Abstract
BackgroundIn Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector. As a result, districts were given authority to undertake local planning and set priorities as well as allocate resources fairly to promote the health of a population with varied needs. Nevertheless, priority setting in the health care service has remained a challenge. The study assessed the priority setting processes in the planning of the prevention of mother to child transmission of HIV (PMTCT) programme at the district level in Tanzania.MethodsThis qualitative study was conducted in Mbarali district, south-western Tanzania. The study applied in-depth interviews and focus group discussions in the data collection. Informants included members of the Council Health Management Team, regional PMTCT managers and health facility providers.ResultsTwo plans were reported where PMTCT activities could be accommodated; the Comprehensive Council Health Plan and the Regional PMTCT Plan that was donor funded. As donors had their own globally defined priorities, it proved difficult for district and regional managers to accommodate locally defined PMTCT priorities in these plans. As a result few of these were funded. Guidelines and main priority areas of the Ministry of Health and Social Welfare (MoHSW) also impacted on the ability of the districts and regions to act, undermining the effectiveness of the decentralisation policy in the health sector.ConclusionThe challenges in the priority setting processes revealed within the PMTCT initiative indicate substantial weaknesses in implementing the Tanzania decentralisation policy. There is an urgent need to revive the strategies and aims of the decentralisation policy at all levels of the health care system with a view to improving health service delivery.
Highlights
In Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector
Whereas the council health management team was responsible for preparation of the Council Health Plan (CCHP), the regional health management team was responsible to prepare the regional health plan
The prime planning and priority setting processes related to the PMTCT programme were, according to the regional and district informants, carried out at the regional level since international donors were the main funders of the programme and their offices were established at the regional level
Summary
In Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector. By devolving decision-making to local authorities, decentralisation aimed at improving planning and accountability and ensuring that priority setting and decision-making processes were located close to the beneficiaries in the health sector [6,7] Under this structuring process, the Ministry of Health and Social Welfare (MoHSW) remained with the responsibility of overall policy making, long-term and macro-planning, as well as of overall monitoring of the health sector. The problem has been compounded by the failure to include effectively community priorities in the district health plan [10] These latter findings are problematic as decentralisation was expected to bring about more public deliberation on major, unsolved public policy problems, with people engaging in debates on how to utilise limited resources fairly to promote the health of a population with substantial and varied needs [17,18]. Previous studies in Tanzania have demonstrated that this has not been the case in actuality [16,19]
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