. Health sector decentralisation in Tanzania: How do institutional capacities influence use of decision space?
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Date
2018-06-29
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International Journal of Health Planning and Management
Abstract
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.
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Keywords
Decentralisation, Decision Space, Tanzania
Citation
Kigume R, Maluka S. Health sector decentralisation in Tanzania: How do institutional capacities influence use of decision space? Int J Health Plann Mgmt. 2018;1–17. https://doi.org/10.1002/ hpm.2587