Evaluation of performance of local governments in health planning and target achievements under health basket funding system in Phase 1 Councils in Tanzania

Abstract

Globally, local governments (LGs) are established to ensure that community-oriented development priorities are set and national policies  are implemented with adequate community participation. In Africa, little is known on the performance of LGs in prioritysetting, financial  planning, resource allocation and budget control. We are add evidence from a study conducted to evaluate the performance of 37 LG  councils in health planning, budget control and target achievements and factors influencing the observed LG performance in Tanzania.

Methods: Interviews were conducted with heads of health facilities and LG council health managers and regional level officers. Overall, 37  councils and 21 regions were covered from where primary and secondary data were collected and analyzed involving multidisciplinary team.

In all councils found with health plans, district and regional level officers acknowledged the national health basket funding system  (HBFS) as having increased budget allocations for LG councils and such councils’ autonomy to set their priorities for health using  standard national guidelines. The concerns expressed by LG council health management teams (CHMTs) and health facility heads were  related to the criteria used by central government authorities and their allied development partners to set budget ceilings for specific  cost centres which all council have to adhere to. All LG council’s health plans reviewed showed ‘community initiatives’ component, but  none indicated explicitly and convincingly the specific activities to be covered. CHMT members alleged central government authorities  and offices of council executive directors (DEDs) for delaying to disburse the funds requested for supporting the planned health  activities/services at council levels. DED’s offices were also alleged for excessively interfering CHMTs on issues of use of vehicles among  other management affairs. Lack of qualified and full-time health accountants lowered some CHMTs’ capacity to set realistic budgets for  health activities, monitor health budget expenditure, and submit the required health plans to higher levels.

LGs could not achieve the  predetermined policy objectives or targets set in situations whereby they cannot exercise their autonomy to set priorities and access  funds for the planned activities, realize clear policy guidelines and good leadership relationships among themselves.