Abstract
BackgroundDecentralised health systems in Tanzania depend largely on funding from the central government to run health services. Experience has shown that central funding in a decentralised system is not an appropriate approach to ensure the effective and efficient performance of local authorities due to several limitations. One of the limitations is that funds from the central government are not disbursed on a timely basis, which in turn, leads to the serious problem of shortage of financial resources for Council Health Management Teams (CHMT). This paper examines how dependency on central government funding in Tanzania affects health activities in Kongwa district council and the strategies used by the CHMT cope with the situation.MethodsThe study adopted a qualitative approach and data were collected using semi-structured interviews and focus group discussions. One district in the central region of Tanzania was strategically selected. Ten key informants involved in the management of health service delivery at the district level were interviewed and one focus group discussion was held, which consisted of members of the council health management team. The data generated were analysed for themes and patterns.ResultsThe results showed that late disbursement of funds interrupts the implementation of health activities in the district health system. This situation delays the implementation of some activities, while a few activities may not be implemented at all. However, based on their prior knowledge of the anticipated delays in financial disbursements, the council health management team has adopted three main strategies to cope with this situation. These include obtaining supplies and other services on credit, borrowing money from other projects in the council, and using money generated from cost sharing.ConclusionLocal government authorities (LGAs) face delays in the disbursement of funds from the central government. This has necessitated introduction of informal coping strategies to deal with the situation. National-level policy and decision makers should minimise the bureaucracy involved in allocating funds to the district health systems to reduce delays.
Highlights
Studies have documented the challenges and barriers facing decentralised health systems in Sub-Saharan Africa in general [16], and Tanzania, in particular [5]. This is one of the few papers in Tanzania and beyond that has documented the strategies used by the decentralised health systems to cope with the identified challenges or barriers that hinder the smooth operation of health service delivery in their localities, and the challenges resulting from the late disbursement of central government funds
The late release of central government funds to district health systems undermines health service delivery and hinders the effective implementation of the health activities identified in the comprehensive council health plans
Despite the fact that the late disbursement of funds for the implementation of health activities at the district level demoralises Council Health Management Teams (CHMT) and other health workers, CHMTs have exerted a great deal of effort to design the best strategies to cope with the situation and to enable the health system to continue operating
Summary
Like many other developing countries, the district (council) health system in Tanzania is the key structure for the delivery of basic health services to the majority of the population. The district health system is suffering from various constraints in its delivery of health services to the people Among others, these constraints include the lack of adequate resources ( funds), the shortage of qualified staff, which leads to poor planning and poor management of the available resources, and corruption [2]. Some developing countries, including Tanzania, have put into place various reforms aimed at reorganising both the central and the local government structures in order to enhance the efficiency and effectiveness of the delivery of social services to communities. The district health system was selected mainly because it is the structure that is the closest to communities and it is where most of the essential health services are provided [1]
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