Journal of Public Health Medicine 24:112-119 (2002)
© 2002 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
The Dar Es Salaam Urban Health Project, Tanzania: a multi-dimensional evaluation
Trudy Harpham
Roger Few
South Bank University, Wandsworth Road, London SW8 2JZ
Address correspondence to Trudy Harpham. E-mail: t.harpham{at}sbu.ac.uk
Background In the 1990s, as a response to rapid urbanization, there were a number of large, urban health initiatives in sub-Saharan Africa. Most tended to be comprehensive as opposed to selective in scope: they aimed at strengthening the health system as a whole, and placed emphasis on delivering improved services at the primary level, with increased community participation. A multi-dimensional approach is required to assess the achievements of such initiatives.
Methods In 2000 an external evaluation of the Swiss-funded Dar es Salaam Urban Health Project, Tanzania, used 50 key informant interviews, 90 health facility exit interviews, 90 community resident interviews and document analysis to assess achievements over a 10 year period. The study considered achievements in terms of capacity building, improving quality of care, community involvement, inter-sectoral action and sustainability.
Results Although the project achieved improvements in capacity building and in structural and technical quality of care, there were difficulties in generating inter-sectoral action and the concept of participation was limited. However, citylevel ‘ownership’ of the activities was high, and, with the advent of sector-wide allocation of funds (SWAPs) in the health sector in Tanzania, the prospects for sustainability of the achievements made in the project appear to be good.
Conclusion Both the multi-dimensional method of the evaluation and the findings can inform future urban health initiatives in sub-Saharan Africa and in other resourceconstrained environments. The decentralization that occurred in Dar es Salaam and the general approach of the project provided a platform to test out various elements that are common to health sector reform across developing countries.
Keywords: urban health, health systems, evaluation, Tanzania