Factors influencing implimentation of council health plants, a case study of sumbawanga urban and Iringa urban districts

Abstract

Introduction: Effective implementation of policy is a challenging process especially in resource constrained countries. The district is the main implementation unit of the Tanzania national health policies and programmes. Implementers at district level face various constraints when implementing health plans therefore understanding their views on factors intluencing implementation of plans is important in ensuring effective execution of health plans to achieve the desired goals. The objectives of this study were to explore the views of Council Health Planning Team (CHPT) on factors influencing implementation of council health plans, and to identify ways of addressing constraints to implementation. Methods: A cross sectional descriptive study was conducted in Sumbawanga and Iringa municipals among CHPT and in-charges of health facilities that had roles in planning and implementation of Comprehensive Council Health Plans (CCHP) through in depth interviews using an interview guide. The participants were purposively selected and a total of 16 people were enrolled in the study. Results: Factors influencing implementation of CCHP were identified. Majority of respondents perceived delay in disbursement of funds, lack of capacity of workers and top down approach to planning as constraints to implementation of health plans. The existence of CCHP guideline, manpower and good leadership at the councils were among the identified enablers. The poor road infrastructure of Sumbawanga and existence of a number of incapable people at decision making positions were further found to undermine performance of implementation of health plans in Sumbawanga municipal compared to Iringa municipal. Proposed solutions include the need to change the procurement act to reduce present bureaucracy, the participatory planning should be strengthened and more motivation of staff especially those allocated in rural areas is required. In addition further training of workers at health centres and dispensaries on planning issues is essential. Conclusion: The delayed in disbursement of funds, lack of human capacity and long bureaucratic procedures are among the constraints to implementation of plans whereas enabling factors include availability of CCHP guideline, good leadership skills and transparency. It is recommended that the constraints should be addressed by the relevant authorities and the enabling factors should be sustained