Abstract

The aim of this study is to investigate Users’ perspectives on community engagement in the health governance structures at the sub-district levels in two rural districts in Tanzania. The specific objectives of the study are: i) to examine health service Users’ awareness about the existence of local health governance structures, ii) to examine the level of community engagement and functionality of the structures, and iii) to identify the contextual factors affecting the functionality of local health governance structures. The study draws on empirical data collected from 281 service users, health service boards and committees’ members and key informants through questionnaire survey, focus group discussions and semi-structured interviews. The study found limited health service Users’ awareness about the existence of health governance structures partly because some health facilities lacked the boards and committees and in some cases community members were not involved in the selection of community representatives through their village assemblies. Further, most of the community health governance structures were not functional as had infrequent meetings and varied composition contrary to the guidelines for their establishment. Consequently, community engagement in these structures was very limited. The factors affecting functionality of these structures included lack of clarity among stakeholders on the procedures for establishing the structures, limited capacity of community members on their roles and responsibilities in the structures and delays in establishing and replacing expired service boards and committees. It is concluded that, the purpose of improving healthcare service delivery through improved community participation and governance in the local health governance structures is still far from being realised. Thus, the district councils should strengthen the functionality of the health governance structures by creating awareness among stakeholders at the ward, village and health facility levels about the guidelines for establishing and functioning of the health governance structures.

Keywords:

Committees, community engagement, decentralization, health governance structures, service boards, users' perspective,

References

1. Boon, S., 2007. How Not to Decentralise: Accountability and Representation in Health Boards in Tanzania. The Hague, SNV.
   
2. Brinkerhoff, D.W., 2012. Community Engagement in Health Services Delivery and Governance: Experience from the Philippines. Proceeding of the International Institute of Administrative Sciences, 2012 International Congress Merida, Mexico June 18-22, 2012.
   
3. Conyers, D., 2007. Decentralisation and service delivery: Lessons from sub? Saharan Africa. IDS Bull., 38(1): 18-32.https://doi.org/10.1111/j.1759-5436.2007.tb00334.x
   CrossRef    
4. Devas, N. and U. Grant, 2003. Local decision making-Citizens participation and local accountability: Some evidence from Kenya and Uganda. Pub. Administ. Develop., 23(4): 307-316.https://doi.org/10.1002/pad.281
   CrossRef    
5. Dodgson, R., K. Lee and N. Drager, 2002. Global Health Governance: A Conceptual Review. Discussion Paper No.1. Centre on Global Change and Health, London School of Hygiene Tropical Medicine.
   
6. Francis, P. and R. James, 2003. Balancing rural poverty reduction and citizen participation: The contradictions of Uganda's decentralization program. World Develop., 31(2): 325-337.
   CrossRef    
7. Grinnell, R.M., 2001. Social Work Research and Evaluation: Quantitative and Qualitative Approaches. 6th Edn., Thomson Brooks/Cole, Belmont.
   
8. Kessy, F.L., 2014. Improving health services through community participation in health governance structures in Tanzania. J. Rural Commun. Develop., 9(2): 14-31.
   
9. Loewenson, R., I. Rusike and M. Zulu, 2004. Assessing the impact of Health Centre Committees on health system performance and health resource allocation. EQUINET Discussion Paper 18. Harare, Zimbabwe: EQUINET.
   
10. Lynch, S.M., 2013. Using Statistics in Social Research. Princeton University, New Jersey.https://doi.org/10.1007/978-1-4614-8573-5
    CrossRef    
11. Maluka, S., P. Kamuzora, M.S. Sebastiån, J. Byskov, T.E. Olsen, E. Shayo and A.K. Hurtig, 2010. Decentralized health care priority-setting in Tanzania: Evaluating against the accountability for reasonableness framework. Soc. Sci. Med., 71(4): 751-759.
    CrossRef    PMid:20554365    
12. Masanyiwa, Z.S., A. Niehof and C.J.A.M. Termeer, 2013. Institutional arrangements for decentralized water and health services delivery in rural Tanzania: Differences and constraints. Basic Res. J. Soc. Pol. Sci., 1(4): 77-88.
    Direct Link
13. Masanyiwa, Z.S., A. Niehof and C.J. Termeer, 2015. A gendered users' perspective on decentralized primary health services in Rural Tanzania. Int. J. Health Plann. Manage., 30(3): 285-306.https://doi.org/10.1002/hpm.2235
    CrossRef    PMid:24285278    
14. McCoy, D.C., J.A. Hall and M. Ridge, 2011. A systematic review of the literature for evidence on health facility committees in low-and middle-income countries. Health Pol. Plann., 27(6): 449-466.https://doi.org/10.1093/heapol/czr077
    CrossRef    PMid:22155589    
15. Nathan, S., L. Johnston and J. Braithwaite, 2010. The role of community representatives on health service committees: Staff expectations vs. reality. Health Expect., 14(3): 272-284.https://doi.org/10.1111/j.1369-7625.2010.00628.x
    CrossRef    PMid:21029280 PMCid:PMC5060580    
16. Ramiro, L.S., F.A Castillo, T. Tan-Torres, C.E. Torres, J.G. Tayag, R.G. Talampas and L. Hawken, 2001. Community participation in local health boards in a decentralized setting: Cases from the Philippines. Health Pol. Plann., 16(Suppl 2): 61-69.https://doi.org/10.1093/heapol/16.suppl_2.61
    CrossRef    PMid:11772991    
17. Saltman, R., V. Bankauskaite and K. Vrangbaek, 2007. Decentralisation in health care: Strategies and outcomes. European Observatory on Health Services Systems and Policies Series. Open University Press, Berkshire, Mc Graw Hill.
    
18. Shivji, I.G. and C.M. Peter, 2003. Village Democracy Initiative Report. President's Office-Regional Administration and Local Government, Dodoma.
    
19. URT (United Republic of Tanzania), 2001. The District Council (Council Health Service Board Establishment) Instrument, 2001. Ministry of Health, Dar es Salaam.
    
20. URT (United Republic of Tanzania), 2007. Primary Health Services Development Programme (PHSDP) 2007-2017. Ministry of Health and Social Welfare, Dar es Salaam.
    
21. URT (United Republic of Tanzania), 2013a. 2012 Population and Housing Census: Population Distri-bution by Administrativer Areas. National Bureau of Stastics, Ministry of Finance, Dar es Salaam.
    
22. URT (United Republic of Tanzania), 2013b. Mwongozo wa Uundaji na Uendeshaji wa Bodi za Huduma za Afya za Halmashauri na Kamati za Usimamizi za Hospitali, Vituo vya Afya na Zahanati Nchini Tanzania. Wizara ya Afya na Ustawi wa Jamii, Dar es Salaam.
    
23. URT (United Republic of Tanzania), 2016. Tanzania and demographic health survey and malaria indicator survey 2015-16. National Bureau of Statistics, Dar es Salaam.
    
24. Vlassoff, C. and C.G. Moreno, 2002. Placing gender at the centre of health programming: Challenges and limitations. Soc. Sci. Med., 54(11): 1713-1723.https://doi.org/10.1016/S0277-9536(01)00339-2
    CrossRef    
25. WHO, 1978. Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978.
    
26. WHO, 2017. WHO community engagement framework for quality, people-centred and resilient health services. World Health Organization, Geneva.
    

Competing interests

The authors have no competing interests.

Open Access Policy

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Copyright

The authors have no competing interests.