title: 'We do not do any activity until there is an outbreak': barriers to disease prevention and health promotion at the community level in Kongwa District, Tanzania.
abstract: BACKGROUND
  Little is known about the barriers to disease prevention and health promotion at the community level--within a decentralized health system.
  
  
  OBJECTIVE
  This paper, therefore, presents and discusses findings on barriers (and opportunities) for instituting disease prevention and health promotion activities.
  
  
  METHODS
  The study was conducted in Kongwa District, Tanzania, using an explorative case study approach. Data were collected through document reviews and in-depth interviews with key informants at district, ward, and village levels. A thematic approach was used in the analysis of the data.
  
  
  RESULTS
  This study has identified several barriers, namely decision-makers at the national and district levels lack the necessary political will in prioritizing prevention and health promotion; the gravity of prevention and health promotion stated in the national health policy is not reflected in the district health plans; gross underfunding of community-level disease prevention and health promotion activities; and limited community participation.
  
  
  CONCLUSIONS
  In this era, when Tanzania is burdened with both communicable and non-communicable diseases, prevention and health promotion should be at the top of the health care agenda. Despite operating in a neoliberal climate, a stronger role of the state is called for. Accordingly, the government should prioritize higher health-protecting physical, social, and economic environments. This will require a national health promotion policy that will clearly chart out how multisectoral collaboration can be put into practice.
authors.affiliation: Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; tumaininyamhanga@yahoo.com.
authors.forename: Tumaini
authors.initials: T
authors.lastname: Nyamhanga
authors.affiliation: Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Gasto
authors.initials: G
authors.lastname: Frumence
authors.affiliation: Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Mughwira
authors.initials: M
authors.lastname: Mwangu
authors.affiliation: Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden.
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Hurtig
mesh_terms: D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration; D004196:Disease Outbreaks / Q000517:prevention & control; D018166:Health Care Reform; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D019982:Organizational Case Studies; D011315:Preventive Medicine / Q000379:methods / Q000458:organization & administration*; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration; D013636:Tanzania / Q000453:epidemiology
keywords: Tanzania; barriers; disease prevention; health promotion
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