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

funds from the Local Government Capital Development Grant (LGCD) for the same
purpose.
In addition some development partners support infrastructure rehabilitation and
construction, for example a new blood bank in Mtwara, built by the Centre for Disease
Control (CDC) with PEPFAR funds and staff housing in Masasi supported by several DPs.
There are also many private initiatives, such as the Tanganyika Wattle Company supporting
water and electricity supply in the district hospital in Njombe. In Mwanza the previous
Regional Commissioner collected about three billion shillings from business owners,
politicians and religious leaders to upgrade the regional hospital. Even local NGOs are
active in health infrastructure construction. The Health Action Promotion Association
(HAPA) in Singida finances the construction of dispensaries, while the MOHSW is
responsible for staffing and equipping them.
All this was clearly visible: in all districts visited there has been major construction,
renovation and upgrading of health facilities and thirteen out of sixteen councils that
assessed themselves saw renovation and construction as a positive change. The single
sector area that has benefited most from the construction of new health facilities is
HIV/AIDS. The evaluation noted that new wards, consulting rooms for VCT, laboratories
and stores were often built with HIV/AIDS funding, reflecting the large flow of resources
to HIV/AIDS programmes and activities.
However, rehabilitation and upgrading of health facility infrastructure seems to be mostly
related to upgrading the buildings as such, while important issues such as water and
electricity supply as well as communication equipment have not been resolved, hampering
service delivery considerably. According to the administration and personnel department in
the MOHSW, only 50 % of government PHFs have electricity from the grid. Some health
centres have a solar panel so that they can run their refrigerators and have light. Most
public hospitals visited by the evaluation did not have continuous electricity supply, while
generators, when present, are not always working. Staff in the Masasi district hospital
perform emergency operations using torches and mobile phone lights. Unreliable electricity
supply also means that the hospitals in Masasi cannot store the blood provided by their
new blood bank.
The water situation is just as difficult. Outside urban areas government PHFs often have
no running water. On a positive note, health facilities visited during the district case studies
were clean. This was confirmed in focus group discussions using the CAST tool. Three
quarters of community members rated the change in cleanliness of HFs as positive or very
positive.
While the infrastructure of the HFs themselves is improving, lack of staff housing is a
major constraint in the rural areas as it makes it difficult for HC and dispensary staff to be
available outside working hours (as they are expected to provide 24 hour service) and is
also related to the unwillingness of staff to stay and serve at lower level and/or remote
facilities.
There are, however, continuing questions about the rationalization of health care facilities
in terms of location and investment in new facilities. The focus on the construction of new
health facilities makes sense as the population of Tanzania has doubled in the past decades
and many inhabitants of remote areas still live a considerable distance from any HF, but at
the same time existing HFs cannot be properly staffed and equipped. The construction of
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