Browsing by Author "San Sebastian, Miguel"

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    Autonomy without capacity: the role of health facility governing committees in planning and budgeting in Tanzania
    (University of Dar es Salaam, 2023-03) Maluka, Stephen; Kamuzora, Peter; Hurtig, Anna-Karin; San Sebastian, Miguel; Mtasingwa, Lilian; Kapologwe, Ntuli
    Since the inception of health-sector reforms in Tanzania in the 1990s, health planning and implementation was decentralised to the Council Health Management Teams (CHMTs) headed by the District Medical Officer (DMO). This arrangement centralised the autonomy for planning, budgeting and resource allocation at the district level with very limited autonomy and authority at the health facility and community level. Since 2017/2018, the government of Tanzania has further transferred the autonomy to plan, budget and manage financial resources to health facilities. Under the current arrangements, each health facility prepares its comprehensive annual health plan and budget, and funds for the implementation of the plans are transferred directly from the Ministry of Finance and Planning (MoFP) to health facilities; the policy known as Direct Health Facility Financing (DHFF). Each health facility is supposed to have a planning team responsible for preparing annual plans. The team is required to: (i) conduct a thorough assessment of the implementation of the previous year comprehensive health facility plans to guide preparation of subsequent annual plan; (ii) gather community opinions regarding priorities and challenges in accessing health care services to inform the planning process; (iii) conduct a robust situational analysis about the morbidity and mortality trends, underlying causes and health system bottlenecks hampering the delivery and uptake of interventions; (iv) prepare plans in accordance to existing guidelines; (v) provide feedback of the approved facility plan to Health Facility Governing Committee (HFGC), Village Development Committee (VDC) and Ward Development Committee (WDC); and (vi) ensure that the plans are responsive to local needs (facility and population). The central government issues guidelines that steer the planning process at the district and health facility levels. The CHMTs and health facilities need to abide by these guidelines when preparing their annual health plans. Similarly, the central government supplies the budget making guidelines, which stipulate the ‘budget ceilings’ that every district and health facility has to adhere to. All facility plans are at later stage consolidated into a Comprehensive Council Health Plan (CCHP) for the whole district. Similarly, the preparation of the CCHP is led by a guideline from the central government. The consolidation process is done by the CCHP planning team led by the District Medical Officers (DMOs). After endorsement at the Council level, the plan is submitted to the Regional Secretariat (RS) for assessment, approval and submission to the national level. At this level, the plan is assessed by assessors comprising members from the President’s Office-Regional Administration and Local Government (PORALG) – Health and MoH and recommended for funding.
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    Promoting community participation through health facility governing committees to improve the performance of district health systems in Tanzania
    (University of Dar es Salaam, 2023-03) Kamuzora, Peter; Maluka, Stephen; San Sebastian, Miguel; Mtasingwa, Lilian; Kapologwe, Ntuli; Hurtig, Anna-Karin
    A research project entitled “Examining the effects of decision-making space and its practices on health systems performance in Tanzania” was conducted in twenty districts of Tanzania between 2020 and 2023. The main objective of this research was to better understand and evaluate how and if decentralised sub-national structures used the opportunities to improve the performance of health systems. Two universities: the University of Dar es Salaam, Tanzania and Umeå University, Sweden, collaborated in the implementation of this project. To understand the opportunities that Tanzania’s decentralization structure has to offer, this research focused on the decision-making space provided to officials at the local levels over the health system functions of planning, financing, human resources, service delivery, and governance. Tanzania’s decentralization policy allows Health Facility Governing Committees (HFGCs), on behalf of the communities, to participate in these health system functions. The HFGCs consisting of community members have become integral in the decentralization reforms which have been implemented since 1990s. The government expects health care providers to involve HFGCs in the management of health facilities, including making decisions that best serve the interests of the community. HFGCs should be involved in decisions such as approving all transactions that are made at the health facilities, inspecting health commodities procured by health facilities prior to dispensing, taking part in the making of plans and budgets of health facility and holding health care providers accountable for the performance of their health facilities. This policy brief synthesizes the key findings of the research conducted to assess how HFGCs participated in the implementation of functions that have been decentralized to the district level in Tanzania.