Health sector decentralisation in Tanzania: How do institutional capacities influence use of decision space?

Ramadhani Kigume and Stephen Maluka

International Journal of Health Planning and Management, 2018, vol. 33, issue 4, e1050-e1066

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.

Date: 2018
References: Add references at CitEc
Citations: View citations in EconPapers (2)

Downloads: (external link)
https://doi.org/10.1002/hpm.2587

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:bla:ijhplm:v:33:y:2018:i:4:p:e1050-e1066

Ordering information: This journal article can be ordered from
http://www.blackwell ... bs.asp?ref=0749-6753

Access Statistics for this article

International Journal of Health Planning and Management is currently edited by Calum Paton

More articles in International Journal of Health Planning and Management from Wiley Blackwell
Bibliographic data for series maintained by Wiley Content Delivery ().