The success of national policies requires dedication of key implementers, such as the targeted respondents for this survey.
Recommendations: 1. CEC Mobilisers should no longer remain to be the "key" implementers of the CEC capacity building and support service delivery approach provided by the Ministries of Education and Regional Education Umbrellas.
Findings from our study urges thorough involvement of key implementers from the district level during development of health policy and the government's full support to back effective implementation of the developed policy.
Health workers are key implementers of any reform such as the provision of free care, and it is crucial to consider how they may support or thwart the implementation of such policy change.
The current study is an in-depth investigation into the knowledge and understanding of health financing policies in general and policies on CHI in particular by policy makers and key implementers.
All key stakeholders at provincial level interviewed in this study also serve as the key implementers for other districts and our findings could serve as the baseline for Provincial MoH Sindh to evaluate the capacity of other districts in Sindh toward effective IMCI implementation.
Factors to assess include characteristics of the key implementers (e.g., job title and professional training, length of time in current role, prior experience with and attitudes towards risk-minimization programs), level of awareness, and degree of 'buy-in' from the local healthcare provider community, features of the local healthcare delivery and reimbursement system, and local laws/regulations.
Despite the fact that the findings of this study were collected from a limited sample of key implementers of decentralization at the district level and decision makers at the national level, we believe that the insights gained from this study are reflective of the general situation in Tanzania.
Importantly, even though the sample was small we had representation of views from most key policy implementers, especially those at the front line in these three remote communities.
As shown by Nimpagaritse and Bertone [ 50], the central government sometimes overlook challenges faced by key policy implementers at the district level, giving an example of how abolition of user fees in Burundi resulted in financial crisis and increase of administrative workload leading to reduced quality of services.
