User:LauraBarluzzi/sandbox

Tanzania is an Eastern African country which formed on 26th of April 1964. The capital is Dodoma but Dar es Salaam is the major commercial city. Between the 1978 and 2012 the population doubled up to a total of 44,929,000. Since 1981, the government started to implement neo-liberal policies which affected the whole society, including the health sector.

1964 – 1985: pre-liberalisation period
During these two decades, under Julius Nyerere, Tanzania was one of the few African countries promoting socialism in order to create an egalitarian society. With the 'Arusha Declaration' Tanzania tried to reach an indipendent development through ISI, parastatal companies and delegating the state the control of goods, services and the ownership of means of production.

'80s – '90s: liberalisation period
At the beginning of the '80s the economy had to deal with both external and internal shocks. Until 1986 the governement tried to follow a self-guided national programme. Later, it agreed to the Structural Adjustment Programme(SAPs) promoted and financed by the World Bank (WB), the International Monetary Fund (IMF) and development donors.

SAPs and general effects
Under the new government of Ali Hassan Mwinyi different programmes were applied such as the Economic Recovery Program (ERP) and the Economic and Social Action Program (ESAP). These policies outlined a neo-liberal agenda:


 * macroeconomic stabilization
 * medium-term horizon
 * economic growth in relation to the GDP
 * reduction of state control and expenditure
 * promotion of the private sector

Since 1986, the World Bank indicator has been showing an improvement of the GDP, presenting a positive outcome of the neo-liberal policies. Nevertheless, Shivji suggests that SAPs were a form of neo-colonialism through which masses were deactivated and elite reiforced, fueling social-economic inequality among the population. Moreover, the combination of inflation, currency devaluation, privatization, austerity and demographic growth caused an increase of commodities prices and a decreased of real earnings.

Changes and unintended consequences
The public health expenditure declined from 7.23% to 4.62 between the FY 1977/78 and 1989/90. As a consequence, new health facilities were not provided despite the growing population. According to Shivji (2006) “Structural Adjustment Programmes of 1980s destroyed the little achivements in education, health, life expectancy, and literacy that we had made during the nationalist period.”

Health workers
Among them there was a lot of discontent during the neo-liberal period as this meant worst working conditions, lack of independence, unemployment, lack of proper equipment and drugs. This led to strikes, violence and increasing corruption within the sector.

Cost-sharing
Cost-sharing was introduced with the intent of making people pay a part of their services. In this way, social inquality increased as the economic status of a person determined the ability to access or not to health services.

Women & children
Since 1980, despite maternal mortality giving birth is decreased, the socio-economic inequalities in the utilization of skilled birth attendance widened. Indeed, in 2010 a Domestic Housing Survey showed that births were 43% in households, 7% in other places and the rest 50% in facilities. Alongside, women lost their economic power and their working hours increased; 57% of women lives in absolute poverty and 1 million has diagnosed chronic malnutrition. Consequently, also children are affected; 40% of newborn deaths is due to LBW (low birth weight).

Water
The combination of public expenditure cuts promoted by the new policies and the significant demographic growth led, in the '90s, to a big concern in relation of safe water access. According to the present Ministry of Water “[w]ater is a basic need and right for all human beings. Value it and conserve it, for our very existence and development depends on it”. Nevertheless, the NGOs Wateraid claims that an approximate number of 22.3 million people, almost half of the population, still do not have access to safe water. In addition, the 2009 Water Health Profile states that since '90s the gap in access the water supply between rich and poor increased. Local governments tend to spend a little in the rural areas; for the financial year 2012/13, the 69% of the Water Sector Development Programme budget was for urban areas and only 21% for rural ones. Along side, since the government started to address the water issue as vital for the country, since 2000 the expenditure increased significally reaching a 1.2% of the GDP in the financial year 2006/07. Unfortunately, the absolute value of this persantage is still not enough for satisfying the growing, and diversified, population.