Challenges For and Against Decentralization by Devolution in Public Health Service Delivery in Tanzania: A case of Ilala Municipal Council and Geita Town Council

Public Administration and Management

The purpose of the study conducted was to examine and analyze the specific challenges associated with Decentralization by Devolution (D-by-D) in the delivery of public health services in Ilala Municipal Council (IMC) and Geita Town Council (GTC). In order to achieve this objective, the study adopted an exploratory design, which employed both quantitative and qualitative research approaches to thoroughly investigate the practicality and effectiveness of decentralization by devolution in the realm of public health service delivery. To gather the necessary data for analysis, the researchers employed a combination of stratified, simple random, and purposive sampling techniques. These methods allowed them to select a representative sample of 424 participants from six strategically chosen wards within the two councils. The data collection process encompassed the use of questionnaires, interviews, and documentary reviews, enabling the researchers to obtain a comprehensive understanding of the challenges faced in the implementation of D-by-D in public health services. The findings of the study unveiled a range of challenges encountered in the D-by-D approach to public health service delivery in both IMC and GTC. These challenges were identified and analyzed, shedding light on the specific areas where improvements and interventions were required. The study concluded that there were six major challenges that the decentralization by devolution system faced in the delivery of public health services in both IMC and GTC, thus emphasizing the significance of addressing these issues for the betterment of healthcare provision. Based on the research outcomes, the study recommended various measures to tackle the challenges identified. One prominent suggestion was the urgent need for capacity building among healthcare workers. The government, in collaboration with other key stakeholders such as the private sector and training institutions, was urged to take the lead in providing the necessary training and skills enhancement opportunities to healthcare professionals. This collaborative effort aimed to empower healthcare workers with the knowledge and expertise required to overcome the challenges associated with D-by-D in public health service delivery.

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