This document provides information about Tanzania and Medicos del Mundo's work there. It summarizes: - Tanzania's population, ethnic and linguistic diversity, poverty levels, and economic reliance on agriculture. - Medicos del Mundo's history working in Tanzania since 1995 on projects related to primary healthcare, HIV/AIDS, and sexual and reproductive health. - The process used in 2008-2009 to identify and select Same and Singida districts for a new project, including rapid rural appraisals, interviews, and participatory rural appraisals over 3 months. - Characteristics of Singida Rural District where Medicos del Mundo works, including its population, ethnic groups, poverty

1. PRA Introduction Briefly history of MdM in TZ
 Estimated population (Census 2002): 38,329,000  PHC (1995-2000)
Extension: 3 times Spain
 Ethnic diversity: more than 120 ethnic groups  Arusha Region (Karatu District)
 Official language: Swahili and english
 IDH 2007: 159 (177)  HIV/AIDS (2000-2008)
 IDG 2007 (Renta, Alfab, Esp.Vida):
138 (157)  Pwani, Arusha and Zanzibar
 Poverty. 57.8% de la población vive por debajo del
umbral de la pobreza (1$ día)  SRH&R, since March 2009
 Economy. Crecimiento anual PIB entre 6 y 7%  Pre-identification process (10/2007-03/2008)
 Agriculture.  Criteria of MdM, extension, sub-sector
(50% PIB; 85% X; 90% trab.)
 48 regions. 13 indicators (poverty, access to health and SSR)
 Cultivable. 4% de superficie
 Cultivos  13 district preselected (communication, logistic, knowledge)
 Consumo interno. Maíz, arroz, trigo,
 Questionnaires (neccessity, capacity, resources) to DMO
mijo, alubias
 Exportación: café, té, flores, sisal, caña  Selection of Same and Singida (March 2008)
de azúcar, cebollas
 Otras exportaciones: tanzanita, oro, pesca,
 Rapid rural appraisal on Same and Singida. April/May 2008
turismo  Interviews with community members, focal groups, secondary data
 Participatory Rural Appraisal (PRA). 3 months
Program cycle (Same Program) Characteristics of Singida Rural District
Year 2009: Opening of program and office
PRA =  MdM works in 2 Divisions (Comarcas) among 7
IDENTIFICATION process May-July 09 divisions in the District (Provincia) (whole district cover
in 9 years by phases)
Revision of results and
reformulation in August 09
 Population: around 80.000 inhabitants (census 2002)
collaboration with SDC
 Different ethnic groups.
From Sept 09  Nyaturu majority
Implementation of Program Activities
 High extension and low density
Continuous Evaluation From Sept 09  Singida Region is the poorest region in TZ
PRA LIMITATIONS Some PRA Techniques and Results
In the Community meetings Secondary data sources
 Poor participation of women  Population for every village range between 3500 – 4000
(1570 male & 1960 Female)
 They have big expectation from Medicos del Mundo
 VEOs doesn’t have data relating with health
 Majority of participants ask what is next after PRA problems in the village.
 Data from Health facility shows that the top five disease
 Poor coordination between Village Executive Officers and are, Malaria, Diarrhea, ARI, Pneumonia and Anemia
community
 In the village that doesn’t have health facility we fail to
 In some village the participants were not the initial ones have statistical data of health problem from VEOs
 Language barrier (kinyaturu vs kisuahili)
 Cholera

2. Some PRA Techniques and Results Some PRA Techniques and Results
Interview to youth (FGD) Interview to PW: age range (19 – 48 yrs)
 Age range (18 – 34)  Delay to attend clinic during pregnant period, one with nine
month attend only two time
 Lack of Knowledge on SRH & R (77% of youth interview
lacked SRH&R knowledge)  Most of them deliver their previous pregnant at home and still
they are planning to do so. (65% under TBAs and 35% under
 Sexual harassment done to the student by their teachers HCP)
 Early pregnancy (85% responded on presence of early pregnancy)  Workload of PW was very high, minimum they are working almost 14
to 17 hours per day
 Lack of knowledge about Sexuality and HIV
 Lack of support from their partners (only 46% receive support)
 They know about condoms but never use it (96% knows, but only
27% use it)  Distance to the nearest health facility rise between Half to 15 km
 Parents are not transparent to them on issues related to SRH & R  Transport fees range between 20000/= to 30000/=(11.4 to 17.14
Euro)
 Behaviour, like using drugs, robbery, cigarette and alcoholism
 Poor balanced diet
Some PRA Techniques and Results Some PRA Techniques and Results
Interview to TBAs: age range (45 – 75 yrs) Gender Resources Mapping and pictorial
 Lack of support from government Gender Based Violence
 Associated with unequal power relation & decision making
 Women beaten with theirs sexual partner
 Most of them are not using protective and delivery equipment  Sexual abuse and harassment
 Patriarchal system
 Most of them attend 3 to 10 deliveries and even more women  Sexual suppression
within a month (example Ghata Village)
FGM: (information were provided in a very secretly way)
 Some refer the complicated case to nearest health facility
 Still practiced very secretly to new born babies except Merya village
 Most of them are aged  In FGD they mention a lot of advantage and few disadvantages
 Some wish to stop
 Lack of knowledge on SRH & R (96% lack the knowledge)
Raping cases
 They don’t have a skills on detecting complicated cases  Marital raping were noted (happen when one spouse forces the other
to have sexual intercourse)
 There are reported raped cases by more than one man
 Some reported that even children are raped (example in Ilongero were
2 children were raped to death).
Pair wise ranking General impressions of facilitators
 lack of HF in many villages, long distance from households to HF in
Need Num villages on Position
st
Comments/result 62 villages we have only 17 health facilities
1 position  Shortage of skilled staff and equipment: discourages patients to
attend the HF
Education on SRH&R to the community 17 1 Early and unwanted  Difficult access in some villages for emergencies due to bad situation
pregnancies of roads
Lack of safe and clean water 10 2
 TBAs have an active role in their community but most feel
not recognized by authorities
Absence of Health facility 9 3 Most PW not attend clinic and  Lack of motivation to VHC
Home delivery
 Lack of Income generating activities
Diseases 8 4 Malaria, Pneumonia,  Alcoholism, Drug abuse
Diarrhoea,  Food insecurity
Out dated traditional and customs 7 5 FGM  Illiteracy especially to women
 As a result of illiteracy and lack of income generating activities
Poor infrastructure 6 6 Weather roads opportunities :
Poor health services 4 7 Human resources and  Imbalanced decision making and resource ownership between
equipment men and women
Domestic violence 4 8 Patriarchal, Women beating,
 Gender based violence: raping , FGM, biting women & children
Raping  Lack of family planning: economic burden for families, lack of
opportunities
Poor Nutrition 4 9 PW and children are more
affected

3. Asanteni kwa kunisikiliza
Thanks for listening!!!
Muchas gracias