Integrating reproductive health services in a reforming health sector: the case of Tanzania.
Universal access to comprehensive reproductive health services, integrated into a well-functioning health system, remains an unfulfilled objective in many countries. In 2000-2001, in Tanzania, in-depth interviews were conducted with central level stakeholders and focus group discussions held with health management staff in three regional and nine district health offices, to assess progress in the integration of reproductive health services. Respondents at all levels reported stalled integration and lack of synchronisation in the planning and management of key services. This was attributed to fear of loss of power and resources among national level managers, uncertainty as to continuation of donor support and lack of linkages with the Health Sector Reform Secretariat. Among reproductive health programmes, sexually transmitted infection (STI) control alone retained its vertical planning, management and implementation structures. District-level respondents expressed frustration in their efforts to coordinate STI service delivery with other, more integrated programmes. They reported contradictory directives and poor communication channels with higher levels of the Ministry of Health; lack of technical skills at district level to undertake supervision of integrated services; low morale due to low salaries; and lack of district autonomy in decision-making. Integration requires a coherent policy environment. The uncoordinated and conflicting agendas of donors, on whom Tanzania is too heavily reliant, is a major obstacle.
Oliff
Monique
M
Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
Mayaud
Philippe
P
Brugha
Ruairí
R
Semakafu
Ave Maria
AM
D001291:Attitude of Health Personnel; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D017144:Focus Groups; D018166:Health Care Reform / Q000458:organization & administration*; D006284:Health Plan Implementation / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D006302:Health Services Research; D006801:Humans; D007587:Job Description; D017146:Models, Organizational; D009313:National Health Programs / Q000458:organization & administration; D020380:Needs Assessment; D011209:Power, Psychological; D017009:Professional Autonomy; D034121:Reproductive Health Services / Q000458:organization & administration*; D013636:Tanzania