Lay Participation, People Policing Money to Improve Health Outcomes in Rural Tanzania
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Date
2014-11-18
Authors
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Journal ISSN
Volume Title
Publisher
University of Dar es Salaam
Abstract
Background:The past twenty years have seen remarkable shits in thinking about health
governance. Increasingly, community-based financial accountability mechanisms such as Health
Governance Committees, Public Report Cards (PRCs), Citizen Score Card (CSCs), Patient
Rights Charters, and Public Expenditure Tracking Systems (PETs) are emphasized as alternative
to the defunct arm’s length financial control mechanisms. It is argued that community actors,
especially citizens, organized citizen groups, and elected representatives at grassroots’ level
enjoy the use of collective action, power, and voice as best tools for holding providers and health
bureaucrats accountable for spending and financial decisions in order to improve health
outcomes. However, little evidences affirm that the lay community actors are capable enough to
hold bureaucrats and providers accountable for financial decisions and spending outcomes. This
paper examines the capability of community actors to hold health bureaucrats and providers
accountable for financial decisions and spending outcomes.
Methods: The study was conducted in two rural districts namely Morogoro and Karagwe. It
involved detailed interviews with 50 key informants including health technocrats and bureaucrats
at district level, elected leaders at village and ward levels, members of facility health governance
committees, representatives of selected civil society organization and a structured questionnaire
with 100 villagers randomly sampled from households in two villages in the districts.
Supplementary data was collected from documentary sources from health facilities, government
reports, and previously published research findings.
Results: Study findings show that community-based financial accountability mechanisms are not
(in practice) as effective as they are theoretically promoted by donors and international
community. There are different limitations that make community-based accountability
mechanisms of limited usefulness including constraining power tensions and rent seeking
behavior among members who form participatory accountability forums, inadequate skills and
limited information access for most of the community actors, cultural virtues that do not support
challenging authorities, and little political will and support from both the central and local
government.
Conclusion: Community based financial accountability mechanisms and initiatives serve an
important role of empowering community actors to participate profitably in making financial
decisions and priority setting forums. However, these mechanisms have not been able to serve as
means for exit, especially facilitating for influence and control of bureaucrats and providers by
community actors. In some of the ways, when participatory forums such as Health Facility
Governance Committees are encouraged to adopt formal and artificial procedures, they
accidentally serve as forums for silencing community actors rather than empowering them.
Description
Keywords
Primary Health Care; Health Governance; Lay Participation, Health Facility Commitees, Community-Based Accountability; Rural Communities; Tanzania
Citation
9. Damian, R.S. (2014). “Lay People Policing Money to Save Lives in Tanzania: Isn’t it another Institutional Fix?”, Presented at Voice of Social Science International Conference held from 17-19 November 2014