Kesale Anosisye M, Kinyaga Ally, Mwakasangula Eliza, Mollel Henry, Rashid Seif S
Department of Local Government Management, School of Public Administration and Management Mzumbe University Morogoro Tanzania.
Center for Reforms Innovation, Health Policies and Implementation Research (CeRIHI) Dodoma Tanzania.
Health Sci Rep. 2023 Nov 5;6(11):e1691. doi: 10.1002/hsr2.1691. eCollection 2023 Nov.
Lower- and middle-income countries have decentralized decision-making at the community level, as well as community governance structures, to encourage community participation in governance processes, particularly in primary healthcare (PHC). In Tanzania, decentralization resulted in the establishment of Health Facility Governing Committees (HFGCs) to encourage community participation in the governance of primary health facilities to improve the quality and responsiveness of health service delivery. Nonetheless, despite the presence of HFGCs, PHC delivery remains ineffective and of poor quality. It is unclear who makes governance decisions at PHC facilities to ensure that services delivered are of expected quality and respond the community's needs, tastes, and preferences. This paper aims to assess the perspectives of members of the HFGC on who make governance decision in the context of fiscal decentralization.
A cross-section design was used to collect both quantitative and qualitative data. A four-multistage sampling technique was adopted to selects regions, council, health facilities, and HFGC members. Respondents who participated in structured questionnaire responses were chosen using proportional sampling, whereas those who participated in in-depth interviews and Focus Group Discussions were chosen using purposive selection. The data was analyzed descriptively and thematically.
The study revealed that HFGCs members perceive that governance decisions in primary health facilities are primarily made by the health facility management, and later are presented in HFGCs. As such, HFGCs are used a passively used to justify participation in decision that was already made by the management, which contradict with the principal of decentralization that emphasizes community participation on fiscal decisions.
Decentralization of PHC facilities does not guarantee the participation of community members in fiscal decision of their respective primary health facilities through HFGCs. HFGC is passively used governance structure to substitute community participation in primary health facilities' fiscal decisions. Enforcement mechanisms are required to facilitate effective community participation.
低收入和中等收入国家在社区层面实行了决策权力下放以及社区治理结构，以鼓励社区参与治理过程，尤其是在初级卫生保健（PHC）方面。在坦桑尼亚，权力下放导致成立了卫生设施管理委员会（HFGCs），以鼓励社区参与初级卫生设施的治理，从而提高卫生服务提供的质量和响应能力。尽管如此，尽管存在HFGCs，但初级卫生保健服务的提供仍然无效且质量不佳。尚不清楚在初级卫生保健设施中由谁做出治理决策，以确保所提供的服务达到预期质量并满足社区的需求、喜好和偏好。本文旨在评估HFGC成员对于在财政权力下放背景下谁做出治理决策的看法。
采用横断面设计收集定量和定性数据。采用四阶段抽样技术来选择地区、理事会、卫生设施和HFGC成员。参与结构化问卷调查的受访者采用比例抽样选择，而参与深入访谈和焦点小组讨论的受访者则采用目的抽样选择。对数据进行描述性和主题性分析。
研究表明，HFGC成员认为初级卫生设施的治理决策主要由卫生设施管理层做出，然后提交给HFGCs。因此，HFGCs被被动地用于为参与管理层已经做出的决策进行辩护，这与强调社区参与财政决策的权力下放原则相矛盾。
初级卫生保健设施的权力下放并不能保证社区成员通过HFGCs参与其各自初级卫生保健设施的财政决策。HFGC是一种被动使用的治理结构，用于替代社区参与初级卫生设施的财政决策。需要执行机制来促进有效的社区参与。
