The road to quality health services remains bumpy, despite
efforts by the government and private sector to address determinants of
health. While the healthcare agenda is a top priority globally, in
Tanzania, the future of the health sector continues to be bleak.
As it is, 90 per cent of the budget depends on
donor funds. The deteriorating situation in health services is much more
vivid at the local level where disbursement of funds from central level
is delayed for two to three quarters and sometimes up to the fourth
quarter.
Other social determinants affecting the health
sector include citizens’ participation in planning, budgeting, and
performance evaluation. Others are Councillors’ capacity to play an
oversight role and participation of other actors/social groups like the
youth, disabled, people living with HIV, and so forth.
In trying to address these determinants, Sikika
embarked on an intensive Social Accountability Monitoring (SAM)
programme that covered ten districts in five regions - Kondoa, Mpwapwa,
Singida Rural, Iramba, Simanjiro and Kiteto.
Other districts covered are Kibaha, Temeke, Kinondoni and Ilala.
SAM refers to a broad range of actions that
citizens, communities, independent media and civil society organisations
can use to hold public servants to account.
It is a five-step process that uses various
documents as tools. With the SAM approach, accountability is monitored
through assessment of plans and resource allocation and tracking
expenditure to examine whether there are any inappropriate spending,
unnecessary expenditures, under-spending or over-spending.
The approach also tracks performance, identifies
mechanisms that exist to prevent and/or correct actions taken in
response to misuse and abuse of public funds. SAM also evaluates how
oversight bodies play their roles to make officials accountable for
their performance.
Health challenges such as prevention and treatment
in the above districts are almost similar but health governance
problems weigh above the dimensional bars; that is why Sikika in efforts
to address social determinants of health, opted for the SAM approach at
both central and local government levels.
SAM interventions were at first not well
understood by some actors at local government level until more efforts
and engagement was sought. Citizens in these districts confirmed that
accountability is finally knocking on the door of local governments.
However, there is feasible change through the
programme as citizens are now demanding public information. “I didn’t
know that any citizen can ask for the CCHP and be given or shown,” says
Mpwapwa resident, Tabu Samila,
Other changes observed through SAM include
increased availability of medicines and health supplies; service
providers have stopped using abusive language, health buildings which
were constructed below standard have been renovated as per Bill of
Quantities (BOQ) and to some extent, there is increased budget
transparency.
By looking at the way local government works, one may end up saying “things will never change”.
A lot of internal challenges embedded within those
from central government, as well as other political pressures, weigh
down on the councils’ growth and on their prime goal of serving the
people. Obviously, in situations such as these, a curse of
unaccountability will never die if interventions such as SAM are not
demonstrated enough in revamping the governance systems.
Most of the district commissioners and district
executive directors from the above districts salute SAM interventions.
This is because it helps expose the misconduct of service providers,
providing the authority with an opportunity to hold the public servants
to account and exercise their oversight role confidently.
“I got to understand that service providers must
do their job knowing that the community knows what they are doing. I
respect SAM because if you get someone to do your work without paying
them, then those people should be respected,” said Mpwapwa district
commissioner Christopher Kangoye.
It should be noted that SAM is not meant to
incriminate any person; rather it sheds light on accountability and
strengthens good governance.
This can be justified with the 2012 SAM reports
published by Sikika, in which almost half of the agreed action points
from issues raised by SAM teams have been rectified by responsible
authorities.
Citizens should continue to exercise SAM in their
districts in order to realise enhanced health and HIV and Aids sector
budget efficiency, transparency and accountability at both central and
local government levels. SAM should also contribute to increased
financial allocation, equitable distribution of health workers and their
adherence to professional ethics.
