<prompt> Translate the following text to SwahiliAdjustments in managed care need to be made--and under pressure from consumers and their representatives in Congress, they are already being made.  <response>: Marekebisho katika huduma kusimamiwa zinahitaji kufanywa - na chini ya shinikizo kutoka kwa watumiaji na wawakilishi wao katika Bunge, tayari zinafanywa. 