In a move intended to empower the citizens and give them mandate to decide on their own development priorities, the government adopted the decentralization policy.
One of the key values of decentralization is embedded in the development planning process. The policy allows citizens to prioritize their development ambitions as an initial stage and basis for execution of social service delivery interventions reflecting what community desires.
This is in contrast with the past. Through the former monopolistic planning process, it was a few government bureaucrats somewhere in the corridors of power who were bestowed with the mandate to decide for the majority. From their air conditioned office rooms mostly located in urban areas, the government technocrats had the powers to draw up a list of social service projects to be implemented in the remote rural areas where the majority live.
As the consequence of this, most such up-bottom projects failed to yield satisfactory impact in overcoming the immediate peoples’ development challenges. For failure to reflect people’s desires, such projects were viewed as unimportant and hence the negative perception among respective communities in sustaining them.
With the new policy in place, the role of central government now remains funding community driven development initiatives. Through respective local government authorities people contribute the locally available materials and human resources.
People are obliged to identify opportunities and obstacles to their development and take the reins of power in deciding, initiating and implementing prioritized development projects. The major role of the government is to provide funds and expertise.
But years on since inception, decentralization policy in one of the villages of Bunda District, Mara region, is more said than done. The illusive pledge by the central government to provide the funds is blamed for derailed execution of a health facility construction project for well over four solid years.
Local leaders in Kinyambwiga village have a feeling that what was meant for enforcing inclusion, efficiency and effectiveness in enforcing community driven project outcomes has increasingly become a sheer political charade.
The village endorsed the construction of a health facility as their priority number one since 2009 but funds for execution of the envisaged project have not yet been disbursed. Due to exposure to harsh weathers, even the local materials that were collected by the villagers to supplement the government support were now rotting along the proposed construction site.
David Magesa, Kinyambwiga village acting executive officer pointing at bricks damaged from exposure to harsh weathers. The bricks were among the local building materials collected by residents in support of construction of a health facility.
Residents of Kinyambwiga, one of the remotest and densely populated villages in Guta ward in Bunda District, proposed the construction of a health facility. The motive behind was to relieve expectant mothers the burden of walking nearly 14 kilometres in search of antenatal health care.
More than 16,000 people across the six villages in Guta ward compete over access to inadequate health services provided at the only government health facility in the area. The facility is already overwhelmed by poor infrastructures, understaffing and lack of various medical consumables including medicines.
Guta ward councilor Mr Mwita Manyerwa said the construction of a health facility was always on top of all development priorities during the past four consecutive years. He said residents of Kinyambwiga considered the plight of women and children in accessing health services to be their immediate development concern.
Highly motivated, the residents could not hesitate to contribute whatever local resources they could afford with anticipation to see mothers and children relieved of the poor health services burden. However, the central government failure to disburse the project funds has now remained their major bottleneck, almost forever.
Mr Manyerwa said it was anticipated that the construction of a health facility would cost about TSH 40ml. Another sum of 35ml was budgeted for construction of a residential structure for the facility’s prospective health workers.
“For more than four years now the development aspirations of the people in Kinyambwiga have remained sheer illusions. Women and children continue to suffer the consequence of walking long distance and unsatisfactory healthcare at the only available health unit at Guta” said the councilor.
The councilor said among those who contributed to the ghost construction of a health facility in Kinyambwiga is the Cabinet Minister, also area Member of Parliament Stephen Wasira. The councilor said Mr Wasira donated about Tsh 2ml as part of the Constituency Development Fund (CDF) and which was spent for purchasing aggregates.
Lucy Charles is a Senior Nurse in Charge at Guta Dispensary. She said the only health facility in place has to suspend routine services for other patients in order to attend expectant women and children during designated antenatal clinic sessions. It was a result of staff shortage amid huge population of clients demanding health services.
Lucy said normally women have to wait since early morning hours to late evening before they have got to be attended by a few available medical staff. This is far more contrary to existing healthcare policies which stipulate that any expectant woman has to be attended within 30 minutes after arrival to a health facility. The facility has 6 health workers and a watchman.
Kinyambwiga village executive officer Mr David Magesa believes that efforts by Kinyambwiga residents to spare off this predicament were frustrated by the government’s failure to heed to its pledges regarding the disbursement of funds for execution of the envisaged project.
Mr Magesa said the people’s willingness to contribute local resources is a clear manifestation that they wanted to have healthcare services at the nearest destination possible. But also to spare themselves of huge costs incurred when they had to send patients to Guta Dispensary and especially expectant women with unexpected pregnancy complications.
One has to part with between 4000 or 5000 for transport costs when an expectant woman relative develops complications necessitating care by skilled medical staff at Guta Dispensary, about 14 kilometres away. He said.
But Lucy says things were not all that smooth when expectant women arrive at Guta Dispensary. The health facility has no electricity. This is despite conventional power lines passing hardly 100 metres from the facility premises. Instead, kerosene lamps serve as source of light especially for night deliveries.
Lucy recalls an incident during which she asked a male night watchman‘s to use his beam torch for producing some light as she assisted an expectant woman to deliver. The nurse was primarily depending on the light from the lamp which went off abruptly after running short of kerosene. The option to ask the watchman to go and buy some kerosene from nearby kiosks was quite unlikely since it was late midnight and all of them had already closed.
The presence of a watchman in a labour room was not only ridiculous but also restricted as pertains to expanded quality of health care standards regarding respect and dignity to expectant women during delivery. According to standards that was unnecessary and humiliating procedure.
Bunda District Council Chairperson Mr Joseph Malimbe said the stalled construction of Kinyambwiga health facility results from the central government’s limited financial capacity to fund all proposed projects in good time. He said this was also the same reason for a health facility in Guta ward which had no electricity and yet the power line passes in the stone throw from the facility premises.
Poor healthcare infrastructure including uneven distribution of health facilities are among the causative factors for expectant women delivering under care by traditional birth attendants and hence high maternal mortality and morbidity.
Statistics indicate that only 37 percent of expectant women in Mara region delivered in facilities between 2005 and 2010, slightly above 36 percent of Rukwa across Tanzania Mainland and 32 percent in Zanzibar respectively.
The fourth Millennium Development Goal (MDG) target is to reduce to maternal mortality to at least 133 deaths out of 100,000 births by 2015. But according to prevailing circumstances, Tanzania will not be able to meet this target, having only managed to reduce maternal deaths from 578 to 454 over the past ten years. It is argued that if in ten years Tanzania has only been able to cut down its maternal mortality rate by 124 deaths, it won’t be able to cut down 321 deaths to meet the MDG target in less than two years remaining.
However, with the Bunda District village case in mind, the major question revolves around why insisting people to prioritize their development ambitions if very least attention is given to their priorities?