Browsing by Author "Kigume, Ramadhani"

Now showing 1 - 4 of 4
  • No Thumbnail Available
    Item
    Decentralisation and Health Services Delivery in Four Districts in Tanzania: How and Why Does the Use of Decision Space Vary Across Districts?
    (International Journal of Health Policy and ManagementManagement, 2018-10) Kigume, Ramadhani; Maluka, Stephen
    Background: Decentralisation in the health sector has been promoted in low- and middle-income countries (LMICs) for many years. Inherently, decentralisation grants decision-making space to local level authorities over different functions such as: finance, human resources, service organization, and governance. However, there is paucity of studies which have assessed the actual use of decision-making space by local government officials within the decentralised health system. The objective of this study was to analyse the exercise of decision space across four districts in Tanzania and explore why variations exist amongst them. Methods: The study was guided by the decision space framework and relied on interviews and documentary reviews. Interviews were conducted with the national, regional and district level officials; and data were analysed using thematic approach. Results: Decentralisation has provided moderate decision space on the Community Health Fund (CHF), accounting for supplies of medicine, motivation of health workers, additional management techniques and rewarding the formally established health committees as a more effective means of community participation and management. While some districts innovated within a moderate range of choice, others were unaware of the range of choices they could utilise. Leadership skills of key district health managers and local government officials as well as horizontal relationships at the district and local levels were the key factors that accounted for the variations in the use of the decision space across districts. Conclusion: This study concludes that more horizontal sharing of innovations among districts may contribute to more effective service delivery in the districts that did not have active leadership. Additionally, the innovations applied by the best performing districts should be incorporated in the national guidelines. Furthermore, targeted capacity building activities for the district health managers may improve decision-making abilities and in turn improve health system performance.
  • Thumbnail Image
    Item
    The Failure of Community-Based Health Insurance Schemes in Tanzania: Opening the Black Box of the Implementation Process
    (BMC Health Services Research, 2021) Kigume, Ramadhani; Maluka, Stephen
    Background: Globally, there is increased advocacy for community-based health insurance (CBHI) schemes. Like other low and middle-income countries (LMICs), Tanzania officially established the Community Health Fund (CHF) in 2001 for rural areas; and Tiba Kwa Kadi (TIKA) for urban population since 2009. This study investigated the implementation of TIKA scheme in urban districts of Tanzania. Methods: A descriptive qualitative case study was conducted in four urban districts in Tanzania in 2019. Data were collected using semi-structured interviews, focus group discussions and review of documents. A thematic approach was used to analyse the data. Results: While TIKA scheme was important in increasing access to health services for the poor and other disadvantaged groups, it faced many challenges which hindered its performance. The challenges included frequent stock-out of drugs and medical supplies, which frustrated TIKA members and hence contributed to non-renewal of membership. In addition, the scheme was affected by poor collections and management of the revenue collected from TIKA members, limited benefit packages and low awareness of the community. Conclusions: Similar to rural-based Community Health Fund, the TIKA scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. In order to achieve universal health coverage, the government should consider integrating or merging Community-Based Health Insurance schemes into a single national pool with decentralised arms to win national support while also maintaining local accountability.
  • No Thumbnail Available
    Item
    Health Sector Decentralisation in Tanzania: Analysis of Decision Space in Human Resources for Health Management
    (Willey & Sons, 2019-04) Kigume, Ramadhani; Maluka, Stephen
    While decentralisation of health systems has dominated the political arena in the low and middle income countries since the 1970s, many studies on decentralisation have focused on understanding who is given more decision-making authority but less attention is paid to understanding what that authority involves. This paper assesses the range of decision-making authority transferred from the central government to sub-national levels in the area of human resources for health management in Tanzania. This analysis was guided by the decision space framework and relied on interviews, Focused Group Discussions and analysis of documents. Data were analysed using thematic approach. While districts had narrow decision space on recruitment and promotion of health service providers, they had wide decision space on distributing health providers within districts and providing incentives. Centrally managed recruitments resulted in frequent delays, thereby intensifying shortages of skilled health service providers. This analysis concludes that decentralisation of Human Resources for Health planning and deployment role to lower levels of the administrative hierarchy in Tanzania is limited. This suggests the need for the central government to increase decision space to districts in the area of recruitment. In order for the Ministry of Health to perform its functions better in the area of human resources for health management, there is a need to strengthen the capacity of the department dealing with recruitment of skilled health staff at the Ministry of Health.
  • No Thumbnail Available
    Item
    . Health sector decentralisation in Tanzania: How do institutional capacities influence use of decision space?
    (International Journal of Health Planning and Management, 2018-06-29) Kigume, Ramadhani; Maluka, Stephen
    While decentralisation of health systems has dominated political arena in the low‐income and middle‐income countries since the 1970s, there is scarcity of studies on how organisational capacities influence the ability of the decentralised local‐level officials to use the available decision space. Using qualitative approach through in‐depth interviews and focus group discussions in 4 districts in Tanzania, this study explored how organisational capacities influence the use of decision space available in the 5 broad categories namely planning, finance, human resources, service organisation, and governance. The findings of the study indicated that while the district health managers had authority in many health system functional areas, limited capacity of the local government in financial resources highly affected their capacity to make use of the available decision space. In addition, while the district health managers had skills, knowledge, and experiences in preparing district health plans, health facilities and community representatives had limited capacity. Most of the health facilities had critical shortage of skilled health providers. Similarly, health committees had limited capacity in knowledge and skills. This study concludes that decentralisation will only improve delivery of health services when an appropriate degree of discretion is combined with adequate institutional capacities to enable exercise of those authorities. The district councils and the Ministry of Health should strengthen the capacities of health service providers and members of health committees and boards.