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The implementation of decentralisation reforms in the health sector of Tanzania started in the 1980s.
The implementation of decentralisation reforms was commended by most of the informants in terms of increased local participation in identifying needs for health care delivery and financing.
However, the present complex recruitment and transfer procedures in FAO, resulting in long delays, which have long been identified as problematic in normal circumstances, are even more of an obstacle to the successful implementation of decentralisation.
In Tanzania, the implementation of decentralisation reform was carried out when the government was responding to the pressure from international financial institutions such as the World Bank, and the reform was tied by the aid conditionality from the donors.
Implementation of decentralisation does not necessarily mean that the decentralised entities can manage the system they are presented with.
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These approaches, when effectively implemented, can facilitate the smooth implementation of the decentralisation policy as it can allow for a shift from vertically-focused health programmes and centrally-controlled budgets to more comprehensive health planning and locally-controlled health budget structures at the district level.
Despite these challenges, it is important to note that improving the implementation of the decentralisation policy entails eliciting values and criteria for priority setting from lower level stakeholders in the health care system.
Thus, it is likely that dilemmas of priority setting related to the continued central role of the donors and of MoHSW, and the challenges linked to the weaknesses inherent in the district planning team that were found in this study as hampering the effective implementation of the decentralisation policy can be of some relevance also in other districts in the country.
The implementation of the decentralisation policy was credited by a majority of the study informants as providing more room for district authorities to request what they needed compared to the recruitment under centralisation, whereby the central government would post health workers to district without taking into consideration the specific needs of each district.
An important factor hampering implementation is decentralisation of the health sector, which created confusion regarding roles and responsibilities.
Human resources for health policy implementation in Brazil has been conducted against a background of decentralisation and with a focus of municipality involvement.
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CEO of Professional Science Editing for Scientists @ prosciediting.com