1. Executive summary

 

In March 1999, the Primary Health Care Institute (PHCI) in Iringa, Tanzania, and the DBL - Centre for Health Research and Development (DBL) in Copenhagen, Denmark signed an institutional Memorandum of Understanding (MOU) with the developmental objective of contributing towards improving human health conditions on the African continent in general and in Tanzania in particular. The justification for formalising the institutional collaboration lay in the sharing of perspectives on health research and development. A close collaboration was found to serve the dual purpose of assisting both institutions reaching their respective but overlapping objectives. DBL would strengthen the performance capacity of an important health sector based training institution in Tanzania and PHCI would gain momentum in fulfilling its objectives related to 1) operational research, 2) collection, documentation and dissemination of health information, and 3) capacity building at the district level regarding health care provision.

 

Right from the start it was considered important that the collaborative initiatives were beneficial and sustainable. This was planned to be approached through joint development and implementation of marketable products in the form of capacity building packages directed towards district health systems and services strengthening. Therefore, the prime targets for capacity building have been the district health management teams in selected target districts. In addition, institutional support has been provided directly to PHCI in order to strengthen the prevailing system for supporting the district health authorities. The collaboration thus emphasises on three packages of activities related to I) human resources strengthening at PHCI, II) information management capacity strengthened at PHCI, and III) development and implementation of marketable capacity building packages. 

 

The aim of this internal review of the PHCI-DBL collaboration is to assess the joint programme activities, and their outputs and impacts over the period 2003 to 2007 vis a vis the targets set in the jointly developed action plans. More specifically, the review assesses a) the relevance, effectiveness, efficiency, sustainability and impact of programme activities, b) the overall quality of programme activities, and c) the appropriateness of programme inputs from PHCI and DBL. The review also provides recommendations on the future of the collaboration between PHCI and DBL.

 

Based on the findings from the review, the key conclusions are that a) the relevance of the PHCI-DBL collaboration is high due to, among other factors, its emphasis on developing, introducing and assessing the effects of measures for strengthening the performance capacity of district health management systems, b) the potential (since the outcome remains to be seen) for a high effectiveness of the collaboration exist  due to, among other factors, the emphasis on contributing towards achieving PHCI's specific objectives, c) the efficiency has overall been poor due to significant inconsistencies between what has been planned and completed, d) the sustainability of developed products is high partly due to the persistent emphasis on inclusiveness, participation and needs-based interventions in planning, implementing and reviewing the collaborative activities, and, finally, e) the prospects (since it remains to be seen) for achieving a positive impact of developed products are good since the objectives are relevant, the quality of work is high and the challenges of introducing and integrating the developed products in practice are confronted.

Recommendations for change relate to the appropriateness of a) maintaining a programmatic focus on what is politically and strategically prioritised by the Ministry of Health & Social Welfare (MOH&SW) and other government institutions, b) focussing on properly finalising the development, implementation, monitoring and evaluation of an intervention package for fair and accountable priority setting at district level in already targeted districts, c) focussing on overcoming prevailing challenges related to power relations, motivation/incentives, tradition/habits, culture and politics in striving towards attaining positive and measurable health, development and socio-economic impacts, d) excluding institutional and human capacity strengthening activities at PHCI that are not directly related to the fulfilment of the intervention package for fair and accountable priority setting, e) increasing PHCI's financial contribution to the collaboration by making PHCI covering all costs related to collaborative assignments involving office-related work and in-town workshops for PHCI staff, f) improving the financial accounting system at PHCI to allow for prompt tracking and regular reporting of reception and consumption of DBL funds in relation to programme package and activity, and g) jointly developing and implementing plans for attracting external funds to sustain and expand key collaborative activities.  

Review report distributed widely in the Ministry of Health in Tanzania and to the Danida health sector support programme.