The First National Conference on Health Leadership,

Management and Governance

The Devolution Experience in Tanzania

Dr. Gabriel L. Upunda

29 January 2013

Getting Started

IN NOVEMBER 1993 THE TANZANIA HEALTH SECTOR REVIEWED BY WIDE CROSS

SECTION OF STAKE-HOLDERS

Identified Problems

• Inadequate Resources to the Sector• Inadequate Managerial Capacity • Poor Implementation• Dual Responsibilities of DMO both the

central and local governments• Lack of an appropriate research

priority policy at all levels• Overall declining economic

performance in the country

Major Areas of Consideration

• Ideological Issues• Organisational Issues • Managerial Issues• Financial Issues• Public/Private Mix• Research• Legal Aspects

Devolution

• The decision to devolve was by the central government

• The Ministry of Health and Social Welfare, Regional Administration and Local Government, and Other Ministries had to abide to it.

Challenges for Devolution

• Different Ministries misunderstanding or not understanding the concept of devolution

• Central Ministries reluctant to leave power to lower Institutions (Regions, Districts)

• Low budget

• Low Managerial Capacity as specially at District level

• Lack of Legal Framework

Challenges

• Public / Private Partnership operating at very low level

• Standards not set for public and private medical premises

Reforms

• IDEOLOGICAL REFORMS • ORGANISATIONAL REFORMS– Administrative structures reforms– District Health Boards – Refinement of the referral health system

• MANAGERIAL REFORMS– Dual responsibilities for district health services

management– Financial Management – Human Resource Management– Logistical Support

Reforms

• FINANCIAL REFORMS – The diversification of sources of health

financing – Allocation of public expenditure

• PUBLIC/PRIVATE MIX REFORMS– Amendment of Legislation– Health Facilities– Resource Control and Human Resource

Development

• RESEARCH REFORMS

• REVISION OF THE HEALTH POLICY

Reforms

• FORESIGHT

–Empowering district, community and household initiatives

–Seeking alternative financing option

–Continuous revision of the implementation of various Acts, Ordinances and regulations

But since 2000…… ….

Summary

• Health reform is a dynamic process. There is no template

 • There are many interested parties

when a country goes into this process.

• Always be prepared to adapt rather than adopt.

Thank you.