Community views on health sector reform and their participation in health priority setting: case of Lushoto and Muheza districts, Tanzania.
BACKGROUND
Community participation (CP) is a key concept under 'primary health care' programmes and 'Health Sector Reform' (HSR) in many countries. However, international literature with current empirical evidence on CP in health priority setting and HSR in Tanzania is scanty.


OBJECTIVE
To explore and describe community views on HSR and their participation in setting health priorities.


METHODS
A multistage sampling of wards and villages was done, involving group discussions with members of households, Village Development Committees (VDCs) and Ward Development Committees (WDCs).


RESULTS
Respondents at village and ward levels in both districts related HSR with a cost sharing system at public health facilities. Views on the advantages or disadvantages of HSR were mixed, most of the residents pointing out that user charges burden the poor, there is a shortage of drugs at peripheral health facilities, the performance of government health service staff and village health workers does not satisfy community needs, health insurance is promoted more than people actually benefit, VDC and WDC poorly function as compared to local community-participatory priority-setting structures.


CONCLUSIONS
HSR may not meet the desired health needs unless more efforts are made to enhance the performance of the existing HSR structures and community knowledge and enhance trust and participation in the health sector programmes at all levels.
Mubyazi
Godfrey M
GM
National Institute for Medical Research, Department of Health Systems and Policy Research & Center for Enhancement of Effective Malaria Interventions (CEEMI), P.O. Box 9653 Dar Es Salaam, Tanzania. gmmubyazi@yahoo.co.uk
Mushi
Adiel
A
Kamugisha
Mathias
M
Massaga
Julius
J
Mdira
Kassembe Y
KY
Segeja
Method
M
Njunwa
Kato J
KJ
D003256:Community Participation; D005260:Female; D017144:Focus Groups; D018166:Health Care Reform / Q000458:organization & administration*; D019981:Health Care Sector / Q000458:organization & administration*; D006292:Health Priorities / Q000458:organization & administration*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D009786:Occupational Health Services; D011320:Primary Health Care / Q000458:organization & administration; D013636:Tanzania