UNU World Institute for Development Economics Research (UNU/WIDER) Research for Action 41 Community and Village-Based Provision of Key Social Services A Case Study of Tanzania Marja Liisa Swantz This study has been prepared within the UNUAVIDER project on New Models of Public Goods Provision and Financing in Developing Countries, which is co-directed by Germano Mwabu, Senior Research Fellow at UNUAVIDER, and Reino Hjerppe, Director General of the Finnish Government Institute for Economic Research. UNUAVIDER gratefully acknowledges the financial contribution to the project by the Government of Sweden (Swedish International Development Cooperation Agency - Sida). UNU World Institute for Development Economics Research (UNU/WIDER) A research and training centre of the United Nations University The Board of UNU/WIDER Harris Mutio Mule Sylvia Ostry Jukka Pekkarinen Maria de Lourdes Pintasilgo, Chairperson George Vassiliou, Vice Chairperson Ruben Yevstigneyev Masaru Yoshitomi Ex Officio Hans J. A. van Ginkel, Rector of UNU Giovanni Andrea Cornia, Director of UNU/WIDER UNU World Institute for Development Economics Research (UNU/WIDER) was established by the United Nations University as its first research and training centre and started work in Helsinki, Finland in 1985. The purpose of the Institute is to undertake applied research and policy analysis on structural changes affecting the developing and transitional economies, to provide a forum for the advocacy of policies leading to robust, equitable and environmentally sustainable growth, and to promote capacity strengthening and training in the field of economic and social policy making. Its work is carried out by staff researchers and visiting scholars in Helsinki and through networks of collaborating scholars and institutions around the world. UNU World Institute for Development Economics Research (UNU/WIDER) Katajanokanlaituri 6 B 00160 Helsinki, Finland Copyright © UNU/WIDER 1997 Camera-ready typescript prepared by Liisa Roponen at UNU/WIDER Printed at Hakapaino Oy, Helsinki The views expressed in this publication are those of the author(s). Publication does not imply endorsement by the Institute or the United Nations University of any of the views expressed. ISSN 1239-6761 ISBN 952-9520-65-4 CONTENTS LIST OF TABLES AND FIGURES iv LIST OF ACRONYMS v GLOSSARY OF SWAHILI WORDS vi FOREWORD vii ACKNOWLEDGEMENTS viii ABSTRACT ix I TANZANIAN SOCIAL POLICY AND PRACTICE 1 1.1 Introduction 1 1.2 Evolution of Tanzanian social policy and practice 3 1.2.1 Developing educational programme 6 1.2.2 Evolving health sector policy 9 1.2.3 Water and sanitation 15 1.3 Decentralization of service delivery 17 1.3.1 Transfer of responsibility for social services to the local governments 18 1.3.2 The basis for decentralization is the people's participation 19 1.3.3 Educational goals and motivation for greater self-support 21 II COMMUNITY-BASED SERVICES IN SOUTH-EASTERN TANZANIA: CASE STUDY OF THE MTWARA AND LINDI REGIONS 24 2.1 Background to social services in the Mtwara and Lindi regions 24 2.1.1 Social service statistics in the Mtwara and Lindi regions 26 2.1.2 Cooperation between external agencies 32 2.1.3 Development as the bridge between the 'traditional' and the 'modern' 34 2.1.4 Women perpetuate the sharing and caring tradition 40 2.2 Cost-sharing through community education fund (CEF) 44 2.2.1 Experimenting in education: the community education fund 44 2.2.2 Participatory rural assessment (PRA) and school reform 47 2.2.3 Economic capacity of the communities for implementing CEF 56 2.2.4 Sample survey of two villages 59 2.2.5 Assessing wealth in relation to service needs 61 III CONCLUSION 66 ANNEX 70 REFERENCES 74 III LIST OF TABLES AND FIGURES Table 1 Survey of functioning shallow wells in the Mtwara region Table 2 Community self-assessment of own wealth Table 3 Criteria for wealth ranking Annex Figures Figure 1 Districts of Lindi and Mtwara regions Figure 2 Tanzanian administrative system Figure 3 Women with support groups IV LIST OF ACRONYMS CCM Chama Cha Mapinduzi CHF community health fund CSPD UNICEF's child survival development programme DANIDA Department of International Development Cooperation (Ministry of Foreign Affairs, Denmark) DEO district education officer ERP economic restructuring programme EDP essential drugs programme EHO environmental health officer EPI expanded programme of immunization FINNID A Finnish International Development Agency (Ministry for Foreign Affairs, Finland) GIS geographic information system GOT government of Tanzania HA health assistant HFA health for all programme HMIS health management information system IDA international development assistance IMF International Monetary Fund JICA Japan International Cooperation Agency MCH mother-child health programme MOH Ministry of Health NGO non-governmental organizations ODA official development assistance PHC primary health care PRA participatory rural appraisal PSAP priority social action programme PSO project support office RMA rural medical aids RMO regional medical officer SAP structural adjustment programme SDA social dimension of adjustment SIDA Swedish International Development Cooperation Agency TANU Tanganyika National Union TBA traditional birth attendant v USAID US Agency for International Development UMCA Universities Missions to Central Africa UNHCR Office of the UN High Commissioner for Refugees UNICEF United Nations Children's Fund UPE universal primary education VA voluntary agency VHW village health worker WB World Bank GLOSSARY OF SWAHILI WORDS dau small boat diwani ward councillor hatujaletewa we have not been given the (necessary) equipment or supplies kanga the traditional cloth worn by women kienyeji traditional kuvuma (verb) to blow, as the wind maendeleo progress, development matoro (singular for watoro) absentee mganga wajadi (singular for waganga) traditional healer mganga wa kienyeji traditional doctor mganga wa kisasa modern doctor ming'oko wild roots mitumbwi small canoe ngoma drum, dance shamb field ujamaa familyhood uvumi gossip vilema people with limited physical capacity waganga traditional health healers wakunga wajadi traditional midwives watoro absentees uhuruna kazi freedom and work VI FOREWORD It is with great pleasure that I introduce the study Community and Village-Based Provision of Key Services: A Case Study of Tanzania by Professor Marja Liisa Swantz. This study has been prepared within the context of the UNUAVIDER project of New Models of Public Goods Provision and Financing in Developing Countries. The development of public provision of public/merit goods (health, education, water and sanitation) has gone through various stages. Initially, the concept of market failure led the state to organize the provision of public goods. Then, evidence of widespread government failure in the delivery and funding of public services caused a turn-about and led to the introduction of a system of provision inspired by market principles. However, the market failure problems of the neoliberal model are also quite pervasive. These failures would eventually lead, even more than in the state-led model, to policy reversals. Consequently, this UNUAVIDER project endeavours to find new models of provision and financing where, hopefully, a better balance between provision by the state and the market, as well as by households and other agents, could be reached. In this study Professor Swantz describes the initial attempts of providing social services undertaken by the Tanzanian government during the early 1970s. Since then, severe economic imbalances, and the policies attempting to redress them, affected the quality and sustainability of public provision of key social services. More recently, the decentralization of the Tanzanian state is further affecting social service provision through the devolution of financial and managerial responsibilities to lower (ward and village) levels of government. At the same time, a new participatory (bottom-up) approach is being implemented including community self-assessment of basic needs and capabilities. Based on extensive field work in southern Tanzania, the author presents some of the effects that these two processes, decentralization combined with community participation, have on the system of social service provision. The author also presents some insights on the possible way ahead in this field. I trust this paper will help the academic community, donors, policy makers and general public to further understand one crucial aspect of poverty in the developing world. Giovanni Andrea Cornia UNUAVIDER Director September 1997 VII ACKNOWLEDGEMENTS I gratefully acknowledge the opportunity to write this study as a visiting scholar at UNUAVIDER. I thank Professor Giovanni Andrea Cornia, the Director of UNUAVIDER, for providing a productive research environment and support. I am especially indebted to Professor Germano Mwabu, Co-director of the project on New Models of Public Goods Provision and Financing in Developing Countries, and the project members for their assistance and encouragement. The fieldwork for the study was done as part of the rural integrated project support programme (RIPS) in Mtwara and Lindi regions. The work of the RIPS staff and the regional headquarters have provided the basis for the study. I also thank FINNAGRO, with whom I have been employed as a senior sociologist. FINNAGRO has been funded by the Department of International Development Cooperation of the Ministry for Foreign Affairs of Finland. Vlll ABSTRACT The first part of the paper