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Health sector reform and STD/AIDS control in resource poor settings—the case of Tanzania
Author(s) -
Hanson Stefan
Publication year - 2000
Publication title -
the international journal of health planning and management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.672
H-Index - 41
eISSN - 1099-1751
pISSN - 0749-6753
DOI - 10.1002/hpm.602
Subject(s) - tanzania , decentralization , horizontal integration , business , control (management) , service delivery framework , vertical integration , resource (disambiguation) , horizontal and vertical , quality (philosophy) , health sector , economic growth , service (business) , health services , economics , public economics , operations management , medicine , marketing , environmental health , computer science , population , market economy , socioeconomics , computer network , philosophy , management , geodesy , epistemology , geography
Integration in health sector reform tends to mean horizontal interaction between vertical programmes. This can result in a larger more complex system than a set of individual vertical programmes. This article looks at the HIV/AIDS programme in Tanzania and the possible impact of system‐wide health sector reform involving ‘decentralization’ and horizontal integration. It implies that the build‐up to reform is likely to be costly, at least initially (although eventually the system may become more cost‐effective). Integration can thus save resources, but it will also demand additional inputs, and may lead to reduced service output if operations depend on horizontal functions that fail to deliver. The objective of reform must be to create a reasonably sized, well‐balanced, system which aims to maximize the output of quality services, both preventive and curative, and to facilitate community efforts to improve health. It is doubtful whether present reform efforts in Tanzania will contribute to more effective services, if not based on a more thorough analysis adapted to the local situation and given considerably more resources, both human and financial. There is also a risk that key preventive programmes, such as those aimed at the control of STD/AIDS, will be further weakened because of both integration with subsequent dependence on poorly functioning horizontal units and reduction in allocated resources. Copyright © 2000 John Wiley & Sons, Ltd.