Introducing payment for performance in the health sector of Tanzania- the policy process

Abstract

BackgroundPrompted by the need to achieve progress in health outcomes, payment for performance (P4P) schemes are becoming popular policy options in the health systems in many low income countries. This paper describes the policy process behind the introduction of a payment for performance scheme in the health sector of Tanzania illuminating in particular the interests of and roles played by the Government of Norway, the Government of Tanzania and the other development partners.MethodsThe study employed a qualitative research design using in-depth interviews (IDIs), observations and document reviews. Thirteen IDIs with key-informants representing the views of ten donor agencies and government departments influential in the process of introducing the P4P scheme in Tanzania were conducted in Dar es Salaam, Tanzania and Oslo, Norway. Data was collected on the main trends and thematic priorities in development aid policy, countries and actors perceived to be proponents and opponents to the P4P scheme, and P4P agenda setting in Tanzania.ResultsThe initial introduction of P4P in the health sector of Tanzania was controversial. The actors involved including the bilateral donors in the Health Basket Fund, the World Bank, the Tanzanian Government and high level politicians outside the Health Basket Fund fought for their values and interests and formed alliances that shifted in the course of the process. The process was characterized by high political pressure, conflicts, changing alliances, and, as it evolved, consensus building.ConclusionThe P4P policy process was highly political with external actors playing a significant role in influencing the agenda in Tanzania, leaving less space for the Government of Tanzania to provide leadership in the process. Norway in particular, took a leading role in setting the agenda. The process of introducing P4P became long and frustrating causing mistrust among partners in the Health Basket Fund.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-015-0125-9) contains supplementary material, which is available to authorized users.

From Scheme to System (Part 2): Findings from Ten Countries on the Policy Evolution of Results-Based Financing in Health Systems

“…In Uganda and Mozambique, strong concerns were raised about the long-term financial sustainability once donor funds were withdrawn. A sense of a donor-driven reform leading to weak national ownership was also noted in the design and implementation of the pilot in Tanzania, also reported in work by Chimhutu et al 13 Second, as we have seen from the examples of Chad and Mozambique, conceptualizing RBF as a vertical program, in terms of either its design (Mozambique) or administration and implementation (Chad), had negative implications for long-term program sustainability.…”

“…This finding highlights the importance for donors to develop clear terms for engagement with national stakeholders and ensure that the design and implementation of pilots contributes to strengthening health systems by addressing structural issues as opposed to undermining them. 13…”

Social Protection in an Electorally Competitive Environment (2): The Politics of Health Insurance in Tanzania

“…Overall, the two papers argue that both the introduction of PSSN and health insurances mirrored international trends at the time of introduction, but that the design of interventions and the timing of their implementation are decisively influenced by Tanzania's political economy. It is not uncommon to depict reforms as having been imposed on Tanzania (for a health-sector example, see Chimhutu et al, 2015), and indeed, the influence of international development partners is undeniable in both sectors. A reform coalition of bureaucrats and development partners has often driven the development of reforms and policy interventions.…”

Social Protection in an Electorally Competitive Environment (1): The Politics of Productive Social Safety Nets (PSSN) in Tanzania

“…Overall, the papers suggest that both the introduction of PSSN and health insurances mirrored international trends at the time of introduction, but that the design of interventions and the speed of their implementation are decisively influenced by Tanzania's political economy. It is not uncommon to depict reforms as having been imposed on Tanzania (for a health-sector example, see Chimhutu et al, 2015), and indeed the influence of international development partners is undeniable in both sectors. A reform coalition of bureaucrats and development partners has often been driving the development of reforms and policy interventions.…”