Browsing by Author "Mpambije, Chakupewa Joseph"

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    Decentralisation of Health Systems and the Fate of Community Health Fund in Tanzania: Critical Review of High and Low Performing Districts
    (2017) Mpambije, Chakupewa Joseph
    The deterioration of health services provision in Tanzania from 1980s to 1990s made decentralization of health service provision through the Health Sector Reform (HSR) a necessity. HSR aimed at bringing better utilization of scarce resources,improved quality of health services, increasing user access and cutting rising costs. It is through HSR that health insurance schemes were introduced. Community Health Fund (CHF) came as a result of such efforts. The efficiency and effectiveness of CHF rests on district councils which are responsible for ensuring better performance of CHF. Although the Government of Tanzania targeted 85% ofthe population to be members of CHF, enrollment has remained as low as 9.2% by 2014. The most sticking problem is the variation in enrollment in different districts. There are districts with higher performance in CHF enrollment like Iramba (54%) and Bariadi(40.9%). Whereas, there are districts with very low enrollments in CHF like Liwale (8%), and Rungwe (6.5%). This paper is an effort to shed some light on this phenomenon of performance variation of CHF enrolment in districts. It argues that poor performing districts are constrained by their own weaknesses such as poor management and leadership capacities of Council Health Management Team (CHMT) and lack of motivation among health facility staff and allied health workers. Also, poor sensitization and mobilization of people to join CHF, as well as poor quality healthcare to people has deterred performance of CHF in some districts. The papers’ conclusion apart from offering recommendation also adds to the broader ongoing debate of decentralization process mainly through health insurance.
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    Decentralization of Health Service Provision in Tanzania: Are Local Government Authorities Improving Anyway? Evidence from Local Government Authorities Audit Reports
    (Research Publish Journals, 2016-09) Mpambije, Chakupewa Joseph
    The economic woes and crisis of the 1980s and 1990s made several countries turn to decentralization of health services as a panacea to the worsening health service provision. Like many other countries, Tanzania introduced decentralization system in health service provision. Through HSR, Local Government Authorities (LGAs) are empowered to run health service delivery while central government acts as an overseer by injecting financial resources to the LGAs. With slight improvements that have been recorded among the LGAs since the implementation of HSR, there is a staggering difference among LGAs between what was thought to be achieved in health service delivery and what is actually seen on the ground. Because the failure of LGAs to equitably deliver health service has been widely researched, this article focuses on the efficacy of the LGAs to make use of financial resources. Drawing data from LGAs Audit Reports for 2007/08-2013/14, the paper analyses the LGAs use of financial resource availed to them for health service delivery. The focus is on health development project/project of Community health Fund (CHF) and Primary Health Services Development Programme (PHSDP). The paper finds that the financial resources meant for health service provision is either put to use or no. Arguably, this is due to lack of political will, poor community participation, and mismanagement of public financial resources and endemic culture of corruption among LGAs.
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    Do Management and Leadership Practices in the Context of Decentralisation Influence Performance of Community Health Fund? Evidence From Iramba and Iringa Districts in Tanzania
    (2016-09) Mpambije, Chakupewa Joseph; Maluka, Stephen
    Background: In early 1990s, Tanzania like other African countries, adopted health sector reform (HSR). The most strongly held centralisation system that informed the nature of services provision including health was, thus, disintegrated giving rise to decentralisation system. It was within the realm of HSR process, user fees were introduced in the health sector. Along with user fees, various types of health insurances, including the Community Health Fund (CHF), were introduced. While the country’s level of enrollment in the CHF is low, there are marked variations among districts. This paper highlights the role of decentralised health management and leadership practices in the uptake of the CHF in Tanzania. Methods: A comparative exploratory case study of high and low performing districts was carried out. In-depth interviews were conducted with the members of the Council Health Service Board (CHSB), Council Health Management Team (CHMT), Health Facility Committees (HFCs), in-charges of health facilities, healthcare providers, and Community Development Officers (CDOs). Minutes of the meetings of the committees and district annual health plans and district annual implementation reports were also used to verify and triangulate the data. Thematic analysis was adopted to analyze the collected data. We employed both inductive and deductive (mixed coding) to arrive to the themes. Results: There were no differences in the level of education and experience of the district health managers in the two study districts. Almost all district health managers responsible for the management of the CHF had attended some training on management and leadership. However, there were variations in the personal initiatives of the top-district health leaders, particularly the district health managers, the council health services board and local government officials. Similarly, there were differences in the supervision mechanisms, and incentives available for the health providers, HFCs and board members in the two study districts. Conclusion: This paper adds to the stock of knowledge on CHFs functioning in Tanzania. By comparing the best practices with the worst practices, the paper contributes valuable insights on how CHF can be scaled up and maintained. The study clearly indicates that the performance of the community-based health financing largely depends on the personal initiatives of the top-district health leaders, particularly the district health managers and local government officials. This implies that the regional health management team (RHMT) and the Ministry of Health and Social Welfare (MoHSW) should strengthen supportive supervision mechanisms to the district health managers and health facilities. More important, there is need for the MoHSW to provide opportunities for the well performing districts to share good practices to other districts in order to increase uptake of the community-based health insurance.
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    The Fallacy of Limited Financial Resources for Development in Tanzania: Evidence from Local Government Authorities Audit Reports
    (2015) Poncian, Japhace; Mpambije, Chakupewa Joseph
    Often times people are told by government officials that there are limited financial resources to finance different development projects/programmes and to provide assistance for self help. This view is also held by the academic world. This is usually taken as an absolute truth and usually as an excuse for the limited socioeconomic development of the citizens and societies. While this may be true, we propose a problematisation of this by gathering and making sense of evidence from the annual audit reports for the Local Government Authorities (LGAs) in Tanzania. The central aim of the proposed paper therefore is to show the fallacy of “the limited resources” by arguing that it is not a matter of limited resources but whether and how the available resources are put to intended use for development and poverty reduction goals. The relevance of this is to shift focus on development resources available to whether and how the extent to which the resources are put to use and toestablish whether LGAs are keeping people into poverty by using or not using the available resources.
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    The Fallacy of Limited Financial Resources for Development in Tanzania: Evidence from Local Government Authorities Audit Reports
    (Public Policy and Administration Research, 2015) Poncian, Japhace; Mpambije, Chakupewa Joseph
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    Poor Maternal and Child Health in Tanzania amidst Plenty: Review from Tanzania’s Grand Corruption Scandals from 2005-2015
    (Punlished by Manuscript Central, 2017-01) Mpambije, Chakupewa Joseph
    Maternal and Child Health (MCH) in Tanzania like other Sub Saharan African countries is in a gloomy state. The country has failed to achieve the Millennium Development Goals (MDG). Sadly,maternal mortality rate (MMR) stand at 454 per 100,000 against MDG target of 133 per 100,000.Similarly, under five mortality rates (U5MR) stand at 81 per 1000 against MDG target of 19 per 1000.The government’s efforts to address MCH problems have not been successful mainly due to funds lost through grand corruption. The paper argues that the lost amount of money through grand corruption scandals could have been used to fix poor maternal and child health problems in Tanzania if it were invested in the MCH policy and programes. Instead, the MCH policy and programmes are marred by several problems including continued dwindling of human resource for health, increase of petty corruption in the MCH sector, declining of MCH budget that gravely impact on availability of medicine and medical supplies. Other impacts of grand corruption to MCH include declining motivation to health workers and overall poor quality health care that impact community trust of the health system. The paper is of the view that fighting grand corruption can result into improving MCH policy programmes. This will be made possible if unwavering efforts will be exerted toward the said problems such as instilling ethical behaviour, strengthening anti-corruption agencies and imposing harsh penalties to grand corruption perpetrators.
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    Water and Sanitation Services in Informal Urban Settlements and their Implications to Peoples Health in Tandale, Dar es Salaam Tanzania
    (2016-07) Mpambije, Chakupewa Joseph; Nuhu, Said
    The alarming growth of informal settlements in Tanzania is bringing with it multifaceted impacts. Health problems are the most felt among others. The study aimed at establishing how residences in informal settlement access sanitation and water service, and the prevalence of water borne diseases due to informal settlement and the public health consequences of this. The study employed both qualitative and quantitative approaches informed by case study design in which Tandale ward from Dar es Salaam Region were used. The study administered closed and open ended questionnaires were administered whereas interview was employed to the selected key informants. The study found that residents do not access clean water and sanitation in which poverty were attested to a major cause for the problem. Also, disposal and collection of wastes is seldom undertaken due to high cost of the service. Moreover, households lack permanent areas for the collection of wastes materials due to overpopulation. It was found that Tandale is worst hit with diseases caused by unsanitary environment and poor water provision. Respondents mentioned diseases like diarrhea, cholera, worms, malaria, schistomiasis and typhoid that have even led to incidences of death especially among children under 5 years. The study concluded that health problems affecting people living in informal settlements are real and that people are really suffering. However, such situation can be averted if the government works together with all stakeholders to get rid of the problem.