Lay Participation, People Policing Money to Improve Health Outcomes in Rural Tanzania
| dc.contributor.author | Damian, Respicius Shumbusho | |
| dc.date.accessioned | 2019-03-03T15:36:37Z | |
| dc.date.available | 2019-03-03T15:36:37Z | |
| dc.date.issued | 2014-11-18 | |
| dc.description.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. | en_US |
| dc.description.sponsorship | This paper was a result of a preliminary research preceding a PhD study, which was partially supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Wellcome Trust (UK) (Grant No: 087547/Z/08/Z), the Department for International Development (DfID) under the Development Partnerships in Higher Education (DelPHE), the Carnegie Corporation of New York (Grant No: B 8606), the Ford Foundation (Grant No: 1100-0399), Google.Org (Grant No: 191994), Sida (Grant No: 54100029) and MacArthur Foundation Grant No: 10-95915-000-INP. I also thank the University of Dar es Salaam, Tanzania and Shumbusho and Associates Tanzania Limited for availing supplementary resources for completion of preliminary study paper. | en_US |
| dc.identifier.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 | en_US |
| dc.identifier.uri | http://hdl.handle.net/20.500.11810/5083 | |
| dc.language.iso | en | en_US |
| dc.publisher | University of Dar es Salaam | en_US |
| dc.subject | Primary Health Care; Health Governance; Lay Participation, Health Facility Commitees | en_US |
| dc.subject | Community-Based Accountability; Rural Communities; Tanzania | en_US |
| dc.title | Lay Participation, People Policing Money to Improve Health Outcomes in Rural Tanzania | en_US |
| dc.title.alternative | Another Institutional Fix? | en_US |
| dc.type | Conference Paper | en_US |
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