From Systems to Services

Local government administrations bring essential services to underrepresented communities in Tanzania

Bunazi Primary School went through a big transformation. Several facilities have been built or are under construction at the moment. / Stefano Bianco, Kino Media

Underrepresentation

Pharmacist Patrick Nwesiga pauses, takes a step back, and gazes in satisfaction as he and his colleague Erick Emmanuel stock the shelves of the Bunazi Health Center Pharmacy with new medicine and medical equipment.

Bunazi, a bustling town situated a mere 20 kilometers south of the border with Uganda, is the capital of Missenyi district, in Kagera, one of Tanzania’s northernmost regions. The town is home to one of Missenyi district’s two health centers. With a population over 245,000, it was once difficult for people in Missenyi to access the medicines they need to lead healthy and productive lives.

Says pharmacist Patrick Nwesiga: “After setting up the FARRS system, centers are now able to purchase and allocate a budget to order their own medicines, and thus the medicines arrive in a very short time.” / Stefano Bianco, Kino Media

“Before, health centers were ordering medicine at the council level, where the district pharmacist consolidates all the orders and sends them to the council,” Patrick explained. “It used to take a very long time for us to receive medicine, sometimes even more than three months.”

With only one medicine dispensary per 9,000 people across Missenyi, people must travel long distances to access lifesaving medicines. When medicines are out of stock, the quality of healthcare services is jeopardized.

Now, in just 14 to 20 days, health facilities receive much needed medicine for their communities. / Stefano Bianco, Kino Media

Systems

The Government of Tanzania addresses these challenges through two efforts — Direct Health Facility Financing (DHFF) and a new Facility Financial Accounting and Reporting System (FFARS). Both grew out of a partnership with the USAID Public Sector Systems Strengthening Plus (PS3+) activity, a five-year, $50 million activity that works with Tanzania across 31 regions to institutionalize public sector systems at the local level.

The programs are behind the now well-stocked pharmacies because they streamlined the accounting so that funding is now allocated directly to health facilities’ accounts — removing the multiple steps that caused delays.

And clearing up procedural roadblocks has positive ripple effects in these communities.

Kokutona Domisiyao, a Bunazi resident, stops into the pharmacy. “The health center always has the medicine and vaccines I need to keep my daughter healthy and safe,” she says. / Stefano Bianco, Kino Media

The activity promotes transparent management and delivery of public services, and works to ensure systems like FFARS are improved and responsive to citizens’ needs for essential quality public services, particularly for underserved populations. These systems also ultimately prevent theft and mismanagement of finances.

When funds are transparently sent to health facilities and managed well, the availability of medicine and medical supplies are prioritized. Now, health centers across Tanzania can order medicine according to their budget and revenue, all of which are visible in FFARS.

With increased availability of funds from FFARS, the school constructed a Special Needs Children’s Unit. Parent Justinian Kalhekolela, left, remarks, “The Special Needs Children’s Unit has helped my child a lot because he didn’t like school before, but now he comes to school every day. He is making good progress and is taught by teachers who understand children with special needs.” / Stefano Bianco, Kino Media

Services

Patrick is pleased with the positive impact this has had on his community.

“After setting up FFARS, centers are now able to purchase and allocate a budget to order their own medicines,” he explained “As a result, the medicines arrive in a very short time. In 14 to 20 days, the medicines are already available.”

The new accounting system that is helping health facilities across Tanzania is also improving the education sector. For example, located only 1.5 kilometers north of the health facility, off a winding red clay road lined with towering eucalyptus trees, Bunazi Primary School is an exemplary beneficiary of the new system.

Bunazi Primary School students head to class. / Stefano Bianco, Kino Media

“Now, the funds from the government go directly to the relevant assignment, because they are earmarked and come in allocations,” remarks Bunazi Primary School Head Teacher Mkama Bazil Waswa. “This makes it easier to administer funds, and decreases mismanagement and mistakes.”

Upon implementation of FFARS, the school’s trust with the central government is enhanced. As a result, Bunazi Primary School receives more funds to construct dormitories, purchase much needed school equipment, and improve education for students with special needs.

School Board Member Edina Nshombo says, “In addition to the new facilities built and under construction, we now have an increasing number of students because of the improved teaching performance.” / Stefano Bianco, Kino Media

Edina Nshombo is a parent and member of the school board. She speaks over a faint chorus of students enthusiastically singing their school anthem in the distance and elaborates on the positive and tangible changes she observes at the school because of FFARS. “Several buildings have been built or are under construction at the moment. In addition, we now have an increasing number of students because of the improved teaching performance, she says.

The Bunazi Primary School and Health Center Pharmacy are not one-off successes. USAID partners with local governments across Tanzania to help them finance economic development by strengthening their ability to transparently and effectively mobilize and manage the resources required to provide public services. As a result of this work, Tanzania is expected to expand enrollment of FFARS to over 20,000 villages and wards.

About the Author

Alex Larrieux is a Development Outreach and Communications Specialist with USAID.