Journal of Public Health Advance Access originally published online on April 25, 2007
Journal of Public Health 2007 29(2):147-156; doi:10.1093/pubmed/fdm016
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Community views on health sector reform and their participation in health priority setting: case of Lushoto and Muheza districts, Tanzania
Godfrey M. Mubyazi, Research Scientist (Economics & Health Policy and Systems Analys)1,2,3,
Adiel Mushi, Research Scientist (Medical Sociology & Anthropology)2
Mathias Kamugisha, Research Scientist (Bio-Statistics)5
Julius Massaga, Research Scientist (Epidemiology)1
Kassembe Y. Mdira, Laboratory Technology2
Method Segeja, Research Scientist (Microbiology and Immunology)1
Kato J. Njunwa, Research Scientist (Entomology) & Dean of Students, Faculty of Community Health Medicine2,4
1 National Institute for Medical Research, Department of Health Systems and Policy Research & Center for Enhancement of Effective Malaria Interventions (CEEMI), P.O. Box 9653 Dar Es Salaam, Tanzania
2 Amani Medical Research Centre, Muheza, Tanzania
3 DBL–Centre for Health Research and Development, Copenhagen, Denmark
4 Kigali Health Institute, Faculty of Community Health Development, Republic of Rwanda
5 Tanga Medical Research Centre, Tanga, Tanzania
Address correspondence to Godfrey M. Mubyazi, E-mail: gmmubyazi{at}yahoo.co.uk/ mubyazig{at}hotmail.com
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Abstract |
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Background Community participation (CP) is a key concept under ‘primary health care’ programmes and ‘Health Sector Reform’ (HSR) in many countries. However, international literature with current empirical evidence on CP in health priority setting and HSR in Tanzania is scanty.
Objectives To explore and describe community views on HSR and their participation in setting health priorities.
Methods A multistage sampling of wards and villages was done, involving group discussions with members of households, Village Development Committees (VDCs) and Ward Development Committees (WDCs).
Results Respondents at village and ward levels in both districts related HSR with a cost sharing system at public health facilities. Views on the advantages or disadvantages of HSR were mixed, most of the residents pointing out that user charges burden the poor, there is a shortage of drugs at peripheral health facilities, the performance of government health service staff and village health workers does not satisfy community needs, health insurance is promoted more than people actually benefit, VDC and WDC poorly function as compared to local community-participatory priority-setting structures.
Conclusion HSR may not meet the desired health needs unless more efforts are made to enhance the performance of the existing HSR structures and community knowledge and enhance trust and participation in the health sector programmes at all levels.
Keywords: community participation, decentralization, health reform, priority setting, Tanzania