The Dar Es Salaam Urban Health Project, Tanzania: a multi-dimensional evaluation.
BACKGROUND
In the 1990s, as a response to rapid urbanization, there were a number of large, urban health initiatives in sub-Saharan Africa. Most tended to be comprehensive as opposed to selective in scope: they aimed at strengthening the health system as a whole, and placed emphasis on delivering improved services at the primary level, with increased community participation. A multi-dimensional approach is required to assess the achievements of such initiatives.


METHODS
In 2000 an external evaluation of the Swiss-funded Dar es Salaam Urban Health Project, Tanzania, used 50 key informant interviews, 90 health facility exit interviews, 90 community resident interviews and document analysis to assess achievements over a 10 year period. The study considered achievements in terms of capacity building, improving quality of care, community involvement, inter-sectoral action and sustainability.


RESULTS
Although the project achieved improvements in capacity building and in structural and technical quality of care, there were difficulties in generating inter-sectoral action and the concept of participation was limited. However, city-level 'ownership' of the activities was high, and, with the advent of sector-wide allocation of funds (SWAPs) in the health sector in Tanzania, the prospects for sustainability of the achievements made in the project appear to be good.


CONCLUSIONS
Both the multi-dimensional method of the evaluation and the findings can inform future urban health initiatives in sub-Saharan Africa and in other resource-constrained environments. The decentralization that occurred in Dar es Salaam and the general approach of the project provided a platform to test out various elements that are common to health sector reform across developing countries.
Harpham
Trudy
T
South Bank University, London. t.harpham@sbu.ac.uk
Few
Roger
R
D003151:Community Health Centers / Q000592:standards*; D018672:Community Health Planning; D003256:Community Participation; D006302:Health Services Research; D006801:Humans; D015397:Program Evaluation; D013636:Tanzania; D017749:Total Quality Management / Q000706:statistics & numerical data*; D019037:Urban Health Services / Q000592:standards*; D014507:Urbanization