Decision making under the tree: gender perspectives on decentralization reforms in service delivery in rural Tanzania

In recent decades, decentralization has been upheld by governments, donors and policy makers in many developing countries as a means of improving people’s participation and public services delivery. In 1996, the government of Tanzania embarked on major local government reforms reflecting the global trends and as part of the wider public sector reforms. The reforms aim at improving the access, quality and equitable delivery of public services through a policy of ‘decentralization by devolution’. Since then, many studies have examined the fiscal, administra­tive, legal and political aspects of the reforms. However, the gender dimensions of both the process and outcomes of the reforms have been less examined. In Tanzania, like in other sub-Saharan African countries, little is documented about decentrali­zation and gender, especially at the village level. This study, therefore, examines the impact of decentralization reforms on service delivery in rural Tanzania using a gender perspective.The study addresses the question of how decentralization affects the user-provider interactions and gender-sensitivity of water and health services in the rural villages. Specifically, it focuses on the institu­tional characte­ristics for decentralized service delivery, the impact of the reforms on service users’ participation in decision-making processes, on access to gender-sensitive water and health services, and on cooperation and trust at the village level. To investigate this, the study draws on governance theory and sociological theory, including an institutional, principal-agent, an actor and a gender perspective. In this study, gender is seen as a cross-cutting perspective taking in account the wider socio-cultural and political structures that influence the process and outcomes of decentralization in a specific context. The study is based on quantitative and qualitative data obtained at district, village and household levels in the districts of Kondoa and Kongwa in the Dodoma Region in Tanzania. The fieldwork consisted of three overlapping phases: an exploratory phase, house­hold survey and in-depth qualitative study. Mixed data collection methods were used because they enrich our understanding of the topic and contribute to the validity and reliability of findings. A house­hold survey was used to collect quantitative data, whereas semi-structured and unstruc­tured interviews, focus group discussions, observations, case studies and life histories were used to collect qualitative data. Overall, 513 respondents (236 men and 277 women) were involved in the study: 332 in the survey (115 men and 227 women), 69 in the focus group discussions (44 men and 25 women), 107 in the interviews (77 men and 30 women) and five women in life histories. In addition, review and analysis of available data at district and village levels provided secondary data to complement the primary data. The study found that the reforms have resulted in a number of institutional changes by restructuring the district and village councils, and by establishing service boards and commi­ttees at each administrative level or service delivery point. These changes have incre­ased local govern­ments’ autonomy to plan and imple­ment service delivery functions, and service users’ participation in planning and managing public services. However, the existing central-local relations limit local governments’ autonomy to fully exercise their decentralized mandates and to address local service delivery needs. Local govern­ments have limited financial and technical capacity, and the central government controls their functions through intergovernmental trans­fers, guidelines and national priorities. At the village level, conflicting roles and responsi­bi­lities of village councils and service committees limit the latter to fun­ction effectively. Thus, decent­ralized service delivery in Tanzania takes on different forms where the nature of sector is an important factor in the kind of institutional arrangements. It was revealed that decentralization reforms have created spaces for service users’ participation in planning and decision-making processes. Men and women participate in these spaces through attending meetings, contributing labour, cash or both, in construction of service infrastructures, membership in committees, speaking up and influencing decisions in meetings. The majority of women participate passively by attending meetings, consultation or through activity-specific spaces. Although the proportion of women in village councils and committees has increased because of the quota-based representation, local decision-making processes conti­nue to be largely male dominated. Women’s participation contributes to meeting practical gender needs, but to a lesser extent addresses their strategic gender needs because of the gende­red power rela­tions which have been largely untouched by the reforms. The main const­raints to effective women’s participation include patriarchy, household respo­nsibilities, compli­cated elec­tion proce­dures, lack of self-confidence and less experience in public affairs. Gender also inter­sects with religion, ethnicity, age and marital status, and may compound women’s disadva­ntaged position in local decision-making structures. While dece­nt­ralization is expected to address gender inequalities, instead it repro­duces them, because it does not address the socio-cultural barriers that inhibit women’s effec­tive participation in local structures. The study shows that the impact of reforms on water and health services delivery is mixed. Access to the services has improved for some users but decentralization has also led to marginalization of other users. The number of water and health services infrastructure has increased, thereby raising the service coverage. However, there is still inade­quate infrastructure to provide full service coverage, and the situation is more critical in the health sector because most villages do not have their own health facilities. Despite improvements in coverage, less has been achieved in other respects, such as adequate staffing and availability of drugs and other essential supplies. Comparatively, more users are satisfied with water services than with health services. For both services, there are overlaps and differences between the users’ and the gender perspectives. Men and women hold similar opinions on some aspects, but there are also marked differences. This confirms the fact that men and women are actually different users because they have different needs, and are positioned differently regarding their access to basic services. Understanding these simi­larities and differences is, thus, an important step in making basic services ‘gender-sensitive’. It was shown that the reforms have strengthened formal cooperation aimed at improving public services and the informal mechanisms of social networks and groups. Decentralization outcomes in terms of increased citizen’s participation in decision-making processes and improved services influence political trust, and also here gender relations proved to play an important role. There is a two-way interface between trust and decentra­lization reforms: trust enhances participation in local institutions and ‘good’ decentrali­zation outcomes can generate trust. Conversely, ‘bad’ decentralization outcomes decrease trust. The study further revealed that political trust is a multi-layered concept where citizens judge local leaders and service providers at different administrative levels differently. These levels are crucial in analysing political trust and the impact of gender on political trust at different levels. The general conclusion of this study is that the current decentralization reforms in Tanzania present both opportunities and challenges for increasing service users’ participation, cooperation and trust, addressing gender equality issues and, for improving service delivery. In order to improve the user-provider interactions and service delivery, a number of design and implementation issues should be addressed. At the national level, policy makers need to address the existing imbalance in central-local relations by redefining the relationship, functions and roles of central and local governments. District councils need to clarify the roles and responsibi­lities of service committees in relation to those of village councils, provide regular gender-sensitive training to service committees, and integrate local needs into district plans. Village leaders should consider holding meetings at times and in locations that are convenient for women, announce meetings and agenda in advance, and address village concerns adequately and transparently in the meeti­ngs. Actors at all levels need to explore effective strategies for transforming the socio-cultural norms that underlie women’s subordinate position in decision-making processes, and in their access to basic services.</p

Cooperation and trust in the context of decentralization reforms in rural Tanzania

This paper investigates the impact of decentralization reforms on cooperation and trust at the village level in Tanzania, using a gender perspective. The paper draws on survey and qualitative data from ten villages in two rural districts. The findings show that the reforms have revitalized 'formal’ cooperative efforts and social networks and groups aimed at improving public services and poverty reduction. Citizen’s participation in decision-making processes and users’ satisfaction with public services are significantly related to social and political trust, in which gender plays a role as well. There is a two-way interface between trust and decentralization reforms. ‘Good’ decentralization outcomes generate trust while ‘bad’ outcomes decrease trust. Key Words: Decentralization, cooperation, gender, political trust, social trust

Institutional arrangements for decentralized water and health services delivery in rural Tanzania: differences and constraints

In recent years, decentralization has been upheld by governments, donors and policy makers in many developing countries as a means of improving public services although opinion is divided on the link between decentralization and service delivery. This article reviews recent literature and research on decentralized service delivery in Tanzania. It uses the principal-agent theory and broader decentralization frameworks to describe and compare decentralization in two sectors: water and health. The analysis shows that decentralization between the two sectors differs, with the water sector displaying a mixture of bottom-up and top-down models while the health sector is more centralized with an orientation towards the top-down model. It is concluded that decentralized service delivery in Tanzania takes on different forms where the nature of sector is an important factor in the kind of institutional arrangements, in which gender plays a role as well

Priority setting for health in the context of devolution in Kenya: implications for health equity and community-based primary care

Devolution changes the locus of power within a country from central to sub-national levels. In 2013, Kenya devolved health and other services from central government to 47 new sub-national governments (known as counties). This transition seeks to strengthen democracy and accountability, increase community participation, improve efficiency and reduce inequities. With changing responsibilities and power following devolution reforms, comes the need for priority-setting at the new county level. Priority-setting arises as a consequence of the needs and demand for healthcare resources exceeding the resources available, resulting in the need for some means of choosing between competing demands. We sought to explore the impact of devolution on priority-setting for health equity and community health services. We conducted key informant and in-depth interviews with health policymakers, health providers and politicians from 10 counties (n = 269 individuals) and 14 focus group discussions with community members based in 2 counties (n = 146 individuals). Qualitative data were analysed using the framework approach. We found Kenya’s devolution reforms were driven by the need to demonstrate responsiveness to county contexts, with positive ramifications for health equity in previously neglected counties. The rapidity of the process, however, combined with limited technical capacity and guidance has meant that decision-making and prioritization have been captured and distorted for political and power interests. Less visible community health services that focus on health promotion, disease prevention and referral have been neglected within the prioritization process in favour of more tangible curative health services. The rapid transition in power carries a degree of risk of not meeting stated objectives. As Kenya moves forward, decision-makers need to address the community health gap and lay down institutional structures, processes and norms which promote health equity for all Kenyans

Can 'functionlaity' save the community management model of rural water supply?

As attention increasingly turns to the sustainability of rural water supplies - and not simply overall levels of coverage or access - water point functionality has become a core concern for development practitioners and national governments, especially in Sub-Saharan Africa. Within the long-enduring Community-Based Management (CBM) model this has resulted in increased scrutiny of the “functionality” of the local water point committee (WPC) or similar community management organisation. This paper reviews the literature written from both practice-focused and critical-academic perspectives and identifies three areas that pose challenges to our understanding of water point functionality as it relates to CBM. These concern the relative neglect of (i) the local institutional and socio-economic landscape, (ii) broader governance processes and power dynamics, and (iii) the socio-technical interface. By examining these three areas, the paper engages with the specific issue of WPC functionality, whilst also considering broader issues relating to the framing of problems in development and the methodological and disciplinary ways that these are addressed. Furthermore, by focusing on community management of rural water points, the paper lays the ground for a more substantial critique of the continuing persistence of the CBM model as a central development strategy

Gender perspectives on decentralisation and service users’ participation in rural Tanzania

Increasing participation in decision-making processes by service users is one of the objectives of decentralisation reforms in Tanzania. The argument is that decentralisation enhances participation by all sections of the community, and by women in particular, and results in decisions that better reflect local needs. This paper examines the impact of decentralisation reforms on service users’ participation for delivery of water and health services in rural Tanzania, using a gender perspective and principal-agent theory. The paper investigates how decentralisation has fostered spaces for participation and how men and women use these spaces, and identifies factors that constrain or encourage women’s participation. It shows that decentralisation reforms have created spaces for service users’ participation at the local level. Participation in these spaces, however, differs between men and women, and is influenced by the sociocultural norms within the household and community. Men have gained more leverage than women to exercise their agency as principals. Women’s participation is contributing to addressing practical gender needs, but strategic gender needs have been less adequately addressed because gendered power relations have been largely untouched by the reforms

Users' perspectives on decentralized rural water services in Tanzania

This article examines the impact of decentralization reforms on improving access to domestic water supply in the rural districts of Kondoa and Kongwa, Tanzania, using a users' and a gender perspective. The article addresses the question whether and to what extent the delivery of gender-sensitive water services to rural households improved after the reforms. Household- and village-level data were obtained through a household survey and qualitative methods. The findings show an increase of the proportion of households using improved sources of domestic water between 2002 and 2011. However, more than half of users still travel over a kilometre and use more than an hour to collect water in the dry season. Despite the increased proportion of women in water management committees, the outcomes of these decentralized arrangements differ for men and women. Overall, the reforms have produced contradictory effects by improving access to water supply for some users, and creating or reinforcing existing inter- and intra-village inequalitie

A gendered users' perpective on decentralized primary health services in rural Tanzania

Since the 1990s, Tanzania has been implementing health sector reforms including decentralization of primary healthcare services to districts and users. The impact of the reforms on the access, quality and appropriateness of primary healthcare services from the viewpoint of users is, however, not clearly documented. This article draws on a gendered users’ perspective to address the question of whether the delivery of gender-sensitive primary health services has improved after the reforms. The article is based on empirical data collected through a household survey, interviews, focus group discussions, case studies and analysis of secondary data in two rural districts in Tanzania. The analysis shows that the reforms have generated mixed effects: they have contributed to improving the availability of health facilities in some villages but have also reinforced inter-village inequalities. Men and women hold similar views on the perceived changes and appropriateness to women on a number of services. Gender inequalities are, however, reflected in the significantly low membership of female-headed households in the community health fund and their inability to pay the user fees and in the fact that women’s reproductive and maternal health needs are as yet insufficiently addressed. Although over half of users are satisfied with the services, more women than men are dissatisfied. The reforms appear to have put much emphasis on building health infrastructure and less on quality issues as perceived by users