, and implement a large-scale randomized controlled trial (RCT) to analyze the intervention’s effectiveness.

Generating and meeting demand: Using journalists to increase health service uptake in Tanzania (Afya Yako Supply Side)

The supply side of the Afya Yako Project aims to improve the quality and uptake of government health services in Tanzania’s rural and peri-urban areas, focusing on COVID-19 vaccinations, maternal and child health, HIV, mental health, and reduced reliance on traditional medicine.

The ESRF implements the project in collaboration with Columbia University, Tanzania’s National Institute of Medical Research (NIMR), and 47 vetted local radio stations, the project leverages accountability journalism to address service delivery gaps.

The intervention for this project involves training journalists on relevant topics and locally appropriate journalistic techniques, supporting radio stations/journalists to visit health facility catchment areas to identify problems encountered by patients, convening collaborative meetings with health experts, providers, and district officials to develop improvement plans, and produce follow-up radio programs to assess progress after four months. The initiative delivers a total of 300 programs across the country, shining a spotlight on health service performance, improving bureaucratic oversight, and rebuilding citizen trust in government services.

Can radio reduce Intimate Partner Violence? A national wide RCT in Tanzania

 This project builds on the established partnership between ESRF and Columbia University, focusing on the role of community radios in advancing national development. Following previous studies on combating public health misinformation and strengthening health service delivery through accountability journalism, this study explores how community radios can help reduce Intimate Partner Violence (IPV) in Tanzania.

The project leverages mass media to increase the uptake of public health services and challenge attitudes and norms that perpetuate IPV, encouraging victims to seek help and perpetrators to change their behavior. It also aims to foster community support, increase reporting of IPV incidents, and promote collective action to address structural causes of violence.

The project utilizes community radio stations to produce and broadcast 12 Sauti Ya Tiba episodes each lasting for 15 minutes and broadcasted over 12 weeks. Out of 12 episodes,4 episodes will focus on general public health messaging, while 8 will address IPV, highlighting its impacts and modeling effective responses.

 

Impact Evaluation Lab

The Impact Evaluation Laboratory’s core purpose is to champion impact evaluation work in Tanzania. The lab has been particularly successful in increasing the number of research projects that estimate the impacts of interventions by using standard Impact Evaluation research designs and implementation of small grants initiative programs for capacity development.

Read More https://www.esrf.or.tz/impact-evaluation-laboratory/#1591079922496-96ab4b38-99d8Small Grants Initiative

The Small Grants Initiative aims to build the capacity of junior and mid-career researchers interested in sharpening research skills using rigorous methods of Impact Evaluation. Under the auspices of the Impact Evaluation Laboratory, the IE Lab funds and supports researchers. The grantees are given funding of up to 5000 USD to carry out their projects. Additionally, they get mentorship from researchers at the lab, have to produce a paper or report, do a presentation at our “Utafiti Wetu” workshop, and also present at other avenues.

Utafiti Wetu Sessions

Utafiti Wetu is a 90-minute virtual workshop on Zoom, which brings together scholars from both within and outside of Africa to present their research to an audience primarily composed of academic faculty, both undergraduate and graduate students from Tanzania, as well as policy researchers from the government and private sector, among other participants.

Annual Impact Evaluation Training Courses

The Department of Governance and Capacity Development organizes short-term training courses as part of strategies for strengthening the capacities of researchers and policy analysis in articulating research findings. The training courses aim at imparting knowledge to both researchers and users of research findings to strengthen their capacity in the management of development processes in different sectors. The training course covers, the introduction to core methods of impact evaluation, introduction to fieldwork design for impact evaluation, and the introduction to data analysis using STATA software.

Afya Yako: Countering public health misinformation through community radio (demand side)

The study examines the role of community radio in combating public health misinformation, addressing a critical development challenge posed by the widespread dissemination of false health-related information. Radio, an influential and underutilized medium, remains the primary source of information for rural populations in Sub-Saharan Africa. Evidence suggests that local radio can effectively mobilize citizens, making it a promising tool for improving public health outcomes.

Health misinformation on topics such as traditional medicines, maternal health, mental health, and COVID-19 continues to be prevalent. The project leverages a local radio campaign, Sauti Ya Tiba (“Voice of Treatment”), to enhance public health service delivery, particularly in rural areas, by promoting accurate health information.

The project is a collaborative effort between ESRF, Columbia University, and NIMR, with funding provided by the Social Science Research Council (SSRC) under its Mercury initiative, a joint enterprise with the Rockefeller Foundation. A Randomized Controlled Trial (RCT) approach is employed to rigorously assess the impact of the local radio campaign on public health knowledge, behaviors, facility-level service delivery, and overall health outcomes in Tanzania.

Overcoming budget, availability, and attention constraints to healthy diets in Tanzania

This project was initiated to address the growing problem of diet-related noncommunicable diseases, driven by shifting food consumption patterns. Funded by the International Development Research Centre (IDRC), the study was conducted in the urban low-income setting of Temeke District, Dar es Salaam, Tanzania. It aimed to assess the impact of food subsidies on dietary habits among low-income households. Using a randomized controlled trial (RCT) design, the intervention provided vouchers for healthy food items—such as eggs, UHT milk, and unflavoured yogurt—to households in the treatment group over three months. The target population, characterized by limited access to nutritious foods and high reliance on processed options, benefited from improved dietary diversity and access to nutritious food.

The intervention yielded significant outcomes. During the subsidy period, the consumption of UHT milk and eggs increased by 1.635 and 2.355 days per week, respectively. Post-intervention, milk consumption remained marginally higher, suggesting a possible shift in dietary preferences. However, unintended consequences were observed, including increased consumption of unhealthy complements like added sugar, illustrating the complexity of influencing dietary behaviors. Minimal spillover effects were observed among neighbouring households, except for notable changes in soda and juice consumption. These findings highlight nuanced social and environmental factors affecting dietary patterns.This study underscores the potential of food subsidies to enhance access to and consumption of nutritious foods among low-income populations. However, it also reveals the need for complementary strategies to mitigate unintended increases in unhealthy food consumption. These insights provide valuable guidance for policymakers and development practitioners aiming to design effective nutrition and health interventions in resource-constrained urban environments.

SMS campaign on COVID-19 vaccine in Tanzania

The study aimed to address high COVID-19 vaccine hesitancy in Tanzania by evaluating the effectiveness of SMS campaigns in promoting vaccination uptake. Specifically, the interventions tested whether messages emphasizing empathy (altruism for others) or self-interest (long-term health impacts) could influence vaccination behavior. The primary objectives were to assess the impact of these messages on self-reported vaccination status, vaccine trust and hesitancy, and compliance with COVID-19 mitigation measures, such as mask-wearing and social distancing. This project was funded by the Partnership for Economic Policy (PEP), a research funding agency that integrates capacity-building elements within its framework. It was implemented in collaboration with the National Institute for Medical Research (NIMR), leveraging both research expertise and field knowledge.

A randomized placebo-controlled trial was conducted with 17,209 participants drawn from a nationally representative sample. Participants were randomly assigned to three groups: one received messages emphasizing the potential harm to others caused by non-vaccination (Empathy Treatment), another received messages highlighting the personal health benefits of vaccination (Self-Interest Treatment), and a placebo group received unrelated messages. Data collection involved phone surveys conducted three weeks after the intervention, with statistical analyses evaluating the outcomes.

The results indicated no significant effects of the SMS interventions on vaccination rates, vaccine trust, or compliance with COVID-19 mitigation measures. These findings were consistent across various demographic groups, suggesting limited influence of the messages. The null results may be attributed to the substantial efforts of government-led vaccination campaigns that were simultaneously underway, including community outreach, public education, and social media initiatives. The study highlights the challenges of using SMS-based interventions in contexts where robust public health strategies are already in place.

Click here to review the working paper https://www.pep-net.org/publications/working-papers

In addition to the four (4) core areas of work itemized above, another major area work for the department is to host and implement some long term research and capacity development programs of interest to the Government of Tanzania, the ESRF and our partners. Some of the projects under implementation by the department at the moment include Impact Evaluation Laboratory and Tanzania Urbanization Laboratory.

The department organizes policy dialogues sessions as a way of communicating research findings produced within ESRF as well as findings of studies implemented by our partners. At least 10 policy dialogues are being implemented each year. Some examples of policy dialogue sessions implemented in recent years is indicated on events section.

Since 2012, the ESRF through Department of Governance and Capacity Development implements a series of annual conferences. The objective of these high level conferences is to bring together wide variety of stakeholders of development processes in the country and have a dialogue on a particular subject of topical relevancy to country’s development process. A list of the annual conferences is provided on conferences section on events.

The Department of Governance and Capacity Development organizes periodic public seminars aiming at engaging members of the general public in discussion forums of matter of relevancy to policy processes in the country. More information on public seminars is provided on the section on events.

1. Internship positions.

The Economic and Social Research Foundation offers internship opportunities to students for academic credit up to Masters Level. All internship positions are non-paid – and therefore students are expected to provide proof that they can meet their cost of living including medical coverage/insurance while in Dar es salaam at ESRF for the internship.

We accept qualified and enthusiastic students who have interest in Economic Policy and Management, Public Administration, Political Science, Economics, Finance/Accounting, Computer Science, International Trade, International Development Studies and other social science related research topics. Since computer skills are helpful in all areas of activities you shall be involved in at ESRF, students should have knowledge of some basics of computer applications. Students should also have excellent verbal and written communication skills, should be willing to work under constraints, abide by professional standards and be trusted with sensitive and confidential materials.

While at ESRF, students will be trained to research, analyze information and prepare reports and/or proposals. The duties that may be assigned to students include proposal writing, data collection and analysis, research report writing and other special projects. All students accepted for internship positions at ESRF shall be assigned supervisors with whom they shall work throughout their stay at the foundation. We encourage students to be open minded and willing to learn and adapt to new research techniques and methodologies as may be required in the various assignments they are involved in from time to time.

ESRF will report back to the candidates’ respective institutions on any progress and misconduct related to the attached candidates.

2. Work Schedule

Work schedules are flexible, depending upon individual office requirements.

3. How to Apply

To apply for internship opportunities, submit the following in one complete package to the address below:-

– Cover letter discussing career goals, computer skills, and your area of interest.
– Resume.
– Official university/college transcript(s); undergraduate and graduate (if applicable).
– Two current letters of recommendation from individuals who can speak for your background and skills in the performing arts and/or arts administration and your ability to learn. Letters must arrive in sealed envelopes with the signature of the letter writer appearing across the envelope flap.
– A letter from your sponsor/learning institutions confirming that you shall be able to finance your stay in Dar es Salaam and throughout your engagement with ESRF.

All materials submitted become the confidential property of the Economic and Social Research Foundation.

4. Application Deadlines.

All applications and related materials must arrive in one package and must be written in English or have a certified translation. They should reach ESRF 2 months prior to the commencement of the field attachment. An official acceptance letter shall be sent to the successful applicant(s) within two to four weeks after the deadline to confirm the dates of their internship period. If you don’t hear from us after that time please consider your application unsuccessful.

When reporting, the successful applicant(s) will be required to produce this acceptance letter to ESRF.

5. Foreign Students.

– Foreign students whose applications for internship positions at ESRF are successful will be required to process for appropriate visa and work permit before coming to Tanzania. The Foundation does not process these permits but may, upon request, issue a letter of confirmation that may be used to process for the permit at the Tanzanian high commission/embassy in the applicant’s country.
– Any successful applicants who report without appropriate work/research permit will be automatically disqualified (tourist visa is not acceptable).
– Applicants who are successful will be required to arrange for their accommodation in Dar es Salaam on their own and at their earliest convenience.