Assessing an intervention to strengthen health facility governing committees to improve social accountability in two semi-rural districts in Tanzania: A pre-post mixed methods study
1
Dar es Salaam University College of Education, University of Dar es Salaam, Tanzania, United Republic of
2
Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
Popul. Med. 2026;8(Supplement Supplement 1):A1729
ABSTRACT
BACKGROUND:
Health sector reforms in Tanzania initiated in the 1990s, prioritized inclusiveness by encouraging a variety of stakeholders to participate in promoting social accountability at the facility level. Thus, health facility governing committees (HFGCs), composed of various stakeholder groups, were introduced as a tool to facilitate this process. Despite over two decades of operation, stakeholders’ awareness and engagement has remained limited. This study assesses an intervention implemented to strengthen HFGCs by providing their members with training and community sensitization to raise awareness and encourage engagement, thereby enhancing social accountability.
METHODS:
A convergent mixed methods design was used. Post-intervention interviews conducted in 2025 captured the views of various stakeholders on changes changes on dimensions of accountability and stakeholder participation. Community-based surveys were also conducted in 2022 (pre-intervention) and 2025 (post-intervention). The qualitative data were analyzed thematically, and the quantitative data estimated absolute differences (AD) using a generalized linear regression model.
RESULTS:
The intervention strengthened the HFGC members’ accountability and increased stakeholder awareness of and participation. The greatest improvements were observed among facility users, facility in-charges, and local government leaders. Survey results showed statistically significant gains across most outcomes in both crude and adjusted models. Largest gains were seen in community support (AD=24.3; 95% CI: 20.6-28.0) and HFGC members´ accountability (AD=42.7%; 95% CI: 39.2-46.2). Challenges included limited accountability among members, low participation by certain stakeholders, gaps in representation, all of which constrained meaningful engagement.
CONCLUSIONS:
Strengthening HFGCs through targeted training and community sensitization improved stakeholder awareness and participation in two semi-rural districts in Tanzania. While substantial gains were observed, persistent challenges related to incentives, representation, and engagement of some stakeholder groups highlight the need for complementary strategies to sustain and deepen accountability at the facility level. District governments should promote education relating to the role of the HFGCs among key health-related stakeholders.
Health sector reforms in Tanzania initiated in the 1990s, prioritized inclusiveness by encouraging a variety of stakeholders to participate in promoting social accountability at the facility level. Thus, health facility governing committees (HFGCs), composed of various stakeholder groups, were introduced as a tool to facilitate this process. Despite over two decades of operation, stakeholders’ awareness and engagement has remained limited. This study assesses an intervention implemented to strengthen HFGCs by providing their members with training and community sensitization to raise awareness and encourage engagement, thereby enhancing social accountability.
METHODS:
A convergent mixed methods design was used. Post-intervention interviews conducted in 2025 captured the views of various stakeholders on changes changes on dimensions of accountability and stakeholder participation. Community-based surveys were also conducted in 2022 (pre-intervention) and 2025 (post-intervention). The qualitative data were analyzed thematically, and the quantitative data estimated absolute differences (AD) using a generalized linear regression model.
RESULTS:
The intervention strengthened the HFGC members’ accountability and increased stakeholder awareness of and participation. The greatest improvements were observed among facility users, facility in-charges, and local government leaders. Survey results showed statistically significant gains across most outcomes in both crude and adjusted models. Largest gains were seen in community support (AD=24.3; 95% CI: 20.6-28.0) and HFGC members´ accountability (AD=42.7%; 95% CI: 39.2-46.2). Challenges included limited accountability among members, low participation by certain stakeholders, gaps in representation, all of which constrained meaningful engagement.
CONCLUSIONS:
Strengthening HFGCs through targeted training and community sensitization improved stakeholder awareness and participation in two semi-rural districts in Tanzania. While substantial gains were observed, persistent challenges related to incentives, representation, and engagement of some stakeholder groups highlight the need for complementary strategies to sustain and deepen accountability at the facility level. District governments should promote education relating to the role of the HFGCs among key health-related stakeholders.
| eISSN: | 2654-1459 |
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