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

Governance and Management
BMC functions as a partnership between the MOHSW, the Catholic Church, the Touch
Foundation and other partners. The Bishop of the local diocese acts as Chair of the
governing Board with representatives from the Catholic Church and the GoT.
The Board meets four times a year and discusses plans, budgets, expenditures, audits,
progress reports and political issues. The Board also approves employment of specialists
and other higher cadre. An Executive Committee of eight people manages the BMC on a
day-to-day basis. There is also a Management Committee, comprising of all heads of
departments (25). With this management structure the BMC complies fully with the
intended hospital reforms.
Access and Quality
The BMC has three social welfare committees, who decide on granting exemptions for the
poor and vulnerable. Nurses assess the financial situation of eligible patients, who can
either be fully exempted or be allowed to only pay part of the regular fees. Patients have
the possibility to appeal, when they don’t agree with the decision of the welfare committee.
The costs of granting exemptions have to be recouped from other sources, as the
government does not compensate for them. The annual value of granted exemptions in
BMC is around TSH 400M.
As referral hospitals are the highest level of care in the country, peer review is the
mechanism used for quality control. There are no regular meetings between the four
referral hospitals and the national Chief Medical Officer (CMO), but in 2003 a peer review
was organised between three referral hospitals. These are supposed to happen every year,
but due to lack of funding this has not happened since. BMC therefore organised its own
peer review by the referral hospital of Nairobi.
BMC has a number of policies to promote quality of care: zero tolerance to corruption and
theft, patients can get all treatment they need in the hospital, nursing attendants cannot
attend patients, patients never sleep on the floor or two in a bed, and relatives are not
allowed to stay overnight in the ward.
It seems clear that hospital reform has not progressed at the same pace as other aspects of
health sector reform. Some informants attribute the continuing problems in governance
and management of regional hospitals to the lack of a management culture in the hospital
sector and a continued preference for management by medical doctors with little or no
training in management. The practice of having hospitals run largely by medical staff also
reduces the number of higher trained staff available for clinical practice.
At the same time, it should be acknowledged that the reform plans were very ambitious.
Such far-reaching reforms would be difficult to implement in a short time frame in any
country. It might be more effective to set more explicit priorities within the reform plans
for the health sector and to implement specific reforms sequentially.
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