Tokenism or Empowerment? Exploring the Decision Space of Primary Health Governing Structures in Tanzania’s Cholera Response
1
Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
ABSTRACT:
Decentralization of power to local communities was introduced in Tanzania to promote inclusive decision-making and equitable access to health services. Within the health system, this is operationalized through community-based governing committees that facilitate local participation in planning and resource mobilization, thereby strengthening system responsiveness and resilience. However, limited evidence exists on the extent of their decision-making space, particularly in addressing public health emergencies that disproportionately affect vulnerable populations, such as cholera outbreaks. This study explored the decision space of primary health governance committees in planning and mobilizing resources for cholera prevention in Korogwe Town Council, Tanga Region, with particular attention to equity, inclusion, and health system resilience. An exploratory case study design was employed in February 2025. Data were collected through 26 in-depth interviews and one focus group discussion with members and leaders of key primary health governance structures, including Council Health Management Team (CHMT) members, Health Facility Governing Committees (HFGCs), Village health committee members, and health facility in-charges. Thematic analysis was used to identify recurring patterns and key themes. The findings revealed several barriers to meaningful and equitable community participation, including low commitment among committee members, tokenistic engagement, limited understanding of roles and responsibilities, and inadequate opportunities for capacity building. These constraints weakened committees' ability to plan and mobilize resources for cholera prevention, particularly in underserved communities. In contrast, strong stakeholder collaboration, well-defined governance structures, and formal guidelines facilitated participation and supported more inclusive decision-making processes. Overall, primary health governance structures have significant potential to promote equity, inclusion, and resilience in health systems when responding to local public health issues, such as cholera. Enhancing these structures through better membership selection, targeted capacity-building efforts, and ongoing institutional support is essential to foster effective community-led governance and improve preparedness and response for future outbreaks.
Decentralization of power to local communities was introduced in Tanzania to promote inclusive decision-making and equitable access to health services. Within the health system, this is operationalized through community-based governing committees that facilitate local participation in planning and resource mobilization, thereby strengthening system responsiveness and resilience. However, limited evidence exists on the extent of their decision-making space, particularly in addressing public health emergencies that disproportionately affect vulnerable populations, such as cholera outbreaks. This study explored the decision space of primary health governance committees in planning and mobilizing resources for cholera prevention in Korogwe Town Council, Tanga Region, with particular attention to equity, inclusion, and health system resilience. An exploratory case study design was employed in February 2025. Data were collected through 26 in-depth interviews and one focus group discussion with members and leaders of key primary health governance structures, including Council Health Management Team (CHMT) members, Health Facility Governing Committees (HFGCs), Village health committee members, and health facility in-charges. Thematic analysis was used to identify recurring patterns and key themes. The findings revealed several barriers to meaningful and equitable community participation, including low commitment among committee members, tokenistic engagement, limited understanding of roles and responsibilities, and inadequate opportunities for capacity building. These constraints weakened committees' ability to plan and mobilize resources for cholera prevention, particularly in underserved communities. In contrast, strong stakeholder collaboration, well-defined governance structures, and formal guidelines facilitated participation and supported more inclusive decision-making processes. Overall, primary health governance structures have significant potential to promote equity, inclusion, and resilience in health systems when responding to local public health issues, such as cholera. Enhancing these structures through better membership selection, targeted capacity-building efforts, and ongoing institutional support is essential to foster effective community-led governance and improve preparedness and response for future outbreaks.
| eISSN: | 2654-1459 |
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