Health system's barriers hindering implementation of public-private partnership policy in the health sector at district level: A case study of partnership for improved reproductive and child health services provision in Bagamoyo district, Tanzania

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dc.contributor.advisorOlivier, Jillen_ZA
dc.contributor.authorKamugumya, Denice Cyprianen_ZA
dc.date.accessioned2015-12-03T14:12:35Z
dc.date.available2015-12-03T14:12:35Z
dc.date.issued2015en_ZA
dc.description.abstractThe role of the private sector in improving health systems performance in lower to middle income countries is increasingly gaining more recognition. Public-private partnership (PPP) has been suggested as a tool, to assist governments fulfil their responsibilities in the efficient delivery of health services. In Tanzania, although the idea of PPP has existed for many years in the health sector, there has been limited coordination, especially at a district level - which has contributed to limited health gains or systems strengthening obviously seen as a result of PPP. In 2009 a formal PPP policy was introduced in Tanzania, which directs the appropriate allocation of resources, and describes risk and rewards that can be achieved by building on the expertise of each partner. The Health Sector Strategic Plan III (2009-2015) further emphasises the need for service level agreements (SLAs), which are seen as an important indicator of improved PPP. This case study that draws on the decision-space framework, was conducted in the Bagamoyo district of Tanzania, and employed in-depth interviews, document reviews, and observations methods. The study findings reveal several forms of informal partnerships between the local government and non-state actors. The lack of SLAs for facilities that receive subsides from the government is argued to contribute to inappropriate distribution of risk and reward leading to moral hazards. This is evidenced by non-state actors who pursue their own interests, diverting from public social goals. Furthermore, findings highlight weak capacity of governing bodies to exercise oversights and sanctions, which is acerbated by weak accountability linkages and power differences. Moreover, restricted flexibility in spending is seen to deter prompt actions to address evolving population needs, given limited local fiscal space. It is concluded that effective PPP policy implementation at a local level depends on the capacity of local government officials to make choices that would embrace relational elements dynamics in strategic plans. Disempowered Council Health Services Board in relation to engaging non-state actors is shown to impede PPP initiatives that are conceptualized at local and national levels. This study highlights a need to consider initiatives that would foster new social contracts with non-state actors at the local level and in return build a people-centred district health system. This study is intended to improve knowledge on health systems policy interventions, strengthen future policy implementation at the sub-national level, and strengthen the district health systems as a result of PPP in a country with similar contextual elements.en_ZA
dc.identifier.apacitationKamugumya, D. C. (2015). <i>Health system's barriers hindering implementation of public-private partnership policy in the health sector at district level: A case study of partnership for improved reproductive and child health services provision in Bagamoyo district, Tanzania</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/15546en_ZA
dc.identifier.chicagocitationKamugumya, Denice Cyprian. <i>"Health system's barriers hindering implementation of public-private partnership policy in the health sector at district level: A case study of partnership for improved reproductive and child health services provision in Bagamoyo district, Tanzania."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2015. http://hdl.handle.net/11427/15546en_ZA
dc.identifier.citationKamugumya, D. 2015. Health system's barriers hindering implementation of public-private partnership policy in the health sector at district level: A case study of partnership for improved reproductive and child health services provision in Bagamoyo district, Tanzania. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Kamugumya, Denice Cyprian AB - The role of the private sector in improving health systems performance in lower to middle income countries is increasingly gaining more recognition. Public-private partnership (PPP) has been suggested as a tool, to assist governments fulfil their responsibilities in the efficient delivery of health services. In Tanzania, although the idea of PPP has existed for many years in the health sector, there has been limited coordination, especially at a district level - which has contributed to limited health gains or systems strengthening obviously seen as a result of PPP. In 2009 a formal PPP policy was introduced in Tanzania, which directs the appropriate allocation of resources, and describes risk and rewards that can be achieved by building on the expertise of each partner. The Health Sector Strategic Plan III (2009-2015) further emphasises the need for service level agreements (SLAs), which are seen as an important indicator of improved PPP. This case study that draws on the decision-space framework, was conducted in the Bagamoyo district of Tanzania, and employed in-depth interviews, document reviews, and observations methods. The study findings reveal several forms of informal partnerships between the local government and non-state actors. The lack of SLAs for facilities that receive subsides from the government is argued to contribute to inappropriate distribution of risk and reward leading to moral hazards. This is evidenced by non-state actors who pursue their own interests, diverting from public social goals. Furthermore, findings highlight weak capacity of governing bodies to exercise oversights and sanctions, which is acerbated by weak accountability linkages and power differences. Moreover, restricted flexibility in spending is seen to deter prompt actions to address evolving population needs, given limited local fiscal space. It is concluded that effective PPP policy implementation at a local level depends on the capacity of local government officials to make choices that would embrace relational elements dynamics in strategic plans. Disempowered Council Health Services Board in relation to engaging non-state actors is shown to impede PPP initiatives that are conceptualized at local and national levels. This study highlights a need to consider initiatives that would foster new social contracts with non-state actors at the local level and in return build a people-centred district health system. This study is intended to improve knowledge on health systems policy interventions, strengthen future policy implementation at the sub-national level, and strengthen the district health systems as a result of PPP in a country with similar contextual elements. DA - 2015 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Health system's barriers hindering implementation of public-private partnership policy in the health sector at district level: A case study of partnership for improved reproductive and child health services provision in Bagamoyo district, Tanzania TI - Health system's barriers hindering implementation of public-private partnership policy in the health sector at district level: A case study of partnership for improved reproductive and child health services provision in Bagamoyo district, Tanzania UR - http://hdl.handle.net/11427/15546 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15546
dc.identifier.vancouvercitationKamugumya DC. Health system's barriers hindering implementation of public-private partnership policy in the health sector at district level: A case study of partnership for improved reproductive and child health services provision in Bagamoyo district, Tanzania. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2015 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/15546en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherHealth Systemsen_ZA
dc.subject.otherPolicy Researchen_ZA
dc.subject.otheren_ZA
dc.titleHealth system's barriers hindering implementation of public-private partnership policy in the health sector at district level: A case study of partnership for improved reproductive and child health services provision in Bagamoyo district, Tanzaniaen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMPHen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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