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Decentralization and health care prioritization process in Tanzania: from national rhetoric to local reality
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.ORCID-id: 0000-0001-7087-1467
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.ORCID-id: 0000-0001-7234-3510
National Institute of Medical Research (NIMR), Dar es Salaam, United Republic of Tanzania.
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2011 (Engelska)Ingår i: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 26, nr 2, s. e102-e120Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

During the 1990s, Tanzania like many other developing countries adopted health sector reforms. The most common policy change under the health sector reforms has been decentralization, which involves the transfer of power and authority from the central level to local authorities. Based on the case study of Mbarali district in Tanzania, this paper uses a policy analysis approach to analyse the implementation of decentralized health care priority setting. Specifically, the paper examines the process, actors and contextual factors shaping decentralized health care priority setting processes. The analysis and conclusion are based on a review of documents, key informant interviews, focus group discussion, and notes from non-participant observation. The findings of the study indicate that local institutional contexts and power asymmetries among actors have a greater influence on the prioritization process at the local level than expected and intended. The paper underlines the essentially political character of the decentralization process and reiterates the need for policy analysts to pay attention to processes, institutional contexts, and the role of policy actors in shaping the implementation of the decentralization process at the district level. Copyright (c) 2010 John Wiley & Sons, Ltd.

Ort, förlag, år, upplaga, sidor
2011. Vol. 26, nr 2, s. e102-e120
Nyckelord [en]
decentralization; health care; priority setting; Tanzania
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Forskningsämne
folkhälsa
Identifikatorer
URN: urn:nbn:se:umu:diva-38476DOI: 10.1002/hpm.1048PubMedID: 20603818OAI: oai:DiVA.org:umu-38476DiVA, id: diva2:378230
Tillgänglig från: 2010-12-15 Skapad: 2010-12-15 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Ingår i avhandling
1. Strengthening fairness, transparency and accountability in health care priority setting at district level in Tanzania: opportunities, challenges and the way forward
Öppna denna publikation i ny flik eller fönster >>Strengthening fairness, transparency and accountability in health care priority setting at district level in Tanzania: opportunities, challenges and the way forward
2011 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background

During the 1990s, Tanzania, like many other developing countries, adopted health sector reforms. The most common policy change under health sector reforms has been decentralisation, which involves the transfer of power and authority from the central levels to the local governments. However, while decentralisation of health care planning and priority-setting in Tanzania gained currency in the last decade, its performance has, so far, been less than satisfactory. In a five-year EU-supported project, which started in 2006, ways of strengthening fairness and accountability in priority-setting in district health management were studied through action research. As part of this overall project, this doctoral thesis aims to analyse the existing health care organisation and management systems, and explore the potential and challenges of implementing Accountability for Reasonableness approach to priority setting in Tanzania.

Methods

A qualitative case study in Mbarali district formed the basis of exploring the socio-political and institutional contexts within which health care decision-making takes place. The thesis also explores how the Accountability for Reasonableness intervention was shaped, enabled and constrained by the interaction between the contexts and mechanisms. Key informant interviews were conducted with the Council Health Management Team, local government officials, and other stakeholders, using a semi-structured interview guide. Relevant documents were also gathered and group priority-setting processes in the district were observed.

Main findings

The study revealed that, despite the obvious national rhetoric on decentralisation, actual practice in the district involved little community participation. The findings showed that decentralisation, in whatever form, does not automatically provide space for community engagement. The assumption that devolution to local government promotes transparency, accountability and community participation, is far from reality.

In addition, the thesis found that while the Accountability for Reasonableness approach to priority setting was perceived to be helpful in strengthening transparency, accountability, stakeholder engagement and fairness, integrating the innovation into the current district health system was challenging.  

Conclusion

This thesis underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority-setting decisions. A broader and more detailed analysis of health system elements, and socio-cultural context, can lead to better prediction of the effects of the innovation, pinpoint stakeholders’ concerns, and thereby illuminate areas requiring special attention in fostering sustainability. Additionally, the thesis stresses the need to recognise and deal with power asymmetries among various actors in priority-setting contexts.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2011. s. 65
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1407
Nyckelord
decentralisation, health care, accountability for reasonableness, priority setting, health systems, Tanzania
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Forskningsämne
folkhälsa
Identifikatorer
urn:nbn:se:umu:diva-40377 (URN)978-91-7459-155-2 (ISBN)
Disputation
2011-03-18, Room 135, Family Medicine, Building 9A, Umeå University Hospital, Umeå, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2011-02-25 Skapad: 2011-02-22 Senast uppdaterad: 2018-06-08Bibliografiskt granskad

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Maluka, Stephen OswaldHurtig, Anna-KarinSebastián, Miguel San

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International Journal of Health Planning and Management
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi

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