Shamba Donat, Baraka Jitihada, Kinney Mary V, George Asha S, Msemo Georgina, Lawn Joy E, Steege Rosie
Department of Health Systems Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania.
Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK.
Glob Health Action. 2025 Dec;18(1):2552531. doi: 10.1080/16549716.2025.2552531. Epub 2025 Sep 5.
In 2015, Tanzania joined the Global Financing Facility (GFF), a global health initiative for Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAH-N). Despite its resource mobilization goals, little is known about power dynamics in GFF policy processes. This paper presents the first power analysis of Tanzania's GFF engagement.
To examine policy processes in developing GFF documents during its first two phases in Tanzania.
An exploratory qualitative case study using document reviews (n = 22) and key informant interviews (n = 21) conducted in 2022-2023. Data were thematically analyzed and interpreted using Gaventa's power cube (levels, spaces, and forms of power).
Stakeholders praised the GFF's country-led, evidence-based approach and local autonomy. However, closed-door decision-making in phase one excluded civil society and the private sector. Invisible power imbalances in funding allocations left stillbirths and adolescent health without dedicated budgets, while vulnerable groups (e.g. people with disabilities) were overlooked. Disbursement-linked indicators emphasized measurable outcomes, reflecting visible power. Phase two showed adaptive learning, with improved inclusivity.
While government-led, global actors (e.g. World Bank, donors) heavily influenced decisions. Greater civil society engagement is needed for accountability. Future efforts must address power imbalances through meaningful citizen participation to strengthen RMNCAH-N services.
2015年，坦桑尼亚加入了全球融资机制（GFF），这是一项针对生殖、孕产妇、新生儿、儿童和青少年健康与营养（RMNCAH-N）的全球卫生倡议。尽管该机制有资源筹集目标，但对于GFF政策制定过程中的权力动态却知之甚少。本文首次对坦桑尼亚参与GFF的情况进行了权力分析。
研究坦桑尼亚GFF前两个阶段制定相关文件的政策过程。
采用探索性定性案例研究方法，于2022 - 2023年进行了文件审查（n = 22）和关键信息人访谈（n = 21）。使用加文塔权力立方体（权力的层次、空间和形式）对数据进行主题分析和解读。
利益相关者称赞GFF采用国家主导、基于证据的方法以及地方自主权。然而，第一阶段的闭门决策将民间社会和私营部门排除在外。资金分配中无形的权力失衡导致死产和青少年健康领域没有专门预算，同时弱势群体（如残疾人）被忽视。与资金支付挂钩的指标强调可衡量的结果，反映了可见权力。第二阶段显示出适应性学习，包容性有所改善。
虽然由政府主导，但全球行为体（如世界银行、捐助方）对决策有重大影响。为了实现问责制，需要民间社会更多地参与。未来的努力必须通过有意义的公民参与来解决权力失衡问题，以加强RMNCAH-N服务。
