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Decentralized Local Health Services in Tanzania

Are Health Resources Reaching Primary Health Facilities, or Are They Getting Stuck at the District Level?

Over two-thirds of Tanzanians reside in rural areas and rely on local health facilities (such as Dispensaries and Health Centers) run by their Local Government Authorities to provide them with basic health services. Therefore, efforts to achieve major, sustainable improvements in local health outcomes will have to ensure that resources (including health staff, drugs and medical supplies, operational expenses, as well as other health-related resources) reach the primary health facilities that form the front-line of public health service delivery in Tanzania.

Although numerous studies have analyzed the distribution of health resources from the central government level to the local government level in Tanzania, much less is known about the “last mile” of health financing in Tanzania: how much—and how—do local health resources trickle down from the district level to the public health facilities? Given that front-line health services cannot meaningfully improve if health resources get stuck at the district level, ensuring that local health finances are managed efficiently at the local level is critical to achieving sustainable improvements in health outcomes.

This study analyzes local health finances in Tanzania by considering the extent to which public health resources in Tanzania flow from the district government level to primary health facilities, or whether these resources get stuck at the district level. Our analysis of health expenditures in six rural Local Government Authorities suggests that less than half of local health funding reaches the front-line dispensaries that provide the vast majority of local health services. The structure of the local health system appears to favor top-down interventions and control, rather than empowering local facilities to improve local health outcomes.
Jamie Boex, Luke Fuller and Ammar Malik. 2015. Decentralized Local Health Services in Tanzania
Are Health Resources Reaching Primary Health Facilities, or Are They Getting Stuck at the District Level? Washington: The Urban Institute.

http://www.urban.org/research/publication/decentralized-local-health-services-tanzania

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