Participation in health planning in a decentralised health system: Experiences from facility governing committees in the Kongwa district of Tanzania

Abstract

Tanzania introduced the decentralisation of its health systems in the 1990s in order to provide opportunities for community participation in health planning. Health facility governing committees (HFGCs) were then established to provide room for communities to participate in the management of health service delivery. The objective of this study was to explore the challenges and benefits for the participation of HFGCs in health planning in a decentralised health system. Data were collected using semi-structured interviews and focus group discussions (FGDs). A total of 13 key informants were interviewed from the council and lower-level health facilities. Five FGDs were conducted from five health facilities in one district. Data generated were analysed for themes and patterns. The results of the study suggest that HFGCs are instrumental organs in health planning at the community level and there are several benefits resulting from their participation including an opportunity to address community needs and mobilisation of resources. However, there are some challenges associated with the participation of HFGCs in health planning including a low level of education among committee members and late approval of funds for running health facilities. In conclusion, HFGCs potentially play a significant role in health planning. However, their participation is ineffective due to their limited capacities and disabling environment.

Youth underrepresentation as a barrier to sexual and reproductive healthcare access in Kasulu district, Tanzania: A qualitative thematic analysis

“…We contributed to the conceptual understanding of representation by revealing that a mere presence of representative participatory organs and having individuals participating in the activities of these organs should be taken as a means rather than an end within itself. The findings challenge the assumption that the existence of decentralized community-and facility-level decisionmaking arrangements such as HFGCs would automatically improve youth representation and subsequently the accessibility of SRH services (Frumence et al 2014;Kilewo and Frumence (2015); URT 2001). It is worth learning that each community has a system of cultural norms through which policies are assigned meanings.…”

“…As some of the previous studies have already revealed (Campero et al 2011;Frumence et al 2014;Damian 2018), effective representation of community voices and health concerns needs to entail at least three major dimensions. The first dimension is the physical presence of representatives of interested community groups in decision-making organs.…”

Effects of the EQUIP quasi-experimental study testing a collaborative quality improvement approach for maternal and newborn health care in Tanzania and Uganda

“…District resources were more limited in Uganda than those in Tanzania where pooled basket funding of approximately one USD per capita is made available to districts and can be spent on local priorities [40]. Improvement teams in Tanzania also tapped into other local resources available through the scale-up of community health funds and other insurance schemes [48], and this might have led to greater improvements in the availability of oxytocin, infection prevention items and supervision in Tanzania compared to those in Uganda. As drugs and supplies are crucial not just to provide quality care, but also to keep health workers motivated and increase community demand, this could be an additional factor.…”

Factors influencing the work efficiency of district health managers in low-resource settings: a qualitative study in Ghana

“…In Ghana, decentralisation was initiated following the Ghana Health Service (GHS) and Teaching Hospital Act (Act 525) in 1996, which involved de-concentration of authority to the RHAs and DHAs in the country [ 6 , 7 ]. Benefits of decentralisation identified in various countries include higher regional and local authority, accountability, improved implementation of health care strategies based on need, greater efficiency, and increased responsiveness to community requirements [ 8 – 11 ]. However, health care decentralisation has also been associated with negative effects, such as the delayed transfer of funds from national government, lack of technical capacity of local governments, and inequity [ 12 – 15 ].…”