Features POPULATION AND HEALTH IN DEVELOPING COUNTRIES Population, Health, and Survival at INDEPTH Sites INDEPTH Network Focusing on health-seeking behaviour Fostering a community voice Health Impact Studies A community based research component Research Overview : Unique opportunity to test a process

The Tanzania Essential Health Interventions Project (TEHIP) aims to translate the 1993 World Development Report's prescription for global health reform into an action plan for improving health care at the district level in Tanzania. Specifically, the project is asking:

• How and to what extent can Tanzanian district health plans be more evidence-based (i.e., grounded in local research)?
• How and to what extent can such plans be implemented?
• How, to what extent, and at what cost do such planning interventions have an impact on population health?

All of TEHIP's research activities are designed to answer these core questions.

TEHIP: A Unique Approach to Building Research Capacity All of TEHIP's research activities are undertaken by Tanzanian researchers [see Research Overview: Unique opportunity to test a process in right-hand column]. A novel aspect of TEHIP's approach is that it funds research through a network of research programs, not as a collection of research projects. In other words, TEHIP does not support individual, short-term projects with specific research objectives. Rather, it facilitates research teams that tackle larger programs over several years. This requires teams or consortia for the four components or research themes: Health Systems, Health Behaviours, Health Impacts, and Planning Tools — each of which is subdivided into individual modules, and can be found below. Each research component addresses questions that demand the skills of numerous disciplines. Such skills and disciplines are often attached to different host institutions in the academic, governmental, nongovernmental, and private sectors. It was therefore necessary to assemble an interdisciplinary, inter-institutional research coalition to adequately and coherently address research questions within and across the four components.

HEALTH SYSTEMS RESEARCH (Component A)

The health systems research component focuses on district health planning, prioritization, and resource allocation processes. The principal research objective is:

• to determine how, and to what extent, district council health management teams can use locally generated information on burden of disease, cost-effectiveness, health system capacity, and community preferences to plan, set priorities, and allocate health resources.

This research component is concerned with process, content, context, and implementation issues, as well as the linkages among them. For example, how are priorities set? Who decides them? On what basis? What support is provided by district, regional and central levels? Is it effective? Do the plans address the priority burdens of disease and consider cost-effectiveness? Do the plans establish how the relevant activities are to be implemented? To what extent do district health managers control the allocation of health resources?

For a detailed description of the health systems research component and its modules, see: "Health Systems Research" in the right-hand column and at the bottom of the page.

Related links:

• Health System Planning Process
• What the district council health management team does

HEALTH BEHAVIOURS RESEARCH (Component B)

This component represents the largest research effort within TEHIP. It focuses on household health-seeking behaviours in relation to essential health interventions. The principal research objective is:

• to identify and analyze trends at the household level in the use of selected essential health interventions provided through district health management team plans with respect to spatial, social, and economic determinants.

Household behaviours may influence the very nature of CHMT planning processes and in turn be affected by CHMT plans. The household level is where health seeking behaviours, health service utilization, risk perception, household decision-making, and household expenditures for health are most likely to change. This research component explores such questions as: who uses health services, why do they use health services, and why do other people avoid using health services. It seeks to understand, for example, why only about half of the people who need malaria drugs actually visit a health facility to acquire them. This component also explores ways to bring "community voice" into a district's health planning process.

For a detailed description of the health behaviours research component, see: "Health Behaviours Research" in the right-hand column.

Related links (in right-hand column):

• Focusing on health-seeking behaviours
• Fostering a community voice

HEALTH IMPACTS RESEARCH (Component C)

This research component focuses on the demographic and health effects of health system process changes at the district level. The principal research objective is:

• to document burden of disease for priority setting and to quantify changes in the burden of disease to assess the impact of health reforms.

To measure short-term changes in the burden of disease, such as child mortality rates, TEHIP uses a demographic surveillance system (DSS) to continuously monitor births, deaths, and migrations in the Rufiji and Morogoro Rural districts. Without regular censuses or registration of births and deaths, household surveys have evolved as an efficient and cost-effective way to obtain household data in Africa's rural areas.

For a detailed description of the health impacts research component, see: "Health Systems Research" in the right-hand column and at the bottom of the page.

Related link (in the right-hand column):

• Health Impact Studies: A community-based research component

PLANNING TOOLS FOR HEALTH SYSTEM ANALYSIS (Component D)

This research component focuses on developing practical tools for routine district health system analysis and planning. The principal research objective is:

• to develop and/or validate practical tools for evidence-based planning processes for the CHMT level.

For information on TEHIP's toolkit, see: "TEHIP in Action" in the right-hand column.