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How not to decentralise : accountability and representation in health boards in Tanzania


Document type: report
Download file(s): 115694 (351 KB)
Abstract: As decentralization expands in Africa, local management structures are also likely to become more important. The paper investigates issues of representation of and accountability to users of public services in local management structures. The study challenges the assumption that user representation in such structures enables users to voice their interests and makes services better adjusted to their needs. The findings reveal that because selection is not democratic, representatives see themselves as primarily accountable to government and not to their communities. The government dominates the selection process of members to the boards and committees. The perception of members on their role is mainly government-focused. It came out clearly that the represented communities, voluntary agencies and private health providers do not have a forum for consultation and raising issues. Voluntary agency and for-profit health providers’ representation is low. One of the recommendations is to use democratic elections.
Note: Paper for presentation at the European Conference of African Studies organised by the Africa-Europe Group for Interdisciplinary Studies. London: 29 June – 2 July, 2005
Authors: Boon, S.
Series Title: SNV publications
Country: Tanzania, United Republic of
Category: Research
Serial number: H0702-08
Keywords: health services , decentralization , governance
Language: eng
Organization: SNV - Netherlands Development Organisation
PAGE: 24
Place: The Hague
Publisher: SNV Netherlands Development Organisation
Year: 2007
Region: Africa South of Sahara , East Africa
Right: © 2007 SNV
Subject: Health and Nutrition
Title: How not to decentralise : accountability and representation in health boards in Tanzania