The Government of Tanzania has decided to prioritise the available resources to strategic sectors so as to realise the Big Results Now (BRN). The Education Sector is among the six prioritised sectors, which has developed 9 key initiatives to improve the quality of basic education and thereby increasing the pass rates in Primary and Secondary Schools. The Official School Ranking as per examination results according to the performance and improvement is among the 9 initiatives. In this ranking, schools are classified into bands of three major groups namely Green, Yellow and Red representing High, Medium and Low performing schools respectively. The schools' information will bring community awareness and engagement as well as improve transparency and accountability.
The rest of the paper is organised as follows: Section 2 provides a short background on NOSs in Tanzania, in particular on recent attempts to foster them. Section 3 explains our concept and methodology. Section 4 presents the major results and Section 5 draws conclusions and elaborates the implications for politically guiding and privately managing NOSs.
The field research was carried out between February and April 2015 in five regions (Iringa, Mbeya, Morogoro, Njombe, Pwani) of Tanzania, as well as in Dar es Salaam, by a team of six researchers from the German Development Institute (DIE). They were supported by a team from the University of Bayreuth, who collected data on the sugar sector, following the same methodology. Local cooperation partners were the Institute for Development Studies from the University of Dar es Salaam, and the Sokoine University of Agriculture. Preliminary results were presented at a workshop in Dar es Salaam at the end of April 2015, where numerous stakeholders provided feedback.
However, some groups are particularly vulnerable to negative impacts, such as women, pastoralists (who are not found everywhere, though), socially weak members of the communities and individuals who are not sufficiently compensated for lost land or other livelihood components, or who do not wisely use their compensations. Quantitative research partially supports this (Osabuohien et al. 2015a, b). The negative impacts on particular groups of rural people is particularly highlighted by NGO-commissioned studies, such as Tandon (2010), Land Rights Research and Resources Institute (2010), Benjaminsen and Bryceson (2012), Oakland Institute (2012), Action Aid (2015), Twomey et al. (2015) and Oakland Institute et al. (2015). The human rights approach highlights individual negative cases, particularly those affecting the weakest parts of the communities. However, the obvious disregard of positive impacts and the lack of rigorous sampling procedures makes it difficult to compare these results with ours, and we think we present the more complete picture.
The leadership and managerial capacity-building programme was designed to be a blended model comprising in-person workshops, e-learning modules and mentoring; informed by the observational findings during initial implementation of the ASDIT project, a project-specific health care provider survey at primary health facilities, and the results of the 2018 BRN assessment conducted by the Quality Assurance Unit of the Ministry of Health. The leadership and management programme for the study was developed to incorporate standard components of leadership, management and the health system, as listed in Table 1. Modules were developed by the team using its collective expertise, peer-reviewed literature, and other publicly available leadership workshops.
As part of the final assessment, the study team used the BRN Star Rating assessment tool to assess the overall quality of services at the facilities and compared results with the findings in the 2018 assessment conducted by the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), which was used as the baseline measure given that it was completed in August 2018. Aimed at improving the quality of healthcare, the BRN Star Rating system measures the performance of various healthcare facilities, with more stars indicating better quality of services. The BRN assessment covers a range of topics, including strengthening leadership capacity and practice, implementing strategic plans, succession planning, clarity on tasks, roles and responsibilities, regular supervisory visits, and improved supply chain mechanisms . The tool was developed by the Tanzania MoHCDGEC quality assurance unit through a consultative process .
The survey measured three key leadership indicators of team climate, role clarity/conflict and job satisfaction, with improved team leadership, role clarity and job satisfaction indicating improved leadership capacity. In this section, results from the analysis of the focus groups are inserted to provide context and support for the survey findings.
The aim of this capacity-building initiative was to address the observed gaps in leadership and management within the participating centres, which occurs at every level of the health system and provides the structure within which the health workforce provides quality health care. The results of this evaluation are discussed in terms of how this initiative addressed areas of leadership and management capacity overall, health workforce factors, and quality of health care provision while also providing insight into continued areas for improvement and scaling up beyond the initial participant group. The limitations of the evaluation are also discussed.
Important to leadership and management for the health workforce is the ability to manage change and cultivate an environment for achieving the behaviour change required. Strengthening leadership requires intervention at individual, team and system levels [4, 29] to have a sustainable impact on the ability for the health system to provide safe and quality health services. In addition, distributed and collective leadership within health care organizations have been shown to contribute to a greater alignment between clinicians and managers  and can impact the ability to influence change . A blended approach is thought to be beneficial to ensuring leadership, management and governance training needs for health professionals are met [12, 30]. The results and experiences of this project support these previous findings that a blended approach, in this case comprising face-to-face, e-learning modules, and on-site mentoring, is useful for ongoing development of skills within the workplace which in turn, will continue to have a positive effect on the functioning of the health facilities.
The authors confirm contribution to the paper as follows: Study conception and design: All authors. Data collection: A.N., G.M., Z.A. and L.M. Analysis and interpretation of results: G.TM., A.N., J.L., G.M and J.R. Draft manuscript preparation: G.TM. and J.R. All authors reviewed the results and approved the final version of the manuscript.
Table 4 shows the results from the multivariable pooled Poisson regression models for the factors associated with stunting across two survey phases. We found that for phase I; children living in rural areas had 10% (APR=0.9, 95% CI: 0.81, 0.99) lower prevalence of getting stunted. Children born to mothers who had at least secondary education had 20% (APR=0.8, 95% CI: 0.64, 0.9), 30% (OR=0.7, 95% CI: 0.64, 0.86) lower prevalence of being stunted for phase I and II respectively. The prevalence of getting stunted decreased as the levels of household wealth increased; there were 50% (APR= 0.5 95% CI: 0.44, 0.6), 40% (APR= 0.6 (95% CI: 0.48, 0.7) and 50% (APR= 0.5 (95% CI: 0.43, 0.59) lower prevalence of getting stunted among children living in the richest wealth index households for phase I, II and III respectively. (Table 4).
Most of the determinants except the area of residence had a positive impact on socioeconomic inequalities in stunting. This is explained by the higher risk of stunting among the disadvantaged socioeconomic groups who were majority thus the combined marginal effect of each determinant influenced socioeconomic status. The larger contribution of the disparities in household wealth index on the socioeconomic inequalities in stunting may be explained by the majority of stunted children living in poor and poorest wealth indexes. Similar results by [26, 27] implyd that equal distribution of stunting across socio-economic groups will be attained if efforts are embarked on equal distribution of socio services like roads, water, and hospitals which will easy transportation of raw materials for construction of houses, availability of safe water at the household level and health monitoring respectively.
The declined contribution of differentials in area of residence on the socioeconomic inequalities in stunting may be explained by governmental efforts of distributing socioeconomic infrastructures in both rural and urban areas which bridges up the gap. These results were consistent with other scholars [30, 45], although the area of residence may be interlinked with other socioeconomic factors including wealth and level of education . Furthermore, the effect of area of residence on stunting was confounded by wealth index.
Despite the drawn conclusions basing on our study findings, these results should be interpreted with caution as the study faced several limitations. Firstly, inadequate information collected from the respondent for-instance lack of information on religion and maternal feeding practices and dietary diversity; lacking these information give the room of worrying about confounding effects as these variables were not included in the model. Secondly, children not living with their mothers were not included in this study; this may lead to biased estimates. Thirdly, the comparability problem of the household wealth index across surveyed years because different items were used in the construction of wealth index across surveyed years. Fifth, the study adhered to Wagstaff and Wantanabe decomposition methods which are limited to continuous variables or dichotomous variables. Last but not least, the study investigated stunting without taking into account of nutritional diseases including underweight and wasting which may be interlinked with stunting. 153554b96e