Stephen Maluka PhD Candidate, MA (DS)

1. Decentralization and health care prioritization process in Tanzania: From national rhetoric to local reality Stephen Maluka PhD Candidate, MA (DS) Priorities 2010: Boston, USA

2. Outline of the presentation • Background • Objective of The Study • Conceptual Framework • Study area & Methods • Findings • Conclusion Priorities 2010: Boston, USA

3. Background • During the 1990s, Tanzania adopted health sector reforms (HSRs) • Objectives of HSRs are improving: • efficiency, • equity and • resource mobilization, through leadership, accountability and partnerships at all levels in the health system • The most common policy change under HSRs has been decentralization. • Fiscal (financial), political and administrative Priorities 2010: Boston, USA

4. Background Cont…….. • As part of the reform programmes, the MoH developed guidelines for district level planning and PS. • The planning guidelines called for partnership in the process of setting priorities. • The partners who were identified were the CHMT local government authority, health facility managers, health facility committees and boards, NGOs, private service providers, and communities. • Aimed at facilitating sensitivity to local priorities, providing space for public involvement, and improving the flexibility, efficiency and accountability of resource use Priorities 2010: Boston, USA

5. Objectives of the Paper • Analyse how was health care decentralization being carried out at the local level (how were priorities identified, negotiated and included in the district plans)? • How did organizational and institutional contexts influence participatory and accountability mechanisms? • How was power exercised during the prioritization process at the district level? Priorities 2010: Boston, USA

6. Conceptual Framework (Walt & Gilson, 1994) CONTEXT • ACTORS • individuals • Groups • organizations CONTENT PROCESS Priorities 2010: Boston, USA

7. Study Setting Mbarali district in Mbeya region of Tanzania. Why Mbarali? - a “typical” rural district in Tanzania and also within the reach for the research institutions. Priorities 2010: Boston, USA

8. Methods Priorities 2010: Boston, USA

9. Findings: What do health policy and guidelines say? • PS to be coordinated by the CHMT • The CHMT collect needs from health facility & community before planning. • Priorities based on locally available data & in light of Nationally defined EHP. • Interventions based on severity, feasibility and CEA. • Actual resource allocation based on budget ceilings. • Priorities to be accommodated in CCHP. Priorities 2010: Boston, USA

10. Policy vs. practice in priority setting process in Mbarali District Priorities 2010: Boston, USA

11. Findings cont....... • The CCHP do not reflect community needs • No clear delineation of responsibilities & relationships between health committees & boards. • Power imbalances in the priority setting process in the districts. • The CHMT had limited autonomy Priorities 2010: Boston, USA

12. Conclusion • Tanzania has good policies on participatory planning & PS –but not implemented. • Public engagement in PS & decision-making is persistent challenge. • Power imbalances limit input from community in decision making. • Engaging citizens & community interest groups is important to ensure broader values and perspectives. • Communities need both opportunity & capacity for true empowerment. Priorities 2010: Boston, USA

13. Thank you Asante Sana Priorities 2010: Boston, USA