Do Institutions Matter? Explaining HIV Prevalence Variations Across Regions in Tanzania

This work researched on the institutions for implementing policies for HIV prevention in Tanzania. It was designed to explain why HIV prevention services are producing contrasting results across regions in Tanzania. Two sampled cases were used for the purposes of this study: high HIV Prevalence case (Njombe region) and high to low to “reversing” HIV prevalence case (Kagera region). The study employed institutionalism as a frame for analysis. Moreover, the study relied largely on qualitative methods for data collection and analysis. Three methods of data collection were employed; documentary review, in depth interviews and focus group discussions. Respondents for the interviews included government officials from National AIDS Control Program, Tanzania AIDS Commission (TACAIDS) and the Prime Minister’s Office-Regional Administration and Local Government (at district level downwards). Other interviewees were from Civil Society Organizations. Participants for the FGDs were drawn from the study villages and included ordinary citizens. The findings of the study show that the enforcement of institutions is constrained by growing clashes between the formal and formal rules on one hand and between formal and informal rules on the other hand leading to unfavorable conditions which in turn affects people’s acceptance attitude towards HIV prevention services. In addition, performance of the institutions is constrained by limited capacity indicated by shortages of human, financial and infrastructural resources. The study concludes that institutions matter, but their actual performance with regard to policy implementation depends on local conditions under which they operate.