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

The fact that the referral system is not working leads to cost increases, largely because
many people are treated at a higher, more costly, level than necessary. It also leads to
overcrowding of the higher levels, as the evaluation was able to observe very clearly at all
six regional hospitals visited.
4.8 Advocacy on Health Sector Reforms
CHMT members generally have reasonable knowledge of health sector reforms and can
name most when asked to do so. Beyond that, however, lower level health workers can
seldom identify reforms without being prompted. Similarly, community members often do
not seem to be aware of the strategic directions of health sector reforms. It is important to
point out, however, that both Public Health Facility (PHF) workers and community
members have a strong sense of very concrete changes occurring in the system over time,
many of which can be related back to the process of reform. For example, it was clear in
the interactions with community members during the CAST sessions that many understand
the concept and reasons for cost sharing, are aware of efforts to increase health worker
skills, and are keenly aware of shortcomings or improvements in the drug supply system.
36