Presentation on LMG in Devolved Health Systems: Learning from an International Experience

1. The First National Conference
on Health Leadership,
Management and Governance
The Devolution Experience in Tanzania
Dr. Gabriel L. Upunda
29 January 2013

2. Getting Started
IN NOVEMBER 1993 THE TANZANIA
HEALTH SECTOR REVIEWED BY WIDE
CROSS SECTION OF STAKE-HOLDERS

3. Identified Problems
• Inadequate Resources to the Sector
• Inadequate Managerial Capacity
• Poor Implementation
• Dual Responsibilities of DMO both the central
and local governments
• Lack of an appropriate research priority policy
at all levels
• Overall declining economic performance in the
country

4. Major Areas of Consideration
• Ideological Issues
• Organisational Issues
• Managerial Issues
• Financial Issues
• Public/Private Mix
• Research
• Legal Aspects

5. Devolution
• The decision to devolve was by the central
government
• The Ministry of Health and Social Welfare,
Regional Administration and Local
Government, and Other Ministries had to
abide to it.

6. Challenges for Devolution
• Different Ministries misunderstanding or not
understanding the concept of devolution
• Central Ministries reluctant to leave power to lower
Institutions (Regions, Districts)
• Low budget
• Low Managerial Capacity as specially at District level
• Lack of Legal Framework

7. Challenges
• Public / Private Partnership operating at very
low level
• Standards not set for public and private
medical premises

8. Reforms
• IDEOLOGICAL REFORMS
• ORGANISATIONAL REFORMS
– Administrative structures reforms
– District Health Boards
– Refinement of the referral health system
• MANAGERIAL REFORMS
– Dual responsibilities for district health services
management
– Financial Management
– Human Resource Management
– Logistical Support

9. Reforms
• FINANCIAL REFORMS
– The diversification of sources of health financing
– Allocation of public expenditure
• PUBLIC/PRIVATE MIX REFORMS
– Amendment of Legislation
– Health Facilities
– Resource Control and Human Resource Development
• RESEARCH REFORMS
• REVISION OF THE HEALTH POLICY

10. Reforms
• FORESIGHT
– Empowering district, community and
household initiatives
– Seeking alternative financing option
– Continuous revision of the implementation
of various Acts, Ordinances and regulations

11. But since 2000……
….

12. Summary
• Health reform is a dynamic process. There is
no template
• There are many interested parties when a
country goes into this process.
• Always be prepared to adapt rather than
adopt.

13. Thank you.