Abstract:
Background: Little is known about the barriers to disease prevention and health promotion at the community
level within a decentralized health system.
Objective: This paper, therefore, presents and discusses findings on barriers (and opportunities) for instituting
disease prevention and health promotion activities.
Design: The study was conducted in Kongwa District, Tanzania, using an explorative case study approach.
Data were collected through document reviews and in-depth interviews with key informants at district, ward,
and village levels. A thematic approach was used in the analysis of the data.
Results: This study has identified several barriers, namely decision-makers at the national and district levels
lack the necessary political will in prioritizing prevention and health promotion; the gravity of prevention and
health promotion stated in the national health policy is not reflected in the district health plans; gross
underfunding of community-level disease prevention and health promotion activities; and limited community
participation.
Conclusion: In this era, when Tanzania is burdened with both communicable and non-communicable diseases,
prevention and health promotion should be at the top of the health care agenda. Despite operating in a
neoliberal climate, a stronger role of the state is called for. Accordingly, the government should prioritize
higher health-protecting physical, social, and economic environments. This will require a national health
promotion policy that will clearly chart out how multisectoral collaboration can be put into practice.
