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Tanzania - Health Sector Development Program Project (英语)

Overall ratings convey a satisfactory project outcome, likely sustainability, and substantial institutional development impacts, including satisfactory performances by the Bank, and Borrower. Lessons address the following. The delayed appreciation, and ownership of reforms, somehow slowed the process. Instead, government, and partners should invest in reform advocacy on a continuous basis with the different stakeholders, including at community levels. It is also reinforced that donor coordination, a necessary input to health reform especially when it involves a sector-wide approach, demands commitment from partners, and management skills from the government. Inconsistencies between the financial years of local, and central government, requires high leadership to anticipate and prepare, and as well, to negotiate an acceptable compromise, while not derailing the project. Nonetheless, the high coordination transactions costs translated into a sharp increase in basket funding, and its efficient utilization. Furthermore, reforms require new and diversified skills, hence training, and continuous education should become the core pillar of the reform program, integrated in the resource allocation of reform. This sector-wide-approach experience shows that while focusing on system capacity strengthening, can be initially detrimental to service delivery due to overall capacity weakness, it is nonetheless a necessary step in achieving long term acceptable performance of health service delivery. Lessons highlight that human resources issues can only be resolved by addressing the civil service as a whole (throughout all ministries), because staff are employed by the public sector, and there are limitations on what the sector alone can accomplish.