Role of Decentralisation by Devolution in Improving Primary Healthcare Service Delivery at Ward Level in Dodoma City.

Mbeke, Leah D. (2024) Role of Decentralisation by Devolution in Improving Primary Healthcare Service Delivery at Ward Level in Dodoma City. Masters thesis, The Open University of Tanzania.

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Abstract

The study investigated the role of decentralisation by devolution (D-by-D) in improving primary healthcare service delivery in Dodoma City Council, Tanzania. The study examines the impact of decentralisation on primary healthcare service delivery in Dodoma City Council, focusing on the distribution of services, household access, and challenges of decentralisation. The research, using both qualitative and quantitative methods, involved 136 participants, comprising patients, relatives, and medical staff practitioners. The study aimed to provide comprehensive insights into the challenges and progress made in primary healthcare since the introduction of the D-by-D policy in the 1990s. The study found that the decentralisation by devolution health facilities from the district to the ward level brought about positive progress in addition to enhancing their provision of healthcare services to the communities at the ward level. The study found that D-by-D policy has enhanced household access to primary healthcare services in residential areas by strengthening collaboration between central and local governments. This policy has also increased the availability, distribution, and accessibility of essential healthcare services at the ward level, thereby improving overall health outcomes. Despite the D-by-D policy’s success, challenges such as inadequate funding, untimely central government disbursement, lack of qualified personnel, interference, and conflict of interests persist in its effective implementation. Overall, the D-by-D policy in Dodoma has improved service delivery by expanding health services distribution, promoting decentralisation Implicitly, it is an intervention that allows local governments to play a crucial role in policy and decision-making, hence preventing political interference. Keywords: Decentralisation, Devolution, Healthcare Services, Local Government, Councils.

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