Proposal Presentation Nairobi_Respicius Shumbusho Damian

8/12/2019 Proposal Presentation Nairobi_Respicius Shumbusho Damian

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Consortium for Advanced Research Training in Africa

Community Role in Promoting FinancialAccountability in Rural Healthcare:A Case of Maternal Health in two Districts of

North-West Tanzania

PhD Thesis Proposal Presentation

Respicius Shumbusho Damian

Department of Political Science & Public AdministrationCollege of Social Sciences

University of Dar es Salaam, Tanzania

Supervisor: Prof. Benson Bana & Bernadeta Killian

Presented at Safari Park Hotel, Nairobi-Keya, April 1, 2014


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OutlineoBackground and Context

oResearch Problem /Question

oResearch Objectives

oProposed Conceptual Framework

oProposed Design and Methods

oReference

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Background and ContextTanzania has been 1 of the leading countries in prioritizingand addressing critical health problems in Africa.(1)

Financing(government and DPs) to reducepreventable deathsof women has been a critical concern since 1989.(1, 2)

Government spending on health increased from Tshs 143.6million to 1,288.7 million between 1999 and 2013. In 2013, 31%was devoted to maternal healthcare.

Relianceon donors and DPs decrease from 56.1% to 40%

between 2000 and 2010.(3)GBSdeclined from 77% to 26% between 2006 and 2013,butDomestic Health Expenditure Share increased from 43.9%to 56.9% in 2005.(3)

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Background and Context2001-2013, average financial commitment was sustained above10%.The highest was 13.8, in 2012 (close to 15%, AbujaDeclaration). (3, 4). 2012/13 (13.4%), 2013/14 (10.8%)**.

PARADOXY: Insignificant Returns; MMR is still unnecessarilyand unpredictably high standing at460/100,000 live births.

(4) (compared with Kenya and Uganda).


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Research Problem/QuestionSignificant increasein financing, but preventable health problems

persist(average maternal mortality ratearound 460) (5, 6,7)Existingresearchand Literatureattribute this to mismanagementoffinance (only 39.2%justifiable, 61.2% =seminars and workshops (8,9)

Consensus: Communities role is critical in managing healthcarefinancing for the best returns(effectiveness)(10,11,12), but littleconsensuswhether communities in the Tanzanian context arecapable-also, what makes up the so called community (13)

Efforts:to empower community actorsincreasingly supported, butimpact on financial accountability promotion remains questionable.(14,15)

???Whatpractically is the role of communities in promoting financialaccountability in rural healthcare. Howand in what capacityarecommunity actors able to play such a role? [Given the Context]

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Research Objectives (to)

Objective 1: Identify actorsand their specific roles inensuring financial accountability practices

Objective 2:Review accountability mechanisms in place forcommunity actors to play their role in promoting financialaccountability.

Objective 3:Review how the mechanismsin placehinder/facilitatecommunity actors role in promoting financialaccountability.

Objective 4:Examine capabilityof community actors toinfluence financial accountability in rural maternal healthcare

Objective 5:Proposea framework for enhancing community-basedfinancial accountability promotion in the context ofrural maternal health care.



Proposed Conceptual Framework

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Proposed Design and MethodsDesign: Case Study-maternal health care a typical healthchallenge in Tanzania and other developing countries

Typical case concern of global health, yet challenging indeveloping countries rural communities' context)

Why?: Not generalizing, but gaining deeper insights based on

peoples experiences, beliefs, meanings in particular context.(2 rural districts used for that purpose)

Focus: systems (actors, structures, process, structures,institutional (soft) procedures ) that shape interactions

Participants (150): Bureaucrats, technocrats, facilities (14),

community leaders, governing structures, OrganizedCommunity groups representatives (36)

Direct beneficiaries of MHC (100 respondents in the twodistricts-selected randomly (only) to control bias


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Proposed Design & Methods...Two first categories selected purposively, possibility of snowball, thethird category located through multistage random sampling, selected

using simple random sampling.Data Collection and Analysis: the two to overlap, focus on objectives[mainly focused ethnography methods].

Obj 1: (Actors and their specific roles) Co: Key informant interview,Observer as participant; An: Interpretive Content Analysis, Doc Rev

Obj2: (Mechanisms Available): Co: Documentary Review, Key InformantInterviews, Observer As Participant. An: Interpretive Content Analysis

Obj3: (Facilitating/hindering): Co: Ethnographic FGD, Semi-structuredInterview questionnaire (one-to-one, self-administered-3rdCategory ).An: Thematic Content Analysis, Qualitative Analysis of DescriptiveStatistics (processed by SPSS)

Obj4: (Actors Capability): Co: SSIQ and OAP. An:thematic/interpretive Content Analysis, QADS.

Obj 5: Propose a framework (descriptive induction from findings 1-4)

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Ethical Standards and Mechanisms

Methods, tools, and questions discussed with supervisor and

senior department researchers, and presented to for approvalProposed methods and tools submitted to the collegepostgraduate committee (ethical review and approval)

Community entry procedure: Seek approval and permits, buildpositive working relationship with administrative and

community authorities.Informed Consent for all Participants: Clarity of purpose,use of data, benefits, risk, confidentiality, voluntaryparticipation, open contact to institution).

Post Research Engagement: Strategy for sharing findings,and empowerment for CSOs engaged in policy analysis andadvocacy in the 2 districts. Linking key CSOs with othernational and international partners supporting communityaccountability empowerment. Support CSOs in testing thedesigned framework.

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Key References1. Kiria, I. B. (2009). Downward Accountability in Public Health Care Systems: The Case of Temeke Municipal Council, . Muhimbili University of Health and Allied Sciences.

Dar es Salaam.

2. Mswia, R., Lewanga, M., Moshiro, C., Whiting, D., Wolfson, L., Hemed, Y. P, S. (2003). Community-based monitoring of safe motherhood in the United Republic ofTanzania. Bulletin of the World Health Organization, 81(1), 87-94.

3. Swiss Development Cooperation. (2010). Swiss Cooperation Strategy for Tanzania 2007-2010: Swiss Development Cooperation

4. WHO, UNICEF,UNFPA, and World Bank (2012), Trends in Maternal Mortality: 1990 to 2010, WHO, UNICEF,UNFPA, and World Bank,https://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdf

5. Kanungo, P. (2005). Public Expenditure Tracking Surveys Application In Uganda, Tanzania, Ghana And Honduras, Washington: World Bank.

6. Strengthening Health Outcomes through Pivate Sector Project. (2013). Tanzania Private Health Sector Assessment Brief MD. Bethesda: Strengthening Health Outcomesthrough the Private Sector Project, Abt Associates.

7. Lawson, A & Rakner, L (2005), Understanding Patterns of Accountability in Tanzania: Synthesis Report, Dar es salaam: Oxford Policy Management and Report on PovertyAlleviation

8. Mushi, R., Melyoki, L., & Sundet, G. (2005). Improving Transparency of Financial Affairs at Local Government Level in Tanzania. Brief No. 2. Dar es Salaam: Research onPoverty Alleviation (REPOA).

9. Mwaikambo, E. (2010). Improving Maternal, Newborn and Child Health in Tanzania: From Science to Action, . Paper presented at the Third Professor Hubert KairukiMemorial Lecture, , Dar es salaam.

10. Brinkerhoff, D. (2003). Accountability and Health Systems: Overview, Framework, and Strategies: Abt Associates Inc.

11. Cooksey, B & Kikula, I, (2005).When Bottom-up meets Top-down: The Limits of Local Participation in Local Government Planning in Tanzania. DSM: M. N. Publishers.

12. World Health Organization. (2012). Addressing the challenge of women's health in Africa. A Summary of the

13. Checkland, K., Allen, P., Coleman, A., Segar, J., McDermott, I., Harrison, S., . . . Peckham, S. (2013). Accountable to whom, for what? An exploration of the earlydevelopment of Clinical Commissioning Groups in the English NHS. BMJ Open, 3(12). doi: 10.1136/bmjopen-2013-003769

14. United Republic of Tanzania. (2013). Public Expenditure Review 2013. Dar es salaam: Retrieved from http://mof.go.tz/mofdocs/news/PER NEWSLETTER Final.PDF.

15. Muhondwa, E. P. Y., Nyamhanga, T., & Frugence, G. (2008). Petty Corruption in Health Services in Dar es Salaam and Coast Regions. Dar es Salaam Youth ActionVolunteers.

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https://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdfhttps://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdfhttps://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdfhttps://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdf


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Proposal Presentation Nairobi_Respicius Shumbusho Damian