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Stephen Maluka PhD Candidate, MA (DS)

Decentralized health care priority setting in Tanzania: Evaluating against the accountability for reasonableness framework. Stephen Maluka PhD Candidate, MA (DS). Outline of the presentation. Background The REACT Project in Tanzania Objective of The Study Study area & Methods Findings

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Stephen Maluka PhD Candidate, MA (DS)

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  1. Decentralized health care priority setting in Tanzania: Evaluating against the accountability for reasonableness framework Stephen Maluka PhD Candidate, MA (DS) Priorities 2010: Boston, USA

  2. Outline of the presentation • Background • The REACT Project in Tanzania • Objective of The Study • Study area & Methods • Findings • Conclusion Priorities 2010: Boston, USA

  3. Background • What is Priority Setting (PS)? • The process of making decisions on how resources should be distributed among competing programmes/ or patients. • Why priority Setting • Resources are always limited. • BIG GAP btn demands, neeeds & available resources. Priorities 2010: Boston, USA

  4. Background Cont…….. • Others Challenges to PS in LDCs (Tanzania) • Lack of credible information & credible methods to deal with the trade-off decisions (Kapiriri & Martin, 2007). • Few systematic and formal processes for decision making. • Corruption. • PS by CHANCE not by CHOICE (Steen, 2003). Priorities 2010: Boston, USA

  5. Background cont…Discipline specific approaches to PS (Sibbald, Singer, Upshur & Martin, 2009). Priorities 2010: Boston, USA

  6. Background cont....... • Accountability for Reasonableness (A4R). • A4R focus on the Fairness & Legitimacy of the PS process. • AFR thus provides structure to the process of PS. • A Fair Priority Setting Process should meet 4 Conditions. Priorities 2010: Boston, USA

  7. Four Conditions for Fairness (Daniels & Sabin, 2002, p. 45) Priorities 2010: Boston, USA

  8. The REACT Project in Tanzania • Began in 2006 at the district level in 3 African countries (Tanzania, Kenya and Zambia) in the context of REACT. • REACT-Response to Accountable priority setting for Trust in health system. • No empirical evidence on its relevance in the LMICs. • In Tanzania intervention began in 2008. • End of the project December 2010. Priorities 2010: Boston, USA

  9. A Application of A4R Develop and introduce the application of AFR • EVALUATION RESEARCH • The evaluation domains • AFR process • Management Capability • Human Resources • HIV/AIDS • Malaria • Emergency Obstetric Care • Generalized Care Describe ACTION RESEARCH Improve Evaluate Three stage research evaluation against AFR: 1. Baseline situation, 2. process of change 3. consequence for quality, equity, trust. The action research team facilitates and informs the cyclic action carried out by the district. How is A4R Implemented in the District?DEI Approach (Byskovet al. 2009) Priorities 2010: Boston, USA

  10. Objectives of the Paper • Describes processes of setting health care priorities in Mbarali district, Tanzania and • Evaluates the descriptions against accountability for reasonableness. Priorities 2010: Boston, USA

  11. Study Setting Mbarali district in Mbeya region of Tanzania. Why Mbarali? - a “typical” rural district in Tanzania and also within the reach for the research institutions. Priorities 2010: Boston, USA

  12. Methods Priorities 2010: Boston, USA

  13. Findings • Lack of evidence-historical allocation. • Driven by CHMT with no inputs from lower levels. • Disseminated through local government channels (ward, village, notice boards). • No appeal mechanisms. • Limited capacity of the oversight institutions to oversee & scrutinize district priorities. Priorities 2010: Boston, USA

  14. Publicity??????Information is more complex and difficult for the citizens to make sense of the information. Priorities 2010: Boston, USA

  15. Conclusion • Notable steps have been taken by the government of Tanzania to strengthen district health boards and committees with intended community representation and more or less active stakeholder engagement • Given the lack of consensus on overarching universal criteria, PS decisions should be worked out locally by describing current priority setting practices, evaluating against empirical based frameworks and designing and implementing improvement strategies. • Efforts to describe and evaluate priority setting could be relevant in the context of low and middle income countries. Priorities 2010: Boston, USA

  16. Thank you Asante Sana Priorities 2010: Boston, USA

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