This article determined the status of public health service delivery under decentralisation in rural Tanzania. It adopted a combined case study design to explore health service delivery and its status in Pangani and Urambo local government authorities. the study was mainly qualitative; primary data collected by using interviews, questionnaires, FGDs and observation. Secondary data extracted from various reports and academic works related to the theme. The study established that, decentralisation had minimal effect on improving public health service delivery in rural Tanzania. The health services were found to be characterised by poor access and quality. Very few health centres, lack of equipment, drugs and medicines, low levels of competency among health workers, distance, lacked clear complaints handling mechanisms and responsiveness were found to be the major bottlenecks. Delayed service, poor time management, lack of accountability and transparency, lack of political will, poor records management and resistance to change persisted in the sampled health centres. The study recommends a review of the existing legal frame, administrative systems, structures and processes. Efforts on resourcing, Human resource capacity building and institutionalisation of health sector reforms and decentralisation are also recommended.

Decentralisation, health service delivery, rural, local government authorities.

1. Ahmad, J., Khemani, S. and Shah, S. (2005). Decentralization and Service Delivery. World Bank Policy Research Working Paper 3603. Washington, D.C: The World Bank.

2. Akin, J, Hutchinson, P. and Strumpf, K. (2005). Decentralisation and government provision of public goods: The public health sector in Uganda. Journal of DevelopmentStudies, 41(8).1417-1443

3. Anderson, K.P. (2004). Who talks with whom? The role of repeated interactions in decentralized forest governance.World Development, 32(2):233-249.

4. Andrews, C.W. and de Vries, M.S. (2007). High expectations, varying outcomes: Decentralisation and participation in Brazil, Japan, Russia and Sweden. International Review ofAdministrative Sciences, 73(3):424-451.

5. Andrews. M. and Schroeder, L. (2003).Sectoral decentralisation and intergovernmental arrangements in Africa.Public Administration and Development, 23(1):29-40.

6. Atkinson, S. and Haran, D. (2005). Individual and district scale determinants of users’ satisfaction with primary health care in developing countries. Social Science and Medicine, 60(3):501-513.

7. Aucoin, P. (1995). The New Public Management: Canada in comparative perspective. Montreal: Institute for research on public policy.

8. Azfar, O., Kahkonen, S., Lanyi, A., Meagher, P. and Rutherford, D. (2004). Decentralization,governance and public services: The impact of institutional arrangements. In: Kimenyi, M.S. and Meagher, P. (eds). Devolution and Development: Governance Prospectsin Decentralizing States. Aldershot: Ashgate Publishing Ltd:19-62.

9. Batley R (2004) The politics of service delivery reform. Development and Change 35(1):31-56

10. Batley, R. and Harris, D. (2014) Analysing the politics of public services: a service characteristics approach. London overseas Development Institute pp1-22.

11. Beall, J. (2001). Valuing social resources or capitalizing them? Limits to pro-poor urban governance in nine cities of the South.International Planning Studies, 6(4):357-375.

12. Besley, T. and Coate, S. (2003). Centralized versus decentralized provision of local public goods: A political economy approach.Journal of Public Economics, 87(12).

13. Blair, H. (2000). Participation and accountability at the periphery: Democratic local governance in six countries. World Development, 28(1):21- 39.

14. Blair, H. (2001). Institutional pluralism in public administration and politics: Applications in Bolivia and beyond. Public Administration and Development, 21(2):119-129.

15. Bless, C. and Higson-Smith, C. (1995). Fundamentals of Social Research Methods: An African Perspective. 2nd ed.Juta Co. Ltd., Cape Town. pp.146

16. Boex, J. (2003). The incidence of local government allocations in Tanzania. Public Administration and Development, 23(5) 381-391

17. Boex., J. and Yilmis., S. (2010) An Analytical Framework for Assessing Decentralized Local Governance and the Local Public Sector. The Urban Institute Center on International Development and Governance.IDG Working Paper No. 2010-06

18. Boon, S. (2007).How Not to Decentralise: Accountability and Representation in Health Boards in Tanzania. TheHague:SNV. http://www.snvworld.org/en/- Documents/Knowledge%20Publications/S NV_series_08_Tanzania_Deescentralizati on_Health.pdf. (Accessed on 10. 10,2015).

19. Bossert, T. (1998).Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance. Social Science and Medicine ,47 (10), 1513- 1527.

20. Bossert, T. J., & Beauvais, J. C. (2002). Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space. Health Policy and Planning , 17 (1), 14-31.

21. Bossert, T. J., Larranaga, O., Giedion, U., Arbalaez, J. J., & Bowser, D. M. (2003).Decentralization and equity of resource allocation: evidence from Colombia and Chile. Bulletin of the World Health Organization , 81 (2), 95-100.

22. Bossert, T., & Mitchell, A. D. (2011). Health Sector Decentralization and Local Decision-Making: Decision space; institutional capacities and accountability in Pakistan. Social Science and Medicine , 72 (-), 39-48.

23. Bossert,. J, T., Mitchell., D. A. &Janjua., M. A. (2015) Improving Health System Performance in a Decentralized Health System: Capacity Building in Pakistan. Health Systems & Reform 1(4):276–284.

24. Boyne ,G. (2007) Performance Targets and Public Service Improvement Journal of Public Administration Research and Theory, Vol. 17, Issue 3, pp. 455-477, 2007

25. Burki, S.J., Perry, G. and Dillinger, W. (1999).Beyond the Centre: Decentralizing the State. World Bank Latin American and Caribbean Studies. Washington, D.C: The World Bank.

26. Chapman, K. B. (2009). Improving Communication among Nurses, Patients, and Physicians. American Journal of Nursing, 109(11), 21-25.

27. Cheema, G. &Rondinelli, D (2007). Decentralizing governance: Emerging concepts and practices. Cambridge: The Brookings Institution Press.

28. Cheema, G. and Rondineli, D (1983).Decentralisation and Development: Policy Implementation in Developing Countries, Beverly Hills: Sage, London.

29. Cheema, G. and Rondineli, D. (1984).Decentralization and Development: Policy Implementation in Developing Countries, Beverly Hills: Sage, London.319 pp.

30. Coleman, J. S. (1986). Social Theory, Social Research, and a Theory of Action. American Journal of Sociology , 91 (6), 1309-1335.

31. Conyers, D. (1983). Decentralization: The Latest Fashion in Development Administration? Public Administration and Development, 3(1), 97–109

32. Conyers, D. (1990). Decentralisation and development planning. In: de Valk, P. and Wekwete, K.H. (eds.). Decentralizing for Participatory Development? Comparing the Experiences of Zimbabwe and Other Anglophone Countries in Eastern and Southern Africa. Aldershot: Avebury.

33. Conyers, D. (2007). Decentralisation and Service Delivery: Lessons From Sub- Saharan Africa. IDS Bulletin, 38, 18–32.

34. COWI and EPOS (2007).Joint External Evaluation of the Health Sector in Tanzania: Draft Report. Dar es Salaam: COWI Management Consultants and EPOS Health Consultants. Online source: http://www.moh.go.tz/documents/JEEHS %20Draft%20-Final%20Report%20 Part%201%20Main%20Report.pdf (Accessed on 20.10.2015

35. Crook, R. (2003). Decentralisation and poverty reduction in Africa: The politics of local central relations. Public Administration and Development, 23(1).

36. Crook, R. and Manor, J. (1998).Democracy and Decentralisation in South Asia and West Africa. Journal of Modern African Studies, 38(4): 713-745..

37. Crook, R. and Manor, J. (2000). Democratic Decentralisation. OECD Working Paper Series No.11. Washington: The World Bank.

38. De Palencia, A.J.F. and Pérez- Foguet, A. (2011).Implementing pro-poor policies in a decentralized context: The case of the Rural Water Supply and Sanitation Program in Tanzania. Sustainability Science.

39. De Vaus, D.A. (2001).Research Design in Social Science. London, Thousand Oaks & New Delhi: Sage Publications

40. Devas, N. and Grant, U. (2003). Local decision making – Citizens participation and localaccountability: Some evidence from Kenya and Uganda. Public Administration and Development, 23(4): 307-316.

41. Doherty and Horne (2002).The New Public Service: Service rather than steering. Public Administration Review, 60:145.

42. Eaton, K. and Schroeder, L. (2010).Measuring decentralization. In: Connerley, E., Eaton, K.and Smoke, P. (eds). Making Decentralization Work: Democracy, Development and Security.Boulder London: Lynne Rienner Publishers:167-190.

43. Ensor, T., and Cooper, S. (2004)Overcoming Barriers to Health Service Access and Influencing the Demand Side.Health, International Programme, Centre for Health Economics, University of York, York, UK.19(2): 69– 79

44. Faguet, J. (2004). Does Decentralization Increase Government Responsiveness to Local Needs?: Evidence from Bolivia. Journal of Public Economics. 88 (3–4), 867–893.

45. Faguet, J. P. (2013) Can Subnational Autonomy Strengthen Democracy in Bolivia?, The Journal of Federalism , Vol. 44, No. 1, pp. 51-81.

46. Faguet, J.P. (2014) Decentralization and Governance.’ World Development . Vol. 53, pp. 2-13.

47. Ferguson, I. and Chandra sekharan, C. (2000).Paths and Pitfalls of Decentralisation for Sustainable Forest Management: Experiences of the Asia- Pacific Region Report. 36pp.

48. Field, A. (2009). Discovering Statistics Using SPSS.Los Angeles, London, New Delhi, Singapore,Washington D.C: Sage.

49. Filmer, D., &Prittchet, L. (1997). Child Mortality and Public Spending on Health: how much does the money matter? (World Bank Policy Research Working Paper No. 1864 ed.). Washington DC.: World Bank.

50. Fjeldstad, O.H., Henjewele, F., Mwambe, G., Ngalewa, E. and Nygaard, K. (2004). Local government finances and financial management in Tanzania: Baseline data from six councils,2000-2003. Working Paper - Chr. Michelsen Institute. Online source: http://bora.-cmi.no/dspace/ bitstream/10202/127/1/Working%20Paper %20WP%202004 7.pdf (Accessed on 20.10.2015).

51. Fleuren, M., Wiefferink, K., &Paulussen, T. (2004). Determinants of Innovation within health care organizations: Literature review and Delphi study. International Journal for Quality in Health Care , 16 (2), 107-123.

52. Forje, J. W. (2006). Rethinking Decentralisation and Devolution of Power Within the African Context: Challenges and Opportunities In: Proceedings from28th AAPAM Roundtable Conference, Arusha, Tanzania, 4th-8th December, 2006.

53. Fredrick M. Nafukho. (2008). Consensus Building Dialogue and Sprituality principles of the Learning Organization Paradigm. Implications for Kenya Public Service reform agenda. Journal of Third World studies, Vol.XXV. No.2

54. Gilson . L, (2016) Community satisfaction with primary health care services: An evaluation undertaken in the Morogoro region of Tanzania. Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England.

55. Gilson, L., Alilio, M. and Heggenhougen, K. (1994). Community satisfaction with primaryhealth care services: An evaluation undertaken in the Morogoro region of Tanzania.Social Science and Medicine, 39(6):767-780.

56. Gilson,L. &Mills,A. (1995) Health sector reforms in sub-Saharan Africa: lessons of the last 10 years. Health Policy, 32, 215- 243.

57. Gilson,L., Kilima,P. &Tanner,M. (1994) Local government decentralization and the health sector in Tanzania. Public Administration and Development, 14, 451- 477.

58. Graham. T and Richard.H (1999).Paper on Tanzania Civil Service Reform Programme.Case study.

59. Gregersen., H. and Contreas, H. (2004). Decentralization. In: Proceedings of Interlaken Workshop on Decentralization in Forestry, 27-30 April, 2004. Interlaken, Switzerland. 23pp.

60. Hair, J. F., Anderson, R.E., Tatham, R.L., & Black, W.C. (1998).Multivariate data analysis. New Jersey: Prentice Hall, Inc.

61. Hakim, C. (1982).Secondary Data Analysis in Social Research, London,

62. Heeks (2000) Reinventing Government in the Information Age: International practice in IT-enabled public sector reform. Routledge, London.

63. Heeks, R.B. (2006) Managing and implementing e-government. Sage, London. Retrieved from http://books. google.com/books/id=hRzAnMulatUC&d q; WITSA (2008) Digital Planet 2008, World IT Services Association, Kuala Lumpur, Malaysia

64. Herrera, V., and Post A. (2014) Can Developing Countries Both Decentralize and Depoliticize Urban Water Services? Evaluating the Legacy of the 1990s Reform Wave. World Development

65. Hood C. (1991). A public management for all seasons. Public Administration. Volume 69. 1991.

66. Hope, K.R. (2001). The new public management: Context and practice in Africa. InternationalPublic Management Journal, 4(2):119-134.

67. Hussein, L. (2013)Client service charter in public institutions in tanzania. A myth orreality?(an assessment of methods and techniques of awareness building to citizens) International Journal of Current Research Vol. 5, Issue, 09, pp.2699-2704

68. Hussein, L.(2014)Decentralization and Human Resource Development; Documented Challenges in Local Government Authorities in Tanzania. IJCR 3 (6) pp. 352-365.

69. Issa, F. (2011), Public Sector Human Resource Managers. Promoting, Professionalism and Implementing, Public Service Charter: Facilitating and Inhibiting Factors and Strategic Action, Addis Ababa

70. Jeppsson, A. and Okuonzi, S.A. (2000).Vertical or holistic decentralization of the healthsector?Experiences from Zambia and Uganda.The International Journal of HealthPlanning and Management, 15(4):273-289.

71. Jiménez, A. and Pérez-Foguet, A. (2010).Building the role of local government authorities towards the achievement of the human right to water in rural Tanzania.NaturalResources Forum, 34(2):93-105.

72. Jimenez-Rubio, D. (2011). The impact of decentralization of health services on health outcomes: evidence from Canada. Applied Economics , 43 (26), 3907-3917.

73. Kamuzora P., and Gilson, L. Factors influencing implementation of the Community Health Fund in Tanzania. Health Policy Plan. 2007 Mar;22(2):95- 102.

74. Katera. .L and Ngalewa .E (2008) The Local Government Reform Programme (LGRP) in Tanzania, REPOA

75. Kerlinger, F.N. (1973). Foundation of Behavioral Research, Holt Rinehart and Winston, New York.201 pp.

76. Kessy, A.T. and McCourt, W. (2010). Is decentralisation still recentralization? The local government reform programme in Tanzania. International Journal of public Administration,33(12)689-97.

77. Kiggundu, M (1998) Civil Service Reforms; limping into the twenty-first century Ideas and Practices in Governance, Canada

78. Kimaro, H.C. and Sahay, S. (2007). An institutional perspective on the process of decentralization of health information systems: A case study from Tanzania. Information Technology for Development, 13(4):363-390.

79. Kimenyi, M.S. and Meagher, P. (2004).Introduction. In: Kimenyi, M.S. and Meagher, P.(eds). Devolution and Development: Governance Prospects in Decentralizing States. Aldershot:Ashgate Publishing Ltd: 1-18.

80. Kiragu, K and Mazikana, P. (2006), StakeholdersPerspectives andImperatives in the Formulation of PRSP Phase II Strategy: Final Report, August 2006

81. Kiragu, K and Mutahaba, G. 2006. Public Service Reform in Eastern and Southern Africa: Issuesand Challenges, MkukinaNyota. Tanzania

82. Kothari, C.R. (2009). Research Methodology, Methods and Techniques (2nd edition), New Age Techno Press, New Delhi. 401pp.

83. Kumar, R. (2005). Research Methodology.A Step-by-Step Guide for Beginners.Second Edition.London: Sage Publications.

84. Kwesigabo, G., Mwangu, M., Kakoko, D. and Killewo, J. (2012) Health challenges in Tanzania: Context for educating health professionals. Journal of Public Health Policy 33(S1): S23–S34.

85. Larbi, G.A. (2005). Freedom to manage, task networks and institutional environment of decentralized service organizations in developing countries. International Review of Administrative Sciences, 71(3):447-462.

86. Leonard, K and Masatu, M.C. (2010). “Professionalism and the Know-Do Gap: Exploring Intrinsic Motivation among Health Workers in Tanzania.” Health Economics 19: 1461–77

87. Litvack, J. Junaid, A. and Bird, R. (1998).Rethinking Decentralization in Developing Countries ,World Bank, Washington. 40pp.

88. Maluka, S., Kamuzora, P., Sebastiån, M.S., Byskov, J., Olsen, T.E,,Shayo, E. and Hurtig,A.K. (2010). Decentralized health care priority-setting in Tanzania: Evaluating againstthe accountability for reasonableness framework. Social Science and Medicine, 71(4):-751-759.

89. Mamdani, M. and Bangser, M. (2004). Poor people's experiences of health services inTanzania: A literature review. Reproductive Health Matters, 12(24):138- 153.

90. Manor, J. (1999).The Political Economy of Democratic Decentralization.World Bank, Washington, DC.120 pp.

91. Manor, J. (2004). User committees: A potentially damaging second wave of decentralisation? The European Journal of Development Research, 16 (1):192-213.

92. Masanyiwa, Z.S., Niehof, A. and Termeer, C.J.A.M. (2013). Institutional arrangements for decentralized water and health services delivery in rural Tanzania: Differences and constraints. Basic Research Journal of Social and Political Sciences, 1(4):77-88.

93. Mitchel, A., & Bossert, T. (2010). Decentralisation, Governance and Health- System Performance: ‘Where You Stand Depends on Where You Sit’. Development Policy Review , 28 (6), 669-691.

94. Mollel, H.A. (2010). Participation for Local Development: The Reality of Decentralization in Tanzania. African Studies Centre Collection Vol. 29. Leiden: African Studies Centre.

95. Morgan, D.L. (1996). Focus groups. Annual Review of Sociology, 22:129-152.

96. Mubyazi, G., Kamugisha, M., Mushi, A. and Blas, E. (2004). Implications of decentralization for the control of tropical diseases in Tanzania: Case study of four districts. International Journal of Health Planning and Management, 19(SUPPL. 1):S167-S185.

97. Mukandala, R.S. (2004). Local Government, Effectiveness and Human Rights: The Case of Bukoba Rural and Mtwara Mikindani Districts in Tanzania. In: Proceedings of ICHRP Workshop, 21- 22 February, 2004, Geneva, Switzerland. pp.7-8.

98. Munga, M., Songstad, N., Blystad, A. and Maestad, O. (2009). The decentralisation centralisation dilemma: Recruitment and distribution of health workers in remote districts of Tanzania. BMC International Health and Human Rights, 9(1):9.

99. Munishi, G.K. (2003). Intervening to address constraints through health sector reforms in Tanzania: Some gains and the unfinished business Journal of International Development15(1):115-131.

100. Mushi S.S. (2002) Privatization and the fate Public Sector in Tanzania. Occasional Paper (Redet-UDSM)

101. Mutahaba, G. and Kiragu, K. (2002).Lessons of International and African Perspectives on Public Service Reform: Examples from five African Countries. African Development. Vol. XXVII, Nos.3 and 4, 2002, pp.48-75

102. NgwareS, and Haule M (1992). The Forgotten Level Village Government in Tanzania. Hamburg: Institute of African Affairs.

103. Nick M. and Neil P. (2004). International Public Administration Reform. Implications for the Russian Federation.The World Bank. Washington, DC.

104. Njunwa, M.H.M. (2005a). Strengthening Tanzania’s Public Administration ThroughElectronic Governance, (pp.141-153).

105. Njunwa, P. (2005b) Public Sector Reforms in Tanzania, Mzumbe University

106. Noiset, L. and Rider, M. (2011). Tanzania's Fiscal Arrangements: Obstacles to Fiscal Decentralization or Structures of Union-Preserving Federalism? In Decentralization in Developing Countries: Global Perspectives on the Obstacles to Fiscal Devolution, ed. Jorge Martinez- Vazquez and Francois Vaillancourt. Northampton, MA: Edward Elger, pp. 465-500.

107. Norman, A.S. and Massoi, L. (2010). Decentralisation by devolution: Reflections on community involvement in planning process in Tanzania. Educational Research and Reviews,5(6):314-322.

108. North, D. (1990). Institutions, Institutional Change and Economic Performance. Cambridge: Cambridge University Press

109. North, D. (1991). Institutions. Journal of Economic Perspectives, 5(1), 97–112

110. North, D. (1999). Institutions, institutional change and economic performance. Cambridge University Press.

111. North, D.C. (1989). Institutions and economic growth: An historical introduction. World Development, 17(9):1319-1332.

112. Nyamhanga T., Frumence G, ,Mwangu M, Hurtig A. (2013) Challenges to the implementation of health sector decentralization in Tanzania: experiences from Kongwa district council. Glob Health Action 2013; 6: 20983, doi: http://www.dx.doi.org/10.3402/gha. V6i0.20983 Accessed on 20.07.2016.

113. Oates, W. (1996).Fiscal Decentralization and Economic Development. National Tax Journal, 46, 237-243.

114. OECD (2005) Managing Senior Management: Senior Civil Service Reform in OECD Member Countries Paris: Online source: http://www.snvworld.org/en/ Documents/Knowledge%20 Publications/SN. Accessed on 12. 01, 2015.

115. OECD. (2012). Strengthening Primary Care. In OECD Reviews of Health Care Quality: Korea 2012: Raising Standards (pp. 113-137). Seoul: OECD Publishing.

116. Olowu D. 2003. Local institutional and political structures and processes: recentexperience in Africa. Public Administration and Development 23(1): 41-52

117. Olowu, D. and Wunsch., J. (2004). Local Governance in Africa: The Challenges of Democratic Decentralization. Boulder, CO: Lynne Rienner Press

118. Olowu, Dele and James Wunsch (1995). “Decentralization, Local Government, and Primary Health Care in Nigeria.” Journal of African Policy Studies. 1 (3): 1-22.

119. Orodho, A. J. (2003). Essentials of Educational and Social Sciences Research Methods, Masola Pulbishers, Nairobi. 102pp.

120. Orodho, A. J. and Kombo, D. K. (2002).Research Methods.Kenyatta University, Institute of Open Learning, Nairobi. 142pp.

121. Pablo, S. A. (2010), A Study of the Impact of Decentralisation on Access to Service Delivery. Georgia State University.

122. Pallangyo, A. W (2010).Why isn't Decentralization Substantially Promoted in Tanzania? Journal of African Studies Vol. 2014 (2014) No. 85 p. 23-31

123. Pallotti, A. (2008). Tanzania: Decentralising Power or Spreading Poverty?" Review ofAfrican Political Economy 35(116):221{235.

124. Peters D. H, Garg A., and Bloom G. (2008). Poverty and access to health care in developing countries. Annals of the New York Academy of Sciences 1136: 161–71.

125. Peters, D.H., Garg, A., Bloom, G., Walker, D.G., Brieger, W.R. and Hafizur, R.M. (2008).Poverty and access to health care in developing countries. Annals of the New YorkAcademy of Sciences, 1136(1):161-171.

126. Phillips,H. (1987) The local state and public health reform in South Africa: Bloemfontein and the consequences of the Spanish 'flu epidemic of 1918. J.South.Afr.Stud.,13, 210-233.

127. Pollitt, C., and Bouckaert, G. (2004) Public Management Reform: A Comparative Analysis, second edition, Oxford: Oxford University Press

128. Pons, V. (1988).Introduction to Social Research, Department of Sociology, University of Dar es Salaam. 79pp.

129. REPOA. (2008). The Oversight Processes of Local Councils in Tanzania (Report).

130. Ribbot, J. and Larson, A. (2001).Democratic Decentralization through a Natural Resource Lens: An Introduction, Macmillan, London. 121pp.

131. Ribot, J. (1999). Accountability in Decentralisation: A framework with South Asia and Africa cases, Journal of Developing Areas, 33, 457-502.

132. Ribot, J. (2003) African Decentralization: Local Actors, Powers and Accountability , Geneva: United Nations Research Institute for Social Development.

133. Ribot, J.C. (2002). African Decentralization: Local Actors, Powers and Accountability. UNRISD Programme Democracy, Governance and Human Rights Paper No. 8. Geneva:United Nations Research Institute for Social Development.

134. Ribot, J.C. and Oyono, P.R. (2005) ‘The Politics of Decentralisation’, in Wisner, B., Toulmin, C.and Chitiga, R. (eds), Towards a New Map of Africa . London

135. Ribot, J.C., Agrawal, A. and Larson, A.M. (2006).Recentralizing while decentralizing: How national governments re-appropriate forest resources. World Development, 34(11):1864-1886.

136. Ringo, C., Khamis, Z. K., Peter, A., &Pazi, R. (2013). The creeping decentralization in Tanzania: Is the strategy accorded full ssupport by the Government? International Journal of Social Sciences and Entrepreneurship, 1(5), 204-227.

137. Rispel. C.L. (2015) Health Policy and Planning, Vol. 00, No. 0 11 Downloaded from http://heapol.oxfordjournals.org/ Accessed on July 14, 2016

138. Rob, L. & Richard, N., (2007), “Imitation and inspiration in public sector reform: lessons from Commonwealth experiences,” International Review of Administrative Sciences, vol. 73, Issue 4, pp. 517-530.

139. Robinson, M. (2007). Does decentralisation improve equity and efficiency in public service.IDS Bulletin, 38(1) 7-17.

140. Rondinelli, D., Nellis, J., and Cheema, G. (1983). Decentralization in developing countries: A review of recent experience. (Working Paper 581, World Bank Staff). Washington, DC.

141. Rondinelli, D., Shabhir, G., Cheema, J. and Nellis, S. (1984). Decentralization in Developing Countries: A Review of Recent Experience, World Bank Staff WorkingPapers No.581: 23-32.

142. Rondinelli, D.A. (2006). Government decentralisation and economic development: The evolution of concepts and practices. In: Otenyo, E.E. and Lind, N.S. (eds).Comparative Public Administration: TheEssentail Readings. Research in Public Policy Analysis and Management Volume 15.

143. Rondinelli, D.A. and Nellis, J.R. (1986).Assessing decentralization policies in developing countries: The case for cautious optimism. Developing Policy Review, 4(1):3-23.

144. Saunders, M.P. Lewis and Thornhill, A. (1997). Research Methods for Business Students, Financial Times Management,

145. Scholz, B., and Flessa, S. (2015) Rapid assessment of infrastructure of primary health care facilities a relevant instrument for health care systems management. BMC Health Services Research (2015) 15:183

146. Semfukwe, M (2008), Factors Contributing to Home Delivery in Kongwa District, Dodoma-September, 2008, Hospitals in Tanzania Mainland

147. Shipman, P. K. (1972). Sampling Techniques in Quantitative Research :The Practice of Social Research, 6th edition, Wadsworth Publishing Company, California, 110pp.

148. Shivji, I. (2003). The Struggle for Democracy, Mkuki na Nyota Publisher, Dar-es- Salaam.

149. Sikika (2013), Report on the Availability of Essential Medicine, Medical Supplies and Bed Capacity in Hospitals in Tanzania Mainland. Report on Availability of Essential Medicines

150. Sikika, (2014) Tanzania Health Sector Budget Analysis 2005/2006- 2011/2012.

151. Smoke, P. (2001) Fiscal Decentralization in Developing Countries: A Review of Current Concepts and Practice. Geneva: United Nations Research Institute for Social DevelopmentVol. 64, pp. 621–641, 2014

152. Standing, H. (1997). Gender and equity in health sector reform programmes: A review. Health Policy and Planning, 12(1):1-18.

153. Steedman, D. (2005), Mid-term Programme Review: Final Report, POPSM Studies Institute, London School of Economics and Political Science, London. pp. 1-26.

154. Sudman, S. (2001).Applied Sampling, Academic Press, New York. 23pp.

155. The World Health Report .(2008). Primary Health Care - now more than ever. Geneva: the World Health Organization.

156. Tibandebage, P., Mackintosh, M., and Kida, T. (2013) The public private interface in public services reforms: analysis and illustrative evidence from the Tanzanian health sector. REPOA

157. Tidermand, P., Olsen, H.B. and Sola, N. (2008).Local Services Delivery, Decentralisation and Governance: A comparative Study of Uganda, Kenya and Tanzania Education, Health and Agricultural sectors Tokyo: Research Group, Institute for International Cooperation(IFIC), Japan International Cooperation Agency (JICA).

158. Tom C. and Per Laegreid. (2002). New Public Management: The Transformation of Ideas and Practice. Ashgate Publishing Limited. Hampshire, England.

159. Tony L. Doherty and Terry Horne. (2002). Managing Public Services: Implementing Changes. Routledge. New York.

160. Tordoff, W. (1994). Decentralization: A comparative experience in Commonwealth Africa. The Journal of Modern African Studies, 32(4):555-580.

161. United Nations Children's Fund (UNICEF) (2007).The State of World’s Children 2008.New York: United Nations Children’s Fund.

162. URT (1977).The Constitution of the United Republic ofTanzania, 1977.Dar es Salaam: Government Printer.

163. URT (1998).Policy Paper on Local Government Reform.Local Government Reform Program. Dar es Salaam: Ministry of Regional Administration and Local Government. Local Government Reform Programme.

164. URT (1999), The Public Service Managementand Employment Policy; Government Press.

165. URT (2000).The Tanzania Development Vision 2025. Dar es Salaam:Planning Commission.

166. URT (2001).The District Council (Council Health Service BoardEstablishment) Instrument, 2001. Dar es Salaam: Ministry of Health..

167. URT (2002). The Local Government System in Tanzania, Tanzania, [http://www.clgf.org.uk/index] Accessed on 20/10/2015 .

168. URT (2002a). The Local Government System in Tanzania, Tanzania, [http://www.clgf.org.uk/index ] site visited on 10 3.2015.

169. URT (2002b).Tanzania Population and Housing Census of.2002, National Bureau of Statistics, 431pp.

170. URT (2003).National Health Policy. Dar es Salaam: Ministry ofHealth.

171. URT (2004).Local Government Reform Programme Restructuring Manual:A Strategic Approach to Reform by Local Councils. Dodoma: President’s Office- RegionalAdministration and Local Government..

172. URT (2005a), Paper on Reforming the Public Service in Tanzania.A critical prerequisite to economic growth, wealth creation and poverty reduction.African Association for Public Administration and Management (AAPAM).

173. URT (2005b), PRSP Review Committee: Comments and Response to the Mid-Term Review.

174. URT (2006).Local Government Reform Programme II (D by D), Government Printers, Dar-es-salaam. 210pp.

175. URT (2006).Tanzania Census 2002 Analytical Report. Dar es Salaam:National Bureau of Statistics, Ministry of Planning, Economy and Empowerment.

176. URT (2007a).National Health Policy. Dar es Salaam: Ministry ofHealth.

177. URT (2007b).Primary Health Services Development Programme (PHSDP)2007–2017. Dar es Salaam: Ministry of Health and Social Welfare.

178. URT (2008).The Status of Implementation of Decentralisation by Devolution on Mainland Tanzania and the Way Forward.Paper Presented at the NationalConvention on Public Sector Reforms 17-18th June 2008, Ubungo Plaza, Dar esSalaam..

179. URT (2009a).Poverty and Human Development Report 2009. Dar es Salaam: Research and Analysis Working Group. MKUKUTA Monitoring System.Ministry of Finance and Economic Affairs.

180. URT (2009b).Local Government Reform Programme II (Decentralizationby Devolution): Vision, Goals and Strategy July 2009–June 2014. Dodoma: Prime Minister’sOffice Regional Administration and Local Government.

181. URT (2010), Health Sector Performance Profile Report 2010 up-todate, Mainland Tanzania July 2009 – June 2010, government printers, DSM

182. URT (2011a).Country Report on the Millennium Development Goals 2010. Dar es Salaam: Government Printer.

183. URT (2011c).MKUKUTA Annual Implementation Report 2010/11:Delivering on Commitments. Dar es Salaam: Ministry of Finance.

184. URT (2012). National Census Report, Government Printers, Tanzania..

185. URT (2013).2012 Population and Housing Census: Population Distribution by Administrative Areas. Dar es Salaam: National Bureau of Stastics, Ministry ofFinance.

186. URT (2013); Human Resource for Health Country Profile 2012/2013 ISBN No: 978-9987-937-07-9.

187. URT(1977).The Constitution of the United Republic of Tanzania, 1977.Dar es Salaam: Government Printer.

188. URT(1996) Local Government Reform Agenda. Dar es Salaam:Ministry of Regional Administration and Local Government. Local GovernmentReform Programme..

189. URT(2010).National Strategy for Growth and Reduction of Poverty II.Dar es Salaam: Ministry of Finance and Economic Affairs.

190. Venugopal, V. and Yilmaz, S. (2010). Decentralisation in Tanzania: An assessment of local government discretion and accountability, Public Administration and Development, 30(3):215-231.

191. Willis .O and Onen .D (2008) Writing Research Proposal and Report.Makerere University..

192. Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P. (2008) Motivation and retention of health workers in developing countries: a systematic review. BMC Health Serv Res; 8: 247.with South Asia and West African Environmental Cases. The Journal of Developing Areas 6: 37-39.

193. World Bank (2001).Decentralization and Governance: Does Decentralization Improve Public Service Delivery? Poverty Reduction and Economic Management Notes No.55. Washington, D.C: The World Bank.

194. World Bank (2004).World Bank Development Report 2004: Making Services Better for Poor People. Washington, D.C: The World Bank.

195. World Bank (2008). Decentralization in Client Countries. An Evaluation of World Bank Support,1990- 2000. Washington, D.C: World Bank Independent Evaluation Group, TheWorld Bank.

196. World Bank (2010) Africa Development Indicators 2010: Silent and Lethal, How Quiet Corruption Undermines Africa’s Development Efforts. Washington, D.C.: The World Bank.

197. World Bank(2006), Public Service Reform Program (PSRP), Review Mission, Aide Memoire,DECEMBER-December, 2006.

198. World Bank, Project Appraisal Document for the Second Phase of the Performance Results and Accountability Project, September 7, 2007, Tanzania

199. World Bank. World Development Report (2004) Making services work for the poor. Washington DC: World Bank; 2004.

200. World Health Organisation (2015) World Health Statistics. Luxembourg.

201. World Health Organisation and United Nations Children's Fund (UNICEF) (2010).Progress on Sanitation and Drinking Water: 2010 Update. Geneva: WHO Press.

202. World Health Organization (2000) World Health Report 2000: Health Systems: Improving Performance. Geneva: World Health Organization.

203. World Health Organization (2007) Everybody’s Business. Strengthening Health Systems to Improve Health Outcomes: WHO’s Framework for Action. Geneva: World Health Organization.

204. Wunsch, J. S. and Olowu, D. (1995).The Failure of the Centralized State: Institutions and Self-Governance in Africa, ICS Press, London. 402 pp.

205. Yilmaz, S., Alam, G., Gurkan, A., Mahieu, S., Venugopal, V., &Felicio, M. (2009).Local Government Discretion and Accountability: Application of a Local Governance Framework. Washington: The World Bank. 31.

206. Yin, R.K. (2003). Case Study Research: Design and Methods. Third Edition. Thousand Oaks, London and New Delhi: Sage publications

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