Promoting Evaluation Capacity Building in Tanzanian Public Health Organizations

Abstract

The need for evaluation capacity building (ECB) by the Ministry of Health, Community Development, Gender and Children (MOHCDGEC) in public health organizations in Tanzania has rapidly increased due to an increased need to engage Tanzanian health professionals at all levels in planning, designing, and implementing a comprehensive evaluation of public health policies and programs. Despite a growing interest by the Ministry of Health, there has been a challenge in how to strengthen evaluation capacity in these organizations. A fundamental question is: how can ECB be promoted in public health organizations (PHOs) in Tanzania to promote an evaluative culture? The purpose of this exploratory study is threefold. First, it intends to explore the current practice of evaluation in PHOs in Tanzania. Second, it explores the challenges and barriers that hinder evaluation capacity development in these organizations. Third, it seeks to determine the most useful and culturally relevant strategies that professionals can adopt to develop evaluation capacity and an evaluative culture specific to PHOs in Tanzania. This study attempts to answer the following research questions: (1) What are the current evaluation practices and efforts to engage in ECB in PHOs in Tanzania? (2) What are the current challenges and barriers that impede evaluation capacity development and strategies to overcome these challenges in PHOs in Tanzania? (3) What are the strategies and approaches to building evaluation capacity and promoting PHOs’ evaluative culture in Tanzania? This study adopted a social constructivism qualitative research method to understand the problem. Thirteen interviews were conducted among managers at both the regional and district municipal councils, representatives from MOHCDGEC, and officials at the President’s Office, Regional Administration, and Local Government (PO-RALG). The interviews were conducted in the Kiswahili language and later translated into English. The study employed thematic analysis to analyze data and generate themes and subthemes. The results of this study show that local staff (at the managerial and non-managerial levels) do most of the evaluation in these PHOs internally. Managers perform a lot of supervision, capacity building, and data quality assessment for staff at the non-managerial level. The findings show a more reasonable evaluation culture at the managerial level than at the non-managerial level. The Ministry of Health managers uses data for planning and decision-making more than non-managerial staff. Findings show a more positive evaluative culture among managers than at the non-managerial level. Despite the presence of an evaluative culture within PHOs, knowledge and skills to perform an evaluation to the fullest are lacking. Participants demonstrated the use of various ECB strategies; however, the most practical, efficient, and effective ones were on-the-job training (i.e., supportive supervision), and hands-on training. Furthermore, the results highlighted several barriers and challenges to the development of ECB, such as a lack of evaluation expertise to provide technical support, a shortage of staff, staff turnover, limited funding, and a lack of clear roles and responsibilities. Generally, this study reveals a high demand for ECB among PHO staff at all levels (managerial, non-managerial, and at the ministry level). The presence of barriers and challenges undermines efforts to develop and sustain ECB in these PHOs. This study supports the findings of other scholars who argue that to build and promote sustainable ECB in an organization, there must be visionary leaders, good communication, and incentives and motivations from the highest policy and management levels. Senior leaders should demonstrate the demand for, and the need for investment in ECB processes to improve the PHOs at all levels. It is important for leaders to be part of the process because they are the key stakeholders in decision-making, and they are the ones who allocate resources. Through the MOHCDGEC and other organizations, the government should consider legal and statutory policies and regulations when designing an evaluation system. This study recommends that managers should design comprehensive ECB activities that are rooted in evaluation approaches, theories, and frameworks to address the needs of the Ministry of Health, the public health system, and the people of Tanzania.