Strengthening accountability for better health outcomes through understanding health system bottlenecks: insights from Tanzania
Tanzania’s public health system is stretched: financing is fragmented and reliant on external support, with increasing out-of-pocket
payments; worker motivation is low, coupled with severe shortages of staff, medicines and supplies; health facilities receive inadequate funds with limited financial autonomy (till recently); and local government authorities are inadequately financed and equally challenged.
This review explores the national context, the policy context for corruption in the health sector and the types of rule-breaking and 'rule-bending' informal practices common among frontline health workers. The paper also reviews the potential of the following five interventions that are currently being implemented and that seek to directly or indirectly mitigate the practice of corruption in the health sector: 1) performance-based financing; 2) direct health-facility financing; 3) improved community health funds; 4) health facility governing committees; and 5) social accountability initiatives.
The paper explores a central question: what is practically feasible and will work best within the Tanzanian context – what mix of strategies and initiatives will result in improved service use and quality, health outcomes and equity to have more meaningful accountability for health-user rights and entitlements?