The Dar Es Salaam Urban Health Project, Tanzania: a multi-dimensional evaluation
Harpham, T.; Few, R.
Journal of Public Health Medicine 24(2): 112-119
2002
ISSN/ISBN: 0957-4832 PMID: 12141579 DOI: 10.1093/pubmed/24.2.112Document Number: 237364
Background: In the 1990s, as a response to rapid urbanization, there were a number of large, urban health initiatives in sub-Saharan Africa. Most tended to be comprehensive as opposed to selective in scope: they aimed at strengthening the health system as a whole, and placed emphasis on delivering improved services at the primary level, with increased community participation. A multidimensional approach is required to assess the achievements of such initiatives. Methods: In 2000, an external evaluation of the Swiss-funded Dar es Salaam Urban Health Project, Tanzania, used 50 key informant interviews, 90 health facility exit interviews, 90 community resident interviews and document analysis to assess achievements over a 10-year period. The study considered achievements in terms of capacity building, improving quality of care, community involvement, intersectoral action and sustainability. Results: Although the project achieved improvements in capacity building and in structural and technical quality of care, there were difficulties in generating intersectoral action and the concept of participation was limited. However, city-level 'ownership' of the activities was high, and, with the advent of sector-wide allocation of funds (SWAPs) in the health sector in Tanzania, the prospects for sustainability of the achievements made in the project appear to be good. Conclusion: Both the multidimensional method of the evaluation and the findings can inform future urban health initiatives in sub-Saharan Africa and in other resource-constrained environments. The decentralization that occurred in Dar es Salaam and the general approach of the project provided a platform to test out various elements that are common to health sector reform across Developing Countries.