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Health sector decentralisation in Tanzania: Analysis of decision space in human resources for health management

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  • Ramadhani Kigume
  • Stephen Maluka

Abstract

While decentralisation of health systems has dominated the political arena in the low‐ and middle‐income countries since the 1970s, many studies on decentralisation have focused on understanding who is given more decision‐making authority, but less attention is paid to understanding what that authority involves. This paper assesses the range of decision‐making authority transferred from the central government to subnational levels in the area of human resources for health management in Tanzania. This analysis was guided by the decision space framework and relied on interviews, focused group discussions, and analysis of documents. Data were analysed using thematic approach. While districts had narrow decision space on recruitment and promotion of health service providers, they had wide decision space on distributing health providers within districts and providing incentives. Centrally managed recruitments resulted in frequent delays, thereby intensifying shortages of skilled health service providers. This analysis concludes that decentralisation of human resources for health planning and deployment role to lower levels of the administrative hierarchy in Tanzania is limited. This suggests the need for the central government to increase decision space to districts in the area of recruitment. In order for the Ministry of Health to perform its functions better in the area of human resources for health management, there is a need to strengthen the capacity of the department dealing with recruitment of skilled health staff at the Ministry of Health.

Suggested Citation

  • Ramadhani Kigume & Stephen Maluka, 2019. "Health sector decentralisation in Tanzania: Analysis of decision space in human resources for health management," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1265-1276, October.
    • Handle: RePEc:bla:ijhplm:v:34:y:2019:i:4:p:1265-1276
    DOI: 10.1002/hpm.2792
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    References listed on IDEAS

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    1. Faguet, Jean-Paul & Poschl, Caroline (ed.), 2015. "Is Decentralization Good For Development?: Perspectives from Academics and Policy Makers," OUP Catalogue, Oxford University Press, number 9780198737506.
    2. Ramadhani Kigume & Stephen Maluka, 2018. "Health sector decentralisation in Tanzania: How do institutional capacities influence use of decision space?," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(4), pages 1050-1066, October.
    3. Stephen Peckham & Mark Exworthy & Ian Greener & Martin Powell, 2005. "Decentralizing Health Services: More Local Accountability or Just More Central Control?," Public Money & Management, Taylor & Francis Journals, vol. 25(4), pages 221-228.
    4. Homedes, Nuria & Ugalde, Antonio, 2005. "Why neoliberal health reforms have failed in Latin America," Health Policy, Elsevier, vol. 71(1), pages 83-96, January.
    5. Bossert, Thomas, 1998. "Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance," Social Science & Medicine, Elsevier, vol. 47(10), pages 1513-1527, November.
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