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Title: Between rhetoric and reality : decentralisation and reproductive health service delivery in rural Tanzania
Author: Masawe, Cresencia Apolinary
ISNI:       0000 0004 6060 990X
Awarding Body: SOAS University of London
Current Institution: SOAS, University of London
Date of Award: 2016
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Tanzanian government has been implementing decentralisation policy based on its theoretical benefits of improving public services delivery. This study provides empirical examination of the implementation of health sector decentralisation, showing how interactions of fiscal, administrative and political decentralisation have had improved access to reproductive health services. A qualitative research design was adopted in which single case study was employed. Data were collected through using in-depth interviews, focus group discussions, observations and documentary analysis. Forty seven key informant participants and fourteen focus group discussions with different backgrounds and perspectives, observation of health facilities and analysis of fifty two key policy documents provide data base for the research. The findings suggest that to some extent decentralisation have granted local authorities with some fiscal, administrative and political power for health service delivery. However, its implementation was manipulated by central government acts, holding decentralised powers which jeopardise the benefits of decentralisation The scant evidence shows that the impact of decentralisation is far from reality as much of the efforts have been to improve democratic without considering the supportive environment under which health service delivery can be enhanced. The supportive environment such working referral system, skilled personnel is lacking; hence the efforts of decentralisation to improve reproductive health service delivery are intended to fail. It is therefore, unfair to charge decentralisation for inefficiencies performance of health system due to the presence of capacity shortfalls, increased financial dependence and weak institutional arrangements that obstruct service delivery. The findings also emphasise on significance of considering all dimensions of decentralisation process when investigating its effects on service delivery. This is because there is an additional positive result coming from the interaction of two or more decentralisation dimensions on health outcomes.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral