title: Decentralizing EPI services and prospects for increasing coverage: the case of Tanzania.
abstract: Primary health Care (PHC) strategies were adopted widely in 1978 after the Alma Ata declaration to improve accessibility to health services and the health of the people. Of the strategies of PHC was the decentralization of health services to lower levels in order to enhance participation and responsiveness of the health system to local problems. While PHC was being promoted vertical programmes such as the expanded programme on immunization (EPI) were also being promoted and achieved substantial benefits. However, almost 25 years later many countries have not been able to achieve these health goals. This study addressed the question: Can we make the process of health care decentralization more likely to support health system and EPI goals? This study analysed the experience of EPI decentralization at national, regional and district levels. Several stakeholders were identified who were supportive and others who were non-supportive of the process. Community support to EPI measured by using willingness to pay (WTP) for kerosene (to keep vaccines cool) was low. It was significantly (p < 0.05) associated with whether providers in the nearest health facility properly attended the target population and whether the providers in the facility were available when needed. There was a substantial stakeholder support and opposition to the process of decentralization at the district level. Community support was not high possibly due to the perceived non-availability of the service providers and their lack of awareness of the population they serve. It was proposed that reforms should give priority to the involvement of communities and peripheral health facility providers in the process.
authors.affiliation: Department of Epidemiology and Biostatistics, Institute of Public Health, P.O. Box 65015, Dar es Salaam, Tanzania. isemali@muchs.ac.tz
authors.forename: Innocent A J
authors.initials: IA
authors.lastname: Semali
authors.forename: Marcel
authors.initials: M
authors.lastname: Tanner
authors.forename: Don
authors.initials: D
authors.lastname: de Savigny
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration; D017598:Efficiency, Organizational; D005382:Financing, Personal; D006297:Health Services Accessibility; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D011050:Policy Making; D011057:Politics; D012424:Rural Population; D013636:Tanzania