Improving Health Services for Lindi Citizens – Transparency and Accountability (TAP) in Tanzania


Save the Children Tanzania

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Basic Project Information

Save the Children Tanzania sought to improve the effectiveness of health service delivery by gathering citizen perceptions and monitoring the quality of maternal, newborn, and child health services.


Project Summary


Improve the effectiveness of public spending and health service delivery in order to improve the lives of marginalized groups

  • Increase community participation and capacity to advocate for improved resource allocation and service delivery
  • Improve government budget allocation and utilization in the health sector


Save the Children Tanzania sought to monitor and improve the quality of maternal, newborn, and child health (MNCH) services by training and empowering community members to design and implement Community Score Cards (CSCs). After an initial period of awareness-raising in target communities, Save the Children selected and trained ward-level community members in the CSC methodology, designating these individuals as “trainers of trainers”. Trainers then mobilized communities to select representatives in each ward to gather community views regarding health service delivery. Through focus group discussions, participants discussed the key issues affecting their access to health services, which were then generated into a matrix and scored. In parallel, health facility workers in each ward completed self-assessment scorecards to evaluate their own performance in delivering health services. Both scorecards revealed similar trends related to poor health service delivery, including: lack of qualified health workers in health facilities, medicine stock-outs, and distances to health centers. Finally, Save the Children staff organized interface meetings between health facility staff members, community leaders, District Medical Officers, and Community Health Management Teams (CHMTs) in each district to discuss the key problems identified during the CSC process. Meeting participants produced recommendations and action points for improving health service delivery.

Use of Information Communication Technology



90 participants across 9 wards took part in the scoring process

Target Population

Marginalized groups, especially children under five, pregnant women, and lactating mothers

Results Methodology

Self-reported results

Indicators Used

  • Percent of the budget allocated to MNCH at the district level
  • Number of people utilizing health services
  • Number of community members trained on health budgeting process

Reported Results

  • Increased utilization of health services:
    • A total of 114,154 children under age 5 attended health services in both districts in 2013, as compared to 36,856 in 2012
    • A total of 11,102 women delivered at health facilities in both districts in 2013, as compared to 11,079 in 2012
  • 63 community members trained on health budgeting process
  • Increased transparency and communication between CHMT members and communities
  • Increased citizen empowerment and understanding of their entitlements in regard to MNCH
  • Improved infrastructure – communities mobilized to construct post-delivery rest rooms in two villages
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