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Strengthening health system research capacity for enhancing innovations and sustainable socio-economic development

Research project This project aims to investigate and produce evidence on the factors that influence the health system functioning to improve its performance and ultimately the health status of the population in Tanzania.

Effective health systems are essential for delivering good care to the population. However, most health systems in low and middle income countries are weak and fragmented which make it difficult to reach the goal for a health system to improve health, social and financial protection, and responsiveness to the expectations of the population. The attention for health systems strengthening has therefore emerged during the last years. To build capacity in health systems research is therefore high on the global health agenda. The ongoing collaboration between Muhimbili University of Health and Allied Sciences (MUHAS) and Department of Public Health and Clinical medicine, Umeå University, Sweden aims to contribute to fill the gap of researchers trained in health systems research in Tanzania. The collaboration will particularly focus on the three broad areas of human resources, financing, organization and governance.

Head of project

Project overview

Project period:

2015-07-01 2019-12-31


Sida, 2015-2019: SEK 2,209,000

Participating departments and units at Umeå University

Department of Epidemiology and Global Health

Research subject

Public health and health care science

Project description


People centered health systems are important in ensuring universal health coverage - whereby all people are enabled to have access to the health services they need without risk of financial ruin or impoverishment (WHO, 2013). In essence, strong health systems should addresses two aspects of universal health coverage, namely: the provision of, and access to, high-quality health services; and financial risk protection for people who need to use these services.
Nevertheless, the health systems of low income countries such as Tanzania are currently in a crisis arising out of multiple factors connected with the overall economic crises facing these countries. The broad manifestation of the crisis is seen in the poor performance of these systems. Improving the performance of health systems is a key factor behind the improvement of health services delivery and overall improvement in the health and wellbeing of the people and so alleviation of poverty. However, improving the health systems performance requires interventions targeting the various aspects of the health system that are impinging on its performance. These aspects include but not limited to the three broad areas of human resources, financing, organization and governance of the health care delivery system.

The proposed research sub-program therefore is essentially a multidisciplinary research aimed at investigating how the various elements of the Tanzania health system impact on the overall functioning of the system. The overall objective is to produce knowledge and insights through research that will help policy making and improvement in the performance of the system to produce optimal health results to the population fuelling their capacity to improve quality of health services.

Objective of the Research Program:
The overall objective is to improve the capability of the health system in addressing problems related to governance, human resource management and health care financing in contributing to the efforts of alleviating poverty in Tanzania by 2020. Whereas the main outcome of the proposed project will be to train high level human resources at the Masters and PhD levels, it is also envisaged that through the training, there will be strengthening of the research capacity both at the Institutional (MUHAS) and national (health system) level towards achieving innovation and sustainable socio-economic development. In that course the following are the specific objectives that shall define the themes to be tackled.

Specific objectives:
The following presents the thematic areas defined by the building blocks within which are sub-specific objectives reflecting the areas of research interest to guide the envisaged PhD and master’s candidates as follows:

1. Understand the role of enhanced Health System governance and accountability on strengthening the health system towards achieving universal health coverage. Within this objective the sub-objectives will be to determine the following:-
1.1 To increase number of trained professionals who apply their new skills and knowledge in Project management, monitoring and evaluation in health care
1.2 To increase number of trained professionals who apply their knowledge and skills in strengthening the health system by developing and utilizing specific courses’ curricula in health system.
1.3 To develop capacity to improve understanding of the role of decentralisation by devolution in creating an accountable health system
1.4 To improve understanding of what works and what doesn’t with respect to the role of Public Private Partnership in enhancing equity, access and quality of health service
1.5 To develop capacity to enhance understanding the role of governance in prevention and combating corruption in health service delivery
1.6 To develop capacity for supporting Council Health Management Teams to and others district governance structures to acquire knowledge and skills in health management
1.7 To promote community participation through enhanced social capital with the ultimate goal of improving quality of health care, equity and health access for all.

2. Generate information on Human resources management and system strengthening and service provision. Specifically the sub-specific objectives will be to:-
2.1 To develop capacity to enhance understanding of the dynamics of training and managing critical health care cadres in a reformed, market economy led and private public partnership driven health care system.
2.2 To raise capacity to understand the deployment process, retention mechanisms and attrition drivers in place.
2.3 To increase capacity to use and manage human resource management information systems in place and identify possible aspects for improvement
2.4 To develop capacity to master appropriate mix of HRH planning and forecasting in the regions and the health care system at large
2.5 To determine the implications of current performance appraisal systems for frontline health care workers and CHW, their interactions and productivity.
2.6 To determine the effects and implications for the implementation challenges of new Community Based Health Workers (CBHC) policy guidelines.

3. To enhance health care financing options and meeting the challenges of utilizations and protection of the vulnerable groups with an aim of improving their health status. Sub-specific objectives under this theme shall be to:

3.1 To explore the role of client’s knowledge and competence on rights to health information and their relationship to joining risk sharing schemes and accessibility of health services.
3.2 To analyse accessibility to essential medicine and their relationship to joining risk sharing schemes
3.3 To explore ways and means of sustaining Community Health Fund (CHF) within the community
3.4 To Identify and respond to gaps in health information literacy in relationship to utilization of health services among vulnerable groups.
3.5 To explore and promote ways of community solidarity in financing health and protection of vulnerable groups.