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Priority-setting for Reproductive Health Services at the Council Level In the Context of Health Sector Reforms in Tanzania

Cresencia A Masawe


Priority-setting has become an important component of health sector reforms (HSRs) seeking to achieve improved health outcomes. However, limited studies have focused on analysing priority-setting processes and the criteria used for resource allocation for sexual and reproductive health services (SRH) at the council level in Tanzania. This study aims at providing a better understanding of the factors affecting SRH prioritisation at council levels. Explicitly, it documents the priority-setting process and expounds whether there is harmonisation or discrepancy between national and local priorities. The study was qualitative in nature, collecting data through interviews with key informants, focus group discussions (FGDs) with members of the Health Facility Governing Committee (HFGC), and a review of relevant documents. The findings show that HSRs in Tanzania support prioritization of SRH although the process is influenced by central directives. The study also found that the priority-setting process is underdeveloped and hardly involve SRH advocates. The study argues that SRH priorities need protection within the reformed health system, as such challenging the current priority-setting mechanism that uses disease ranking as the main criteria for setting council health priorities. For HSRs to provide a chance to improve SRH status, there is a need to ensure that the provision of, and access to, essential SRH services such as reproductive system cancer screening, fertility, among others, are inclusive. Thus, a needs-driven priority-setting that embraces bottom-up approach with the inclusion of SRH advocates and experts is recommended.


health system reform, priority-setting, sexual and reproductive health services, Tanzania

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Akor, W., G. Maniatopoulos & L. Vale. 2017. The Contextual Setting of Health Care Prioritization in Nigeria. Athens Journal of Health, Volume X, N0.Y.

Chitama, D., R. Baltussen, E. Ketting, S. Kamazima, A. Nswilla & P. G. Mujinja. 2011. From Papers to Practices: District Level Priority-Setting Processes and Criteria for Family Planning, Maternal, Newborn and Child Health Interventions in Tanzania. [Research Support, Non-U.S. Gov't]. BMC Womens Health, 11: 46.

Cromwell, I., S. J. Peacock & C. Mitton. 2015. 'Real-World' Health Care Priority-Setting Using Explicit Decision Criteria: A Systematic Review of the Literature. BMC Health Serv Res, 15:164.

Denscombe, M. 2003. A Good Research Guide for Smiall Scale Social Research Project. Buckingham Open University Press.

Ensor, T. & J. Ronoh. 2005. Impact of Organizational Change on the Delivery of Reproductive Services: a Review of the Literature. Int J Health Plann Manage. 20(3): 209–225.

Kamuzora, P., S. Maluka, B. Ndawi, J. Byskov & A. K. Hurtig. 2013. Promoting Community Participation in Priority-Setting in District Health Systems: Experiences From Mbarali District, Tanzania. Glob Health Action, 6(1): 22669.

Leighton, C. 1996. Strategies for Achieving Health Financing Reforms in Africa. World Development, 24(9): 1511–1525.

Maluka, S., P. Kamuzora, M. San Sebastian, J. Byskov, B. Ndawi & A.K. Hurtig. 2010a. Improving District Level Health Planning and Priority-Setting in Tanzania Through Implementing Accountability for Reasonableness Framework: Perceptions of Stakeholders. BMC Health Services Research, 10(1): 322 (pp. 1–13).

Maluka, S., P. Kamuzora, M. San Sebastian, J. Byskov, B. Ndawi, O. Olsen & A.K. Hurtig. 2010b. Decentralized Health Care Priority-Setting in Tanzania: Evaluating Against the Accountability for Reasonableness Framework. Social Science and Medicine, 71: 751–759.

—. 2011. Decentralization and Health Care Prioritization Process in Tanzania: From National Rhetoric to Local Reality. Internal Journal of Health Planning and Management, 26, 55–73.

Mayhew, S. H. & S. Adjei. 2004. Sexual and Reproductive Health: Challenges for Priority-Setting in Ghana's Health Reforms. [Research Support, Non-U.S. Gov't]. Health Policy Plan. 19 Suppl 1: 50–I61.

Mcgirr, N. J., L. Lacey & C. Woodsong. 1994. Decentralization of Population and Family Planning Programs: Worldwide Experience. Washington, D.C: Futures Group International.

Ministry of Health (MOH). 2000a. National Package of Essential Reproductive and Child Health Interventions. Dar es Salaam: Ministry of Health.

—. 2000b. National Package of the Essential Health Interventions in Tanzania. Dar es Salaam: Ministry of Health.

Nyandieka, L., Y. Kombe, J. Byskov & M. Njeru. 2015. An Assessment of Priority-Setting Process and Its Implication on Availability of Emergency Obstetric Care Services in Malindi District, Kenya. The Pan African Medical Journal, 2015;22:156. doi:10.11604/pamj.2015.22.156.7296.

Olowu, F. 2003. Priority-Setting in Africa for Sexual and Reproductive Health Under the Essential Primary Care Package in Health Sector Reform. Lagos: Intellfit Research Group and Social Fund.

Reichenbach, L. 2002. The Politics of Priority-Setting for Reproductive Health: Breast and Cervical Cancer in Ghana. [Research Support, Non-U.S. Gov't]. Reprod Health Matters, 10(20): 47–58.

Sen, G., P. Östlin & A. George. 2007. Unequal, Unfair, Ineffective and Inefficient Gender Inequity in Health: Why It Exists and How We Can Change It. Karolinska Instituet, Women and Gender Equity Knowledge Network

Standing, H. 1997. Gender and Equity in Health Sector Reform Programmes: A Review. Health Policy and Planning, 12(1): 1–18.

—. 2000. Gender Impacts of Health Reforms - The Current State of Policy and Implementation. Paper for ALAMES Meeting, Habana, Cuba.

—. 2002. an Overview of Changing Agendas in Health Sector Reforms. Reproductive Health Matters, 10(20): 19–28.

United Nations. 2010. The Millennium Development Goals Report. New York: United Nation.

Walt, G. & L. Gilson. 1994. Reforming the Health Sector in Developing Countries: the Central Role of Policy Analysis. [Review]. Health Policy and Planning, 9(4): 353–370.

WHO. 2010. Social Determinants of Sexual and Reproductive Health: Informaing Future Research and Programme Implementation. Geneva: World Health Organisation

—. 2014. Trends in Maternal Mortality: 1990 to 2013 Estimates By WHO, UNICEF, UNFPA, the World Bank and the United Nations Population Division. Geneva: World Health Organisation.

Williams, A. 1988. Priority-Setting in Public and Private Health Care. A Guide Through the Ideological Jungle. J. Health Econ., 7(2): 173–183.


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