Tax compliance in an EFD-enabled environment: Evidence from a developing economy

The focus of this study was to assess the contribution of Electronic Fiscal Devices (EFDs) to ensuring tax compliance among small business owners in the Arusha Region in Tanzania. The study was motivated by the fact that the government of Tanzania has invested effort and funds to ensure that revenue adequately supports development projects. Regardless of effort, there is continued reliance on external sources of funds to support development projects. This poses a question on how the introduction of EFDs would increase tax compliance and eventually impact the government income for development projects. The main objective of the study was to determine whether the rate of using EFDs, the level of transparency, fairness in tax procedures, and the perceived audit effectiveness affect the level of tax compliance. Data was analyzed using descriptive procedures, One Way ANOVA, Chi-Square, and ordinal regression. Findings of the study are as follows: First, fairness in tax procedures, the perceived level of transparency and the rate of EFD use had no impact on the level of tax compliance; second, business and EFD use experience, audit effectiveness, and the use of EFDs in tax audits have impacted tax compliance. The study recommends other government departments to consider adopting relevant technology in operational areas where transparency, fairness and compliance are required. The inclusion of other sectors not currently captured by EFD use will be a step in the right direction.

Effectiveness of Hospitality Programme Design in Developing Skills among the Graduates from Vocational Education and Training in Arusha Region, Tanzania

Tourism and hospitality sector in Tanzania contributes to 18 percent of the Gross Domestic Product (GDP) and about 10 percent employment rate in the country. However, industry professionals are complaining about the quality of human resource from training institutions. While some authors have addressed the quality of human resources in relation to graduates’ skills possession using the managers, trainers and the nature of services they render, the researcher could not find a study that has addressed the issue in relation to programme design from the trainers, heads of department and hotel managers. This study was set to answer the main research question: How is VET hospitality programme designed to contribute to skills development among the graduates in Arusha region? The study employed convergent design to assess VET hospitality programme design in developing skills among the graduates. Participants were obtained through simple random sampling of training institutions and purposive sampling of hotels belonging to HAT in Arusha region. Data were collected through semi structured interview with the hotel managers and heads of department, structured interview with the trainers and content analysis of programme document. Data were analyzed by transcription of data from the interviews. Programme activities were used to analyze the collected data and used for data interpretation. Interpretation and discussion of data analysis results were summarized and compared with the reviewed literature and theories. The findings for this study indicated that VET programme for Food and Beverages Service and Sales and Front Office Operations are well designed to enhance skills development among the graduates and if well implemented should lead to the acquisition of hospitality knowledge, skills, values and attitudes. English and communication skills, as a supporting course needs to be structured for implementers to understand designated learning outcomes, learning activities, teaching and training methods and assessment activities.

Missed opportunity for family planning counselling along the continuum of care in Arusha region, Tanzania

Introduction Adequate sexual and reproductive health information is vital to women of reproductive age (WRA) 15 to 49 years, for making informed choices on their reproductive health including family planning (FP). However, many women who interact with the health system continue to miss out this vital service. The study aimed to identify the extent of provision of FP counselling at service delivery points and associated behavioral factors among women of reproductive age in two districts of Arusha region. It also determined the association between receipt of FP counselling and contraceptive usage. Methods Data were drawn from a cross-sectional survey of 5,208 WRA residing in two districts of Arusha region in Tanzania; conducted between January and May 2018. Multistage sampling technique was employed to select the WRA for the face-to-face interviews. FP counseling was defined as receipt of FP information by a woman during any visit at the health facility for antenatal care (ANC), or for post-natal care (PNC). Analyses on receipt of FP counseling were done on 3,116 WRA, aged 16–44 years who were in contact with health facilities in the past two years. A modified Poisson regression model was used to determine the Prevalence Ratio (PR) as a measure of association between receipt of any FP counseling and current use of modern contraception, controlling for potential confounders. Results Among the women that visited the health facility for any health-related visit in the past two years, 1,256 (40%) reported that they received FP counselling. Among the women who had had births in the last 30 months; 1,389 and 1,409 women had contact with the service delivery points for ANC and PNC visits respectively. Of these 31% and 26% had a missed FP counseling at ANC and PNC visit respectively. Women who were not formally employed were more likely to receive FP counselling during facility visit than others. WRA who received any FP counseling at PNC were significantly more likely to report current use of modern contraception than those who did not (adjusted PR [adj. PR] = 1.28; 95% Confidence Interval [CI]: 1.09, 1.49). Conclusion Overall, only 40% women reported that they received any form of FP counseling when they interfaced with the healthcare system in the past two years. Informally employed women were more likely to receive FP counselling, and women who received FP counselling during PNC visits were significantly more likely to use contraceptive in comparison to the women who did not receive FP counselling. This presents a missed opportunity for prevention of unintended pregnancies and suggests a need for further integration of FP counseling into the ANC and PNC visits.

Predictors of contraceptive discontinuation among postpartum women in Arusha region, Tanzania

Background Postpartum contraceptive discontinuation refers to cessation of use following initiation after delivery within 1 year postpartum. Discontinuation of use has been associated with an increased unmet need for family planning that leads to high numbers of unwanted pregnancies, unsafe abortion or mistimed births. There is scant information about contraceptive discontinuation and its predictors among postpartum women in Tanzania. This study aimed to determine predictors of contraception discontinuation at 3, 6, 12 months postpartum among women of reproductive age in Arusha city and Meru district, Tanzania. Methods This was an analytical cross-sectional study which was conducted in two district of Arusha region (Arusha city and Meru district respectively). A multistage sampling technique was used to select 13 streets of the 3 wards in Arusha City and 2 wards in Meru District. A total of 474 women of reproductive age (WRAs) aged 16–44 years residing in the study areas were included in this analysis. Data analysis was performed using STATA version 15. Odds ratios (ORs) with 95% confidence interval (CI) for the factors associated with contraceptives discontinuation (at 3, 6 and 12 moths) were estimated in a multivariable logistic regression model. Results Overall, discontinuation rate for all methods at 3, 6, and 12 months postpartum was 11, 19 and 29% respectively. It was higher at 12 months for Lactational amenorrhea, male condoms and injectables (76, 50.5 and 36%, respectively). Women aged 40–44 years had lower odds of contraceptive discontinuation at 3 months as compare to those aged 16 to 19 years. Implants and pills users had also lower odds of contraceptive discontinuation compared to injectable users at 3, 6 and 12 months respectively. Conclusion Lactational amenorrhea, male condoms and injectables users had the highest rates of discontinuation. Women’s age and type of method discontinued were independently associated with postpartum contraceptive discontinuation. Addressing barriers to continue contraceptive use amongst younger women and knowledge on method attributes, including possible side-effects and how to manage complications is warranted.

Economic Costs of Providing District- and Regional-Level Surgeries in Tanzania

Background: Access to surgical care is poor in Tanzania. The country is at the implementation stage of its first National Surgical, Obstetric, and Anesthesia Plan (NSOAP; 2018-2025) aiming to scale up surgery. This study aimed to calculate the costs of providing surgical care at the district and regional hospitals. Methods: Two district hospitals (DHs) and the regional referral hospital (RH) in Arusha region were selected. All the staff, buildings, equipment, and medical and non-medical supplies deployed in running the hospitals over a 12 month period were identified and quantified from interviews and hospital records. Using a combination of step-down costing (SDC) and activity-based costing (ABC), all costs attributed to surgeries were established and then distributed over the individual types of surgeries. These costs were delineated into pre-operative, intra-operative, and post-operative components. Results: The total annual costs of running the clinical cost centres ranged from $567k at Oltrumet DH to $3453k at Mt Meru RH. The total costs of surgeries ranged from $79k to $813k; amounting to 12%-22% of the total costs of running the hospitals. At least 70% of the costs were salaries. Unit costs and relative shares of capital costs were generally higher at the DHs. Two-thirds of all the procedures incurred at least 60% of their costs in the theatre. Open reduction and internal fixation (ORIF) performed at the regional hospital was cheaper ($618) than surgical debridement (plus conservative treatment) due to prolonged post-operative inpatient care associated with the latter ($1177), but was performed infrequently due mostly to unavailability of implants. Conclusion: Lower unit costs and shares of capital costs at the RH reflect an advantage of economies of scale and scope at the RH, and a possible underutilization of capacity at the DHs. Greater efficiencies make a case for concentration and scale-up of surgical services at the RHs, but there is a stronger case for scaling up district-level surgeries, not only for equitable access to services, but also to drive down unit costs there, and free up RH resources for more complex cases such as ORIF.

Association between dietary diversity with overweight and obesity: A cross-sectional study conducted among pastoralists in Monduli District in Tanzania

Background The prevalence of overweight and obesity is rising at a rapid pace and is associated with negative health consequences like cardiovascular diseases, type 2 diabetes and cancer. Obesity is a multifactorial problem that develops mainly from lifestyle factors including physical inactivity and poor dietary intake. Dietary diversity is a simplified method for assessing the adequacy and quality of diet and is associated with nutritional need and overall health status. Therefore, we conducted this study to synthesize the associations between consumption of a diversified diet and overweight/ obesity among adults living in pastoral communities in Monduli district in Tanzania. Methods This was a cross-sectional study conducted among 510 adults aged ≥ 18 years old in the Monduli district, Arusha region in Tanzania. We conducted face-to-face interviews to collect information about socio-demographic characteristics, 24-hours dietary recall, and anthropometric measurements. The dietary diversity score (DDS) was constructed and used to determine the diversity of the diet consumed. We performed the multivariate Poisson regressions to determine the prevalence ratio (PR) with 95% confidence intervals (CI). The dependent variables were overweight and general obesity as measured by body mass index (BMI), abdominal obesity measured by waist-hip ratio (WHR) and waist circumference (WC). Results The prevalence of general obesity based on BMI was 20.2% (95%CI; 16.9–23.9), abdominal obesity based on WHR was 37.8% (95%CI; 33.7–42.1), and WC was 29.1% (95%CI; 25.2–33.1). More than half (54.3%) of the participants consumed an adequate dietary diversity (DDS ≥4). After adjustment for potential confounders, the prevalence of abdominal obesity by WHR decreased with higher DDS among male (APR = 0.42; 95% CI, 0.22–0.77) and female participants (APR = 0.63; 95% CI, 0.41–0.94). There were inconsistent positive associations between DDS and prevalence of overweight and general obesity among male and female. There was no association between DDS and abdominal obesity by WC. Conclusion More than half of the pastoralists have consumed an adequate diversified diet. Given the inconsistent findings on associations between dietary diversity and obesity measures, this study suggests that targeting dietary diversity as an overweight/obesity prevention strategy requires careful consideration.

Using Group Model Building to Capture the Complex Dynamics of Scaling Up District-Level Surgery in Arusha Region, Tanzania

Background: Scaling up surgery at district hospitals (DHs) is the critical challenge if the Tanzanian national Surgical, Obstetric, and Anesthesia Plan (NSOAP) objectives are to be achieved. Our study aims to address this challenge by taking a dynamic view of surgical scale-up at the district level using a participatory research approach. Methods: A group model building (GMB) workshop was held with 18 professionals from three hospitals in the Arusha region. They built a graphical representation of the local system of surgical services delivery through a facilitated discussion that employed the nominal group technique. This resulted in a causal loop diagram (CLD) from which the participants identified the requirements for scaling-up surgery and the stakeholders who could satisfy these. After the GMB sessions, we identified clusters of related variables using inductive thematic analysis and the main feedback loops driving the model. Results: The CLD consists of 57 variables. These include the 48 variables that were obtained through the nominal group technique and those that participants added later. We identified 6 themes: patient benefits, financing of surgery, cost sharing, staff motivation, communication, and effects on referral hospital. There are 5 self-reinforcing feedback loops: training, learning, meeting demand, revenues, and willingness to work in a good hospital. There are four self-correcting feedback loops or ‘resistors to change:’ recurrent costs, income lost, staff stress, and brain drain. Conclusion: This study provides a systems view on the scaling up of surgery from a district level perspective. Its results enable a critical appraisal of the feasibility of implementing the NSOAP. Our results suggest that policy-makers should be wary of ‘quick fixes’ that have short term gains only. Long term policy that considers the complex dynamics of surgical systems and that allows for periodic evaluation and adaption is needed to scale up surgery in a sustainable manner.