Abstract
Similar to many other low- and middle-income countries, public private partnership (PPP) in the training of the health workforce has been emphasized since the launch of the 1990s’ health sector reforms in Tanzania. PPP in training aims to contribute to addressing the critical shortage of health workforce in these countries. This study aimed to analyse the policy process and experienced outcomes of PPP for the training of doctors in Tanzania two decades after the 1990s’ health sector reforms. We reviewed documents and interviewed key informants to collect data from training institutions and umbrella organizations that train and employ doctors in both the public and private sectors. We adopted a hybrid thematic approach to analyse the data while guided by the policy analysis framework by Gagnon and Labonté. PPP in training has contributed significantly to the increasing number of graduating doctors in Tanzania. In tandem, undermining of universities’ autonomy and the massive enrolment of medical students unfavourably affect the quality of graduating doctors. Although PPP has proven successful in increasing the number of doctors graduating, unemployment of the graduates and lack of database to inform the training needs and capacity to absorb the graduates have left the country with a health workforce shortage and maldistribution at service delivery points, just as before the introduction of the PPP. This study recommends that Tanzania revisit its PPP approach to ensure the health workforce crisis is addressed in its totality. A comprehensive plan is needed to address issues of training within the framework of PPP by engaging all stakeholders in training and deployment starting from the planning of the number of medical students, and when and how they will be trained while taking into account the quality of the training.
Highlights
From the mid-1980s to the late 1990s, many low- and middle-income countries (LMICs), including Tanzania, launched health sector reforms in response to the urging of the World Bank (WB) and International Monetary Fund (IMF) as a means to improve deteriorating health systems [1]
Following the global economic crisis of the 1980s, economic hiccups resulting from the break-up of the East African community in 1977, resource diversion to support the Uganda–Tanzania War in 1978/1979, and the reduction of donor support, the government capacity to fund the health sector declined substantially [24]
Intended outcomes From the interviews and document review, we found that an increase in the number of medical training institutions, the use of public health facilities in the training of medical students by private universities, growth of collaboration among training institutions in the public and private sectors, government sponsorship of medical students in private training institutions, and the control of cost escalation in private training institutions by the government are among the positive outcomes linked to the implementation of private partnership (PPP)
Summary
From the mid-1980s to the late 1990s, many low- and middle-income countries (LMICs), including Tanzania, launched health sector reforms in response to the urging of the World Bank (WB) and International Monetary Fund (IMF) as a means to improve deteriorating health systems [1]. PPP is defined as a collaboration between public and private sector organizations where there is a pooling together of resources (financial, human, technical, and information). By the mid-1980s, most of the governments in many countries had failed to adequately train, employ, or retain enough doctors in their health systems [7]. The latter issue saw some doctors leaving their countries in search of greener pastures in higher-income countries [8,9,10]
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