The TEHIP Spark: Planning And Managing Health Resources At The District Level

Executive Summary

"Beginning in 2001, IDRC’s Evaluation Unit carried out a strategic evaluation to observe whether or not the research it supports in the South influences public policy and decision-making, and if so how does it do this. As part of this strategic evaluation, 25 field studies were conducted covering the range of research areas and geographic areas within the Centre’s programming. The case study presented here is one of these studies.

The Tanzanian Essential Health Interventions Project (TEHIP) started in 1996 as a four-year research and development project designed to test the feasibility and measure the impact of an evidence-based approach to health planning at the district level. From its inception, through to the development and implementation of the tools, TEHIP was designed to influence health policies at the local and national levels. The project was both timely and relevant since it supported and coincided with the decentralization component of Tanzania’s health sector reform movement.

TEHIP developed and implemented several tools for district level health planning. A method for calculating and presenting Burden of Disease data (the BoD tool) and district health accounting were developed to help policy makers better understand the effects of the burden of disease in their respective districts, to allocate resources based on the burden of disease, and to manage and track those allocations. Another tool, the Cascade System, evolved after the project was started in order to organize and integrate health service delivery at the district level more efficiently and economically.

Using a framework for analysis developed for this strategic evaluation, findings in this case study suggest that TEHIP has influenced health policies by expanding policy capacities, broadening policy horizons and affecting policy regimes. TEHIP’s work with the district health services in both Morogoro-Rural and Rufiji was seen as having influenced the thinking and actions affecting how research data and other kinds of evidence can be used to make decisions about health policies, programs and priorities. This influence occurred both in terms of (1) the processes of policy formulation, implementation and reform; and (2) the content of the policies, programs and reforms.

Some of the factors that appeared to have facilitated these influences include: political commitment from senior level officials at both the national and district levels, the collaborative efforts between IDRC and the government of Tanzania and the additional resources TEHIP provided to the districts, that TEHIP was designed and implemented with the intent to work within the existing health planning and management systems, rather than creating a parallel system, and the commitment, dedication and expertise supplied by the TEHIP personnel.

There were also factors that were seen as constraining or inhibiting TEHIP’s influence, or potential future influence. These factors include: the “experimental” nature of TEHIP, the existing capacity in the remaining 112 districts to implement the tools on a national scale, limited dissemination of the tools and the results, and the strained relations between TEHIP and AMMP.

Although TEHIP was seen as having made significant contributions to both the processes of and changes to policies, programs and priorities, the challenge to sustaining this influence are numerable. Among other things, this study illustrates the paradoxical nature of “successful projects: then what”? A key question for both donors and governments of developing countries to consider in the future is: how to expand externally funded, district-level support projects to a national scale?"