Informal Practices among Tanzania's Public Sector Health Workers- Determinants and Policy Implications.

    The front-line of health service delivery in Tanzania encompasses public health facilities (health centres, dispensaries, district and regional hospitals) that provide basic health services to majority of the population. In 2014, the Government of Tanzania owned72% of all health facilities with the rest owned by Faith Based Organizations (FBOs), Non-Governmental Organisations (NGOs), Civil Society Organizations (CSOs) and other profit-based Private Health Service Providers (URT,2017).Within the government, the responsibility for delivery of public health services falls under the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDEC) as well as the President’s Office- Regional Administration and Local Government (PO-RALG). The MoHCDEC carries the overall responsibility ofpolicy formulation, supervision and regulation of all health services throughout the country, as well as playing a direct role in the management of tertiary health services delivered by referral hospitals. PO-RALG on the other hand is in charge of policy implementation, supervision and monitoring ofhealth services delivered byhospitals at regional and district levels as well as dispensaries and health centres that operate within areas of jurisdiction of respective regional and district councils.

    Over the years, the Government of Tanzania has been making efforts to improve health service provision as indicated by increasing budget allocations to the health sector, both in terms of budgeted and actual amounts disbursed. During the financial year 2015/16, the health sector was allocated over Tshs 1.5 trillion, equivalent to 71 percent increase over the sector’s actual spending in 2012/13 (UNICEF, 2016). The Government has also formulated and is in the course of implementing strategic plans to guide operations of the health sector. Currently key strategies at national level include the National Community Based HealthStrategy (2015–2020);Primary Health Services Development Programme (2007– 2017);National Multi-Sectoral Strategy for HIV/AIDS (2015–2020); Health Sector Strategy Plan IV (2015– 2020);The Third Health Sector HIV/AIDS Strategic Plan (2013–2017); and the Tanzania Development Vision 2025 implemented through five-year development plans. Despite the efforts, Tanzania’s health sector still faces resource constraints particularly human and financial which impact the availability and quality of health service delivery. In an attempt to ensure that services are delivered in the midst of resource scarcity , some health sector employees have adopted informal practices that aim at getting their jobs done despite challenges faced.

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ESRFs activities are supported by the Government of the United Republic of Tanzania, United Nations Development Programme (UNDP), African Capacity Building Foundation (ACBF),Think Tank Initiative of IDRC and The Foundation for Civil Society.