The Decentralisation Challenges on Public Health Service Delivery in Rural Tanzania

Abstract

This study assessed decentralisation challenges on health service delivery in rural Tanzania. It adopted a combined case study design to explore health service delivery challenges in Pangani and Urambo local government authorities (LGAs). Both qualitative and quantitative approaches were employed, primary data was collected using interviews, questionnaires, FGDs and observation. The study established that, decentralisation had minimal positive effect towards improving public health service delivery in rural Tanzania. Legal framework systems and administrative structures were the main hindrance in the implementation of decentralisation of health services and its delivery in the rural areas. Health services were found to be characterised by poor access and quality. Unavailability of health centres, equipment, drugs and medicines, health workers, mechanisms for handling complaints and responsiveness were found to be the major challenges. Delayed service, time mismanagement, lack of accountability and transparency, lack of political will, poor records management and resistance to change persisted in the sampled health centres. The study recommends a review of the existing legal framework, administrative systems, structures and processes. Efforts on resourcing, human resource capacity building and institutionalisation of health sector reforms and decentralisation are also recommended.

Keywords: Decentralisation, health service delivery, rural, local government authorities