Joint External Evaluation of the Health Sector in Tanzania: Draft ...

of the purposive sampling of two districts for both approaches (Njombe and Mwanza City)
it was possible to review the fit between the self-assessment and case-study findings.
This analysis demonstrated that the evaluation could rely on both sources of information
with the proviso that they should be dealt with as two distinct sources. As a result, the
evaluation covers twenty (sixteen plus six with two overlapping) districts on the Tanzania
mainland.
Ensuring Diverse Representation and Lack of Bias
Some key stakeholders worried that discussions with community members could be biased
since the primary responsibility for organizing them would be with health services staff.
Some also expressed concern that the health facilities visited by the evaluation might
represent the best or most advanced in a given district.
The evaluation responded to these concerns in several ways;
• On arrival in a district, the evaluation consultants reviewed the planned
itinerary and made suggestions for the addition of new health facilities where
needed;
• During district visits, the evaluation team sometimes asked for changes in
itinerary to include private and public facilities not on the original list;
• Evaluators took care to observe any evidence that health facility staff were
prepared in advance or inhibited in providing answers and observations;
• Community members were often gathered at short notice from houses, shops
and/or schools in the vicinity of a primary health facility.
The variety of conditions observed by the external evaluation consultants suggests that
there is little probability that only more advanced or well-managed health facilities were
included in the sample. Community members consulted were clearly capable of directing
criticism at the health facilities and their staff.
Accessing Data on Financial Flows for Off-Budget Resources
While mapping the volume of off-budget financial resources flowing to the public health
sector in Tanzania, the evaluation has relied on less than exact data for both the domestic
and foreign component.
As regards the domestic component, which mainly includes cost-sharing revenue from the
Health Services Fund (HSF), Drug Revolving Fund (DRF) and Community Health Fund
(CHF), the evaluation did not obtain any comprehensive aggregated picture. Although a
requirement exists for hospitals, health facilities and councils to report collection and
expenditures to the central level, this is not done in any comprehensive way. Accordingly,
the data available to the MOHSW is downward biased.
With respect to the foreign component, the evaluation relied on data provided through the
Public Expenditure Reviews (PER) for health. This data in turn has been constructed on
the basis of a database maintained by the Ministry of Finance on externally financed
projects and programmes.
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