Effectiveness of Decentralisation by Devolution Approaches in Public healthcare services Delivery in Ilala Municipal Council and Geita Town Council, Tanzania

Abstract

This study investigates the effectiveness of Decentralisation by Devolution (D-by-D) in public healthcare service delivery within Ilala Municipal Council and Geita Town Council, Tanzania. Employing a mixed-methods approach, including quantitative surveys and qualitative interviews with local key informants, the research reveals critical insights into how D-by-D frameworks impact healthcare quality and accessibility. Findings indicate that while some approaches, such as project monitoring and budget allocation, are perceived as effective, others—particularly multi-stakeholder involvement, participation, and strategic planning—are regarded as ineffective. The average effectiveness score across both councils suggests a moderate perception of D-by-D functioning, yet significant gaps exist regarding community engagement, resource allocation, and local governance capabilities. Challenges include inadequate funding, personnel shortages, and a lack of transparency, which hinder the realization of Decentralisation’s intended benefits. The study underscores a prevalent sense of skepticism regarding healthcare quality in both councils and highlights the necessity for reforms to better align local health priorities with community needs. To enhance the effectiveness of D-by-D, the research recommends strengthening financial support to Local Government Authorities, enhancing human resource capacity, fostering community participation, and promoting accountability and transparency in healthcare governance. This research contributes to the understanding of local governance in Tanzania and offers essential insights for policymakers aiming to improve healthcare outcomes through decentralized frameworks.