Achievements and challenges of resource allocation for health in a decentralized system in Tanzania: perspectives of national and district level officers.

OBJECTIVE: The goal of this study was to identify the achievements and challenges of a resource allocation process in a decentralized health system in Tanzania as they are perceived by national and district level officers.

METHODOLOGY: This study was conducted between May 2011 and July 2012 in two districts of Dodoma region: Kongwa and Bahi. Data were collected from 25 key people involved in policy, planning and management aspects for the allocation of financial resources from the central government to local government districts. Thus, the recruitment of the study participants was purposive, as it took account of their positions and experience in health resource allocation and management. The data were collected through conversation in face-to-face in-depth interviews with the officers concerned. The data were analysed manually using qualitative content analysis.

RESULTS: The study has identified the achievements and challenges of resource allocation in a decentralized health system of Tanzania. The achievements include: the design and use of a needs-based resource allocation formula; reduced resource allocation inequalities between rural and urban districts; and a wide discretion by the district council to mobilize and utilize health insurance funds and user fees. On the other hand, the challenges are: the disbursed funds fall far short of centrally determined budget ceilings, and the funds are sent late; Council Health Management Teams (CHMT) develop budgets but are restricted on the percentage they can allocate to different areas--so there is severe under-funding of disease prevention and health promotion initiatives at the community level.

CONCLUSION: This study has identified achievements that should be further nurtured and challenges that should be worked on for the improvement of the decentralized health system. Thus, as a way forward, it is recommended that the equitable allocation of resources should go beyond the recurrent costs for the delivery of health services.