CAN THE POOR AFFORD ‘FREE’ HEALTH SERVICES? A CASE STUDY OF TANZANIA. B Abel-Smith and P Rawal. (London Shoo I of Economics and Political Science). Health Policy and Planning. Vol 7 N04. 1992. 12 pages.
This study, based on interviews of nearly 900 outpatients and over 1,800 households, points out that, because of inadequate supplies of drugs and of food at hospitals, many patients have to incur substantial costs to use the ‘ free’ services. Information was collected on travel time, travel cost (84% of rural patients had to walk; only 7% used a bicycle) ) and waiting time (an average of about one and a half hours); which health facilities were chosen (18% of the poorest people used mission services; 42% used government services) and why; the cost of using them (average total cost of admission to hospital varied from Shs 500 to Shs 5,000) and difficulty in finding the money to pay and willingness to pay user charges.
Other useful statistics: there are 6 referral hospitals; 17 regional hospitals; 129 district hospitals; 266 health centres; 2,205 dispensaries; and, 1800 village health centres. (3% of the population is within 10 kms of a health facility). However, the level of government financing is not sufficient to provide for this substantially expanded service and even the poor often have to resort to the private sector and pay.
Is there a case for charges in government hospitals? The following represents a much abbreviated summary of the authors’ conclusions:
– To stop frivolous use? No, as government service are far from free and waiting time discourages unnecessary use.
– Because the mission health services make a charge? No. The government and non-government services are perceived as serving separate markets. Those using government services do so primarily because they are cheap. Those using mission services primarily because drugs are available.
– To improve services for all users? Yes, if the money can be used to improve the services, especially the provision of drugs.
– To lighten the burden on the poor? Yes. As the poorer section of the population are the main users of the government services they would be better off if drugs were always available, free only for the poor and at modest charge for other users.
But the administrative problems of collecting the charges, exempting the poor and ensuring that charges are used in improving services points to the need for any change in policy to be very carefully planned – DRB.
AID TO AFRICAN AGRICULTURE: LESSONS FROM TWO DECADES OF DONORS’ EXPERIENCE. Uma Lele (Ed). Johns Hopkins University Press. 627 pp. $52.95.
This book is a result of a study launched by the World Bank in 1984 under the title, “Managing Agricultural Development in Africa” (MADIA), in a collaborative project between the Bank and seven other donors and six African governments – Kenya, Malawi, Tanzania, Cameroon, Nigeria and Senegal.
Between 1970 and 1987 Tanzania received the highest level of official development assistance; this peaked at US$ 684 million in 1987. During this period donors contributed a total of US$ 8.1 billion; Sweden was the largest contributor. A substantial amount of the aid was directed to agriculture, which is responsible for 58% of the GDP and 86% of the employment, but it grew at only 1.45% per annum, while population grew at 3.1%.
Several authors from the major donor countries describe the successes and failures of their aid programmes in Tanzania, including valuable comments on the lessons learned. The Danish aid programme devoted about 30% of its resources to agriculture in which livestock and co-operatives were the major recipients. An interesting lesson from this programme was that poverty-oriented projects, focused on marginal producers, were neither replicable nor sustainable.
African socialism, as defined by President Julius Nyerere, had great appeal to the Swedish aid constituency. Initially a substantial part of this aid was concentrated on agriculture and rural development; the latter had a very large component of rural water supplies. By 1984 nearly 40% of the rural population had received supplies but only about half were functional because of lack of attention to operation and maintenance. The review concludes that it is essential to quantify the recurrent costs when designing an aid project and it emphasises that Sweden must improve its understanding of the macro-economic issues if it is to be a more effective donor.
Unlike Sweden, the UK was not strongly in favour of the political system and consequently its aid programme had not the same long term commitment. After a period of project aid with substantial investment in agriculture, it decided that these resources could be more efficiently used in programme aid, directed to agricultural inputs and policy reform. The review notes that agricultural research, which was strongly supported in the colonial era, had deteriorated, but concluded that long term support like that given to cotton research had left the most useful legacy.
The descriptions of the German, EEC, US and World Bank aid projects show that they too have had mixed success in their attempts to help Tanzania.
This book provides an excellent review of several important lessons that must be incorporated into future development programmes if they are to fulfil both the country and the donors’ expectations.
John K. Coulter
DONKEY’S GRATITUDE. THE PENTLAND PRESS. Tim Harris. 1992. 478 pages. £21.95 (hardback).
When Tim Harris arrived in Bukoba, as D.C., I was then a standard VII pupil at Ihungo Secondary School some three miles north of the district headquarters. My status then could allow only a glance of him from a distance during rare occasions such as Empire Day celebration. When I joined the Tanzanian Civil Service in Dar es Salaam in 1963, Harris had already terminated his term of office though his memories in the capital were still fresh. In more recent years when visiting my daughter at the University of Bristol, I was reminded that Bristol was his birth place. All this background enabled me to read with exceptional enthusiasm and pleasure Donkey’s Gratitude.
The book narrates a lifetime from the cradle to the grave and presents, in a palatable prose full of humour, the experience of an unusual colonial administrator. It provides a deep insight into the emotional, physical and intellectual elements of which a colonial career is made as well as the circumstances which might influence the choice of colonial service as a calling.
Harris’ journey from Cornwall to Tanganyika and his arrival in Dar es Salaam was marked by traumatic experiences which might have discouraged anyone with a weaker will power. It is, however, the details of the daily chores in Korogwe, Singida, Iringa and other places, which provide captivating scenes. Overall, the book reveals a rare Cornish character undaunted by the debilitating climate, hostile environment and unsympathetic hierarchy in Dar es Salaam.
Equally revealing is the account of the district administrator who became a scapegoat of the higher echelons of the bureaucracy on the one hand, and the disenchanted natives, on the other. The fact that on many occasions he had to defend the interests of the subjects against the demands of the colonial structure, elevates his status to that of a good philanthropist.
The painstaking details of the places, individuals and communities tend to enhance the wide application of the book. The episodes relating to roads, ravines, streams, animal trails, and so on, appear to breathe life into what would otherwise have been spots on a map. Narratives on goats, trout, gazelles, elephants confirm the author’s love for nature and demonstrate his highly observant and analytical mind.
His interactions with domestic servants, the sick, litigants and social groups reveal a rich, humane heart committed to the advancement of the African.
Inadvertently or otherwise, the author has provided an interesting insight into the culture of a number of communities including the Barbaig, the Kwavi, the Hehe and the Haya. His analysis covers tribal idiosyncrasies with respect to such traits as honesty, discipline and work attitude.
There are a few shortcomings however. Foremost, the narrative has not ben able to identify specific themes so as to highlight how certain targets were formulated and pursued. While the reader can appreciate the coherence generated by adherence to chronology, one encounters unnecessary repetitiveness.
Secondly, the dating of some events and the identification of the actors is regrettably subdued, most likely in order to minimize controversy. However, the overall effect of this, which involves the use of pseudonyms, is to reduce the value of the account as an historical reference.
Lastly, the chapter on specific philosophical themes such as religion, Nilohamitic Bantu conflict, witchcraft, etc., should be presented in the annex because they do not fit into the flow of the narrative. They constitute significant digressions which are amateurishly presented.
However, this book is a rare narrative on colonial experiences and contrasts with the accounts produced by historians, anthropologists, and other categories of theorists. As an account of personal experience it is unexcelled and should be a good reference for any student on Tanzania.
The language considerably enhances the value of the book. The softness of the style that is seasoned by cynical humour makes the book an ideal accompaniment in a good English course for Tanzanians. The local setting of the narrative enhances the readability of the book which is a must for anyone aspiring to the civil service of Tanzania as well as jurists.
One cannot doubt the disappointment experienced by the author on the day of Independence following the action of an angry and mocking mob. One ought to remember I however, that ingratitude being one of the earliest sins of man is bound to be encountered by those who inherited the reins of government and who, after some three decades of leadership, ought to have discovered already that a donkey’s gratitude is a kick in the stomach.
Dr. C.M. Tibazarwa
(Sadly, Tim Harris died before completing the book and the final chapter was written by Geoffrey Bullock – Ed)
BEING MAASAI. ETHNICITY AND IDENTITY IN EAST AFRICA. Eds: T Spear and R WaIler. James Currey. Cloth £35. Paper £12.95.
This book is about the several peoples who speak Maa, the Maasai language, and not only about the proud and photogenic, red-caped and red-ochred pastoralists who tourists travel to East Africa to gawk at. It includes the camel herding Ariaal of northern Kenya, the Okiet of the forests, the cultivating Arusha, the Parakuyo and others who are often not thought of as ‘proper Maasai’. ‘Maasai society is seen as encompassing a triangle of economic forces – pastoralism, hunting-gathering and agriculture – within which the complex cultural structures were both highly differentiated and complimentary’. The myths which have come to surround, and partially obscure, Maasai ethnic identity are questioned in order to understand: firstly, the cultural mixes which compose that identity; secondly, how that identity has endured, so remarkably and so persistently, despite all the gloomy prognostications that it was doomed. Hinde published a book in 1901 entitled ‘The Last of the Masai’ about the Kenyan Maasai, and Merker, their first serious ethnographer, forecast in 1910 that in Tanganyika they would soon cease to be Masaai. Both authors, of course, were quite wrong. Reasonably enough, neither had realised how resistant to cultural swamping so many African cultures were to prove themselves to be.
The book is divided into five titled sections: an ‘Introduction’ which is a prospectus; ‘Becoming Maasai’ which has one linguistic and five historical essays; ‘Being Maasai’ which has four essays on contemporary negotiations of identity; ‘Constraints & Redefinitions’ which has three essays on changing perceptions of identity in response to modern developments such as market forces, emergent social class and politics; and a brief ‘Conclusion’. Including the editors there are fourteen contributors but nevertheless the book is a triumphant unity. Prehistory, linguistics, history and social anthropology are used to complement each other and produce that rarity, a real interdisciplinary study written in accessible prose. The book is both a major contribution to Maasai studies and to African studies as a whole. There is hardly a redundant word, so summary in a brief review would only be misleading. I can only point to those essays which may be of most interest to the general reader.
Students of Tanzania will particularly enjoy Spear’s essay ‘Being Maasai’ but not ‘People of the Cattle; Arusha agricultural Maasai in the Nineteenth Century’; but they should certainly not restrict themselves just to that. The short essay by Sommer and Vossen on dialects is original and, unlike so much linguistics, reasonably comprehensible to the non-specialist. ‘The World of Telelia’ is the mature and touching reflections of a woman who is the senior of seven wives, the mother of two daughters and four sons and the grandmother of thirteen grandchildren. Her words (accompanied by an unobtrusive commentary) were recorded by Paul Spencer, whose knowledge of Maasai is unmatched, as his own essay on maturing into becoming a proper man demonstrates. ‘Aspects of “Becoming Turkana'” by John Lamphear demonstrates how, the Turkana were able to displace and/or assimilate their Maa-speaking neighbours in the nineteenth century, by a rather subtle territorial drift, but punctuated by interactions, borrowings, adjustments, conflicts and assimilations (p87). The essay is a salutary corrective to the myth that the Maasai were so terrifying that they overcame wherever they went. It also complements Sobania’s fine essay on the defeat and dispersal of the Laikipiak. Both those last two essays add to the current revaluation of the “permanence” of East African tribal and clan names which has been initiated by Gunther Schee and David Turton.
Finally, the essay by Donna Klump and Corrine Kratz on Okiek and Maasai perspectives on bodily ornamentations is itself a gem. The data are new. So are the insights into the ways in which girls and women construct individual ethnic identities and reinterpret, through appropriation and modulation, the symbolic content and patterns of the beadwork adornments they make for themselves and their friends.
P T W Baxter
STATE AND INSTITUTIONAL RESPONSES TO PARASTATAL GROWTH IN TANZANIA. J Wagona Makuba. Scandinavian Journal of Development Alternatives. Vol. 11. Nos 3 and 4. Sept-Dec 1992. 21 pages.
TRAINING MICROENTREPRENEURS: DOES IT PAY? Irmgard Nubler. Small Enterprise Development. December 1992. 10pp. This paper describes an ILO evaluation methodology.
AGRICULTURAL CREDIT IN TANZANIA: THE POLICY AND OPERATIONAL PROBLEMS OF THE COOPERATIVE AND RURAL DEVELOPMENT BANK. Anacleti K Kashuliza. savings and Development. 1992. Vol. 16. No 4. 25 pages
ZUR DISKUSSION: IMPORTHILFE STATT EXPERTEN EINE BETRACHTUNG AMFALL TANZANIA. In German. (‘For Discussion: Import Aid Instead of Experts: Reflections using the Example of Tanzania’). Helmut Zell. vierteljahresberichte. December 1992. This short paper argues that growth arises from development aid is often hindered by shortage of foreign exchange. The solution is to use savings in project aid for the importation of the means of production.
SOUTH ASIANS IN EAST AFRICA. An Economic and Social History, 1890-1980. Robert G Gregory. 402pp. 1992. westview Press.$65. Chapter headings include ‘The Primary Occupations’ – Commerce Transport, Clerical etc.: ‘The Secondary Occupations’ – Law, Medicine, Teaching etc. and ‘The Exportation of Savings and Profits’ .
SOUTH-SOUTH TRADE AND DEVELOPMENT: MANUFACTURERS IN THE
INTERNATIONAL DIVISION OF LABOUR. S Folke and others. MacMillan. 1992. 267 pages. Case studies from seven countries including Tanzania.
LIBERALIZING TANZANIA’S FOOD TRADE. Deborah Fahy Bryceson. James Currey. 1993. £35 (Cloth) £ 12.95 (Paper). The author shows why and how Tanzania liberalized trade in staple rice and maize and how the process has affected 197 grain traders and 188 houseolds in five Tanzanian towns.
ADUI MBELE (Enemy in Front). John pitt. 95 pages. £5.00. Obtainable from the author, Flat 20, Parklands, Eynsham Rd., Farmoor, Oxford OX2 9NL. The book contains the recollections of a young Tanganyika Forest Officer on Kilimanjaro who joined the Tanganyika Battalion of the King’s African Rifles in 1940 and subsequently served in Somali land, Abyssinia and Madagascar.
SAFE MOTHERHOOD IN TANZANIA. K Kanda and R Landy. World Health. May-June 1992. 2 pages.
TRYING ANIMAL TRACTION. G Mwakitenge and W Beijer. ILEIA Newsletter. Vol. 8. No 3. 1992. 2 pages. The authors describe how the animal traction component of an integrated agricultural project in Mbozi district in Mbeya Region was developed in collaboration with local services.
IS DIABETES MELLITUS RELATED TO UNDERNUTRITION IN RURAL TANZANIA? A B Swai and others. British Medical Journal. Vol. 305. October 1992. 6 pages. This paper is based on a study in eight villages in four regions. The short answer to the question posed in the title is no. Diabetes is not more common in the most undernourished members of the population and is much less common in Tanzania than in well nourished Western populations.
A CULTURAL ANALYSIS OF THE ECONOMY OF AFFECTION AND THE UNCAPTURED PEASANTRY IN TANZANIA. T Waters. Journal of Modern African Studies. Cambridge Univ Press. Vol. 30. No 1. 1992.
UNESCO GENERAL HISTORY OF AFRICA. Vol. Ill. AFRICA FROM THE SEVENTH TO THE ELEVENTH CENTURY. Editor: I Hrbek (from Czechoslovakia). James Currey. 1992. £5.95. The latest volume of this excellent (and remarkably reasonably priced) series contains, unfortunately, very little about Tanzania and what it does contain is, necessarily, tentative e.g.: ‘some of the Southern Cushites appear to have known of iron as early as the period of Bantu settlement’ … ‘among the proto-Chaga there arose a new kind of chiefly position in which the chief was not tied to a single clan .. this development appears to coincide with the emergence of mature highland planting agriculture’ …. ‘trade appears not at all to have penetrated the East African interior … ‘
PASTORALISM, CONSERVATION AND DEVELOPMENT IN THE GREATER SERENGETI REGION. International Institute for Environment and Development Issues Paper No 26. M S Parkipuny. 1991. 31 pages. Indicates how wildlife conservation affects rural development in the Serengeti.
STRATEGIE DE DEVELOPPEMENT ET AJUSTEMENTS STRUCTURELS, UNE ALTERNATIVE A LA POLITIQUE DU FMI: APPLICATION A MADAGASCAR ET A LA TANZANIE. G Blardone. Canadian Journal of Development Studies. Vol 13. No 1. 9 pages. 1992. Analyses the impact of IMF structural adjustment programmes.
LOCAL AGRO-PROCESSING WITH SUSTAINABLE TECHNOLOGY: SUNFLOWER SEED OIL IN TANZANIA. E L Hyman. International Institute for Environment and Development Gatekeeper Series No 33. 1992. 15 pages.
CROSS-CONDITIONALITY, BANKING REGULATION AND THIRD WORLD DEBT. E Rodriguez and S Griffith-Jones. McMillan. 1992. 347 pages. Contains case studies from six countries including Tanzania.
REVENUE PRODUCTIVITY OF THE TAX SYSTEM IN TANZANIA, 1979-1989. N E Osoro, Univ of Dar es Salaam. Journal of African Economies. Vol 1. No 3. 21 pages. This paper mentions some of the tax reforms which have occurred in Tanzania and points out, with mathematical formulae, how an elastic tax structure is appropriate in a developing country since it implies that tax collections will grow automatically with growing income without the need for resort to politically sensitive tax rate increases.
ZANZIBAR – OLD BUILDINGS AND OLD AND NEW SKILLS. S Holmes and M wingate. Appropriate Technology. Vol 19 No 3. 1992. 3 pages. An analysis of small-scale lime production is followed by recommendations on surveying buildings in Stone Town so as to arrest the decay and protect the lives of the inhabitants.
THE TANZANIAN PEASANTRY. P G Forster and S Maghimbi (Eds). Avebury. 1992. 287 pages. A dozen contributors write on such subjects as anthropological research, cooperative policy, peasant production, marketing, the environmental crisis.