Enhancing district health planning and management in Tanzania: a social political analysis of the role of the health management information system (HMIS)

This thesis has attempted to analyse the Health Management Information System (HMIS) introduced in the Tanzania some ten years ago, from a social political perspective. The overall objective of the study was to find out the extent to which the system is facilitating district health planning and management by emprowering the districts, health facilities and members of the community to play a greater role in planning, monitoring and evaluating health service delivery. The study adopted a qualitative participatory approach involving an extensive use of focus group discussions and feedback meetings, in addition to interviews. Data has largely been analysed qualitatively using descriptive and analytical methods. Key findings of the study indicate that the HMIS was introduced by the MOH in collaboration with donors. The system was designed and developed by the MOH (with donor support) without full involvement of the lower level stakeholders – particularly districts, NGOs and grassroots health workers and communities. The study has further revealed that despite the good intentions of the system, users of the system, particularly district health managers, and health facility workers are not yet able to fully make use of the system. Health workers are finding it difficult to use some of the HMIS data collection and analysis tools because of their complexity. A general feeling among workers was that the HMIS had exerted a huge workload on them given their rather difficult working conditions that included shortage of personnel and low salaries and fringe benefits. The study has documented various forms of personnel and low salaries and fringe benefits. The study has documented various forms of struggle and resistance against the system by various categories of health workers.