Browsing by Author "Shayo, Elizabeth"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Challenges to Fair Decision-Making Processes in The Context of Health Care Services: A Qualitative Assessment from Tanzania
    (2012-06) Shayo, Elizabeth; Norheim, Ole F.; Mboera, Leonard; Byskov, Jens; Maluka, Stephen; Kamuzora, Peter; Blystad, Astrid
    Fair processes in decision making need the involvement of stakeholders who can discuss issues and reach an agreement based on reasons that are justifiable and appropriate in meeting people's needs. In Tanzania, the policy of decentralization and the health sector reform place an emphasis on community participation in making decisions in health care. However, aspects that can influence an individual's opportunity to be listened to and to contribute to discussion have been researched to a very limited extent in low-income settings. The objective of this study was to explore challenges to fair decision-making processes in health care services with a special focus on the potential influence of gender, wealth, ethnicity and education. We draw on the principle of fairness as outlined in the deliberative democratic theory. The study was carried out in the Mbarali District of Tanzania. A qualitative study design was used. In-depth interviews and focus group discussion were conducted among members of the district health team, local government officials, health care providers and community members. Informal discussion on the topics was also of substantial value. The study findings indicate a substantial influence of gender, wealth, ethnicity and education on health care decision-making processes. Men, wealthy individuals, members of strong ethnic groups and highly educated individuals had greater influence. Opinions varied among the study informants as to whether such differences should be considered fair. The differences in levels of influence emerged most clearly at the community level, and were largely perceived as legitimate. Existing challenges related to individuals' influence of decision making processes in health care need to be addressed if greater participation is desired. There is a need for increased advocacy and a strengthening of responsive practices with an emphasis on the right of all individuals to participate in decision-making processes. This simultaneously implies an emphasis on assuring the distribution of information, training and education so that individuals can participate fully in informed decision making.
  • Thumbnail Image
    Item
    Decentralization and Health Care Prioritization Process in Tanzania: from National Rhetoric to local Reality
    (2011) Maluka, Stephen O.; Hurtig, Anna-Karin; Sebastián, Miguel S; Shayo, Elizabeth; Byskov, Jens; Kamuzora, Peter
    During the 1990s, Tanzania like many other developing countries adopted health sector reforms. The most common policy change under the health sector reforms has been decentralization, which involves the transfer of power and authority from the central level to local authorities. Based on the case study of Mbarali district in Tanzania, this paper uses a policy analysis approach to analyse the implementation of decentralized health care priority setting. Specifically, the paper examines the process, actors and contextual factors shaping decentralized health care priority setting processes. The analysis and conclusion are based on a review of documents, key informant interviews, focus group discussion, and notes from non-participant observation. The findings of the study indicate that local institutional contexts and power asymmetries among actors have a greater influence on the prioritization process at the local level than expected and intended. The paper underlines the essentially political character of the decentralization process and reiterates the need for policy analysts to pay attention to processes, institutional contexts, and the role of policy actors in shaping the implementation of the decentralization process at the district level. Copyright © 2010 John Wiley & Sons, Ltd.
  • Thumbnail Image
    Item
    Decentralization and Health Care Prioritization Process in Tanzania: From National Rhetoric to Local Reality
    (2011-03) Maluka, Stephen; Hurtig, Anna-Karin; Sebastian, Miguel San; Shayo, Elizabeth; Byskov, Jens; Kamuzora, Peter
  • Thumbnail Image
    Item
    A systems perspective on the importance of global health strategy developments for accomplishing today’s Sustainable Development Goals
    (Oxford University Press, 2019-07-30) Byskov, Jens; Maluka, Stephen; Marchal, Bruno; Shayo, Elizabeth; Blystad, Astrid; Bukachi, Salome; Zulu, Joseph; Michelo, Charles; Hurtig, Anna-Karin; Bloch, Paul
    Priority setting within health systems has not led to accountable, fair and sustainable solutions to improving population health. Providers, users and other stakeholders each have their own health and service priorities based on selected evidence, own values, expertise and preferences. Based on a historical account, this article analyses if contemporary health systems are appropriate to optimize population health within the framework of cross cutting targets of the Sustainable Development Goals (SDGs). We applied a scoping review approach to identify and review literature of scientific databases and other programmatic web and library-based documents on historical and contemporary health systems policies and strategies at the global level. Early literature supported the 1977 launching of the global target of Health for All by the year 2000. Reviewed literature was used to provide a historical overview of systems components of global health strategies through describing the conceptualizations of health determinants, user involvement and mechanisms of priority setting over time, and analysing the importance of historical developments on barriers and opportunities to accomplish the SDGs. Definitions, scope and application of health systems-associated priority setting fluctuated and main health determinants and user influence on global health systems and priority setting remained limited. In exploring reasons for the identified lack of SDG-associated health systems and priority setting processes, we discuss issues of accountability, vested interests, ethics and democratic legitimacy as conditional for future sustainability of population health. To accomplish the SDGs health systems must engage beyond their own sector boundary. New approaches to Health in All Policies and One Health may be conducive for scaling up more democratic and inclusive priority setting processes based on proper process guidelines from successful pilots. Sustainable development depends on population preferences supported by technical and managerial expertise.