Kigume Ramadhani, Maluka Stephen
Department of History, Political Science and Development Studies, Dar es Salaam University College of Education, Dar es Salaam, Tanzania.
Institute of Development Studies, University of Dar es Salaam, Dar es Salaam, Tanzania.
Int J Health Plann Manage. 2018 Oct;33(4):e1050-e1066. doi: 10.1002/hpm.2587. Epub 2018 Jul 27.
While decentralisation of health systems has dominated political arena in the low-income and middle-income countries since the 1970s, there is scarcity of studies on how organisational capacities influence the ability of the decentralised local-level officials to use the available decision space. Using qualitative approach through in-depth interviews and focus group discussions in 4 districts in Tanzania, this study explored how organisational capacities influence the use of decision space available in the 5 broad categories namely planning, finance, human resources, service organisation, and governance. The findings of the study indicated that while the district health managers had authority in many health system functional areas, limited capacity of the local government in financial resources highly affected their capacity to make use of the available decision space. In addition, while the district health managers had skills, knowledge, and experiences in preparing district health plans, health facilities and community representatives had limited capacity. Most of the health facilities had critical shortage of skilled health providers. Similarly, health committees had limited capacity in knowledge and skills. This study concludes that decentralisation will only improve delivery of health services when an appropriate degree of discretion is combined with adequate institutional capacities to enable exercise of those authorities. The district councils and the Ministry of Health should strengthen the capacities of health service providers and members of health committees and boards.
自20世纪70年代以来，卫生系统分权在低收入和中等收入国家的政治舞台上占据主导地位，但关于组织能力如何影响分权后的地方官员利用现有决策空间的能力的研究却很少。本研究采用定性研究方法，通过对坦桑尼亚4个地区进行深入访谈和焦点小组讨论，探讨了组织能力如何影响在规划、财务、人力资源、服务组织和治理这5大类中可用决策空间的利用情况。研究结果表明，虽然地区卫生管理人员在许多卫生系统功能领域拥有权力，但地方政府财政资源有限严重影响了他们利用现有决策空间的能力。此外，虽然地区卫生管理人员在制定地区卫生计划方面具备技能、知识和经验，但卫生设施和社区代表的能力有限。大多数卫生设施严重缺乏技术熟练的卫生服务提供者。同样，卫生委员会在知识和技能方面的能力也有限。本研究得出结论，只有当适当程度的自主权与足够的机构能力相结合，以行使这些权力时，分权才能改善卫生服务的提供。地区议会和卫生部应加强卫生服务提供者以及卫生委员会和董事会成员的能力。
