The politics of implementing intersectoral policies for primary health care development: experience and lessons from Tanzania.
The paper reviews the initiatives made by the Government of Tanzania to develop intersectoral collaboration for the implementation of Primary Health Care(PHC). It explains why there has been little in those directions. A number of shortcomings were identified during the different phases of PHC implementation, these include: misconception of PHC by the MoH as PHC was paradoxically initiated in the MoH (national level) as a vertical programme alongside other vertical programmes which were not coordinated, formation of the PHC coordinating committees alongside development committees existing at village, district and regional levels gave rise to unnecessary multiplication of committees at these levels: a tendency by the MoH to refrain from implementing its past decisions such as dropping the formation of a National Health Council to guide the PHC-oriented policy formulation process at national level; weakening the national level coordinating mechanism by lack of political legitimacy it deserves; and inadequate legal mechanisms proposed in the 1983 PHC guidelines to back up PHC implementation which were made in reference to only the village level PHC committee. Experience of implementing PHC in Tanzania highlights the point that intersectoral collaboration is not simply a technical issue but as influenced by socio-political factors. This article has raised a number of issues which have to be noted in order to improve intersectoral collaboration in Tanzania. First, is the need to place PHC on Tanzania's political agenda. This may taken time but it is a necessary exercise to undertake. Second, effective mechanisms to foster policy coordination at national level should be developed. Third, intersectoral coordination processes at national level should guide similar processes at subnational levels. Fourth, is always to be aware of an counteract the problems presented by the medical model in health programmes implementation processes.
Kamuzora
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Institute of Development Studies, University of Dar-es-Salaam, United Republic of Tanzania.
D006284:Health Plan Implementation; D006291:Health Policy; D007373:Interinstitutional Relations; D011050:Policy Making; D011057:Politics; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D013636:Tanzania