Social Accountability in Tanzania's Health Sector

Summary:

There are many reasons why healthcare providers should be accountable to the communities that they serve, including: enhancing the trust that underpins the patient-health worker relationship, strengthening popular support for health care, and above all, ensuring that care that is provided in ways that benefit patients and their communities rather than those providing care.
Unfortunately, many aspects of healthcare provided in some countries fails, benefiting providers at the expense of patients. A lack of accountability allows corrupt practices to flourish, leading to a provision of care that is at best ineffective and at worst harmful, both to health and to the economic wellbeing of the patient and their family.

The corruption issue

Access to affordable medicines in Tanzania, Nigeria and Bangladesh is known to be poor. One of the many reasons is the presence of corruption at all levels of the supply chain. Each country has nascent mechanisms in place to provide a degree of social accountability, that, if effective, should reduce the space for corrupt behaviours (and from incompetence and inefficiency that compound the problem). Yet these mechanisms are often weak.
In Tanzania, we will explore two specific initiatives seeking to achieve greater community involvement in reducing corrupt practices and thus improving governance, responsiveness and management of health facilities:

1. Health Facility Governing Committees
2. the Score Card system used at facility and community level.

Theory of Change:

• IF: We can strengthen Local Health Facility Committees, with wider representation of the communities they serve, and adapt the score card system, linking access to drugs with performance and empowering poor people
• THEN: we can improve access to essential medicines by reducing the corruption that impairs operation of drug supply chains
• BECAUSE: the strengthened system of accountability and transparency will expose the activities associated with local hierarchies and patronage that prevent people getting the medicines they need.

Research Methods:

The research will combine qualitative and quantitative methods such as: Focused literature/document reviews, consensus building techniques, qualitative and key informant interviews and focus group discussions, questions will be incorporated in the quantitative provider survey of 400 households in one or more regions to explore the effects of the facility and community level Score Card systems on citizen empowerment, on access to drugs, medicines and services.

Main Partners: The London School of Hygiene and Tropical Medicine (LSHTM) and the Ifakara Health Institute (IHI) in Tanzania.