MONEY IS THERE BUT WE ARE DYING BECAUSE IT GETS STOLEN.

WHO IS STEALING OUR MONEY?

Documenting Voices from Tanzanian Rural Communities
Respicius Damian Shumbusho
This study was conducted by
Respicius Damian Shumbusho
from the department of Political
Science
and
Public
Administration,
University
of
Dar
L
es Salaam, Tanzania.
The original research was a communitymapping study conducted as part of designing
a PhD project on Community-Empowerment
and
Community-Based
Financial
Accountability in Rural Healthcare. It was
conducted to develop a strategy for analyzing
community-based healthcare interventions in
the context of Tanzania and verify anecdotal
claims that there are wider spread leakage of
money allocated for community healthcare,
especially in rural communities. The study was
financed through a fellowship funding from
the Consortium for Advanced Research
Training in Africa (CARTA).
The findings of the whole project will be
availed by the University of Dar es Salaam
upon completion and copyright clearance or
accessing related conference papers and
publications directly from the author through
his email: shumbusho35@gmail.com

Open Mind Tanzania (OMT)

POLICY BRIEF
APRIL 2015

INTRODUCTION
Tanzania is one of the countries that have demonstrated higher commitment to
healthcare financing in Africa. As part of commitment to the call of the international
community to prioritize healthcare and increase allocation of resources to healthcare
up to 15 percent of the total government budget, funding healthcare has increased
from 10% in 2000, 17% in 2006, then dropped to 13.8% in 2013. Community health
financing initiative expanded coverage from 2.0% to 7.3% of the total population
between 2001 and 2012. Donors and DPs contribution to healthcare increased from
27.1% reaching a climax of 44.1% in 2006, then 39.6% of the total funding in 2011. In
2011, the World Health Organization (WHO) report on the Abuja Declaration ranked
Tanzania among countries with good progress (others being Guinea, Togo, Rwanda,
and Malawi) maintaining average financing closer to the international threshold.
While these progress in health financing were being appreciated, anecdotal evidence
from scholars, donors, as well as the government report misuse of resources allocated
for community healthcare as a critical challenge. In addition, some empirical studies
reported that leakages, use of money for reasons that are not directly connected with
improvement of health outcomes, and general lack of financial accountability was more
critical among the rural communities posing a threat to health financing commitment
by the government and development partners. However, such claims are hardly
verified if there are no empirical evidences from the rural communities regarding the
misuse of money allocated for healthcare and what they do to prevent such misuse and
ensure financial accountability.

RESEARCH QUESTION
The study sought to explore and document
experiences of the rural communities regarding
misuse of resources allocated for community
healthcare. The focus was on understanding a
sense of identity as a healthcare community,
existence of misuse of funds, and what
communities do to prevent misuse of money if
so far such a sense and complaints of misuses
exist.
METHODS USED
Data collection in two villages from each of
the two rural districts, Karagwe and
Morogoro from May 2014 to January 2015.
A semi structured qualitative survey
questionnaire with 388 respondents aged 18
at household level (equal male & females)
4 FGDs with community representatives and
Interviews with 50 key informants.
Interpretive Content Analysis supported by
statistical analysis of proportions.

KEY FINDINGS
COMMUNITY AND ITS SENSE
The sense of a health community differed from one geographical area
to another depending on existence of overarching shared health financial
accountability, access to, and quality of services concerns.
A village was a default marker of common identification. However,
sharing a primary healthcare facility by villages made them feel a single
community while economic gap among close households within in a
village made members identify each other not as a single community.
Therefore, a sense of community identity was found intricate due to
mismatch between the political administrative structure (village) and
sharing a primary healthcare unit (dispensary) to which shared concerns
are attached. Thus, a sense of community exist at village level, but may
dynamically shift due to income inequalities in a population or lack of
something to share regarding healthcare problems and expectations.
MISUSE OF FINANCE
In all the four communities, respondents (88.42%) believed that money
allocated for healthcare does not reach the end beneficiaries. 58.22%
think money is stolen, 22.04% think it is not enough, 16.15% believe it is
used for other services, while 3.59% do not know where money is going.

There is a general mistrust of officials who are entrusted with functions related to management of finance for ensuring delivery
of quality services. Only 39.05% have trust that Village Executive Officers (VEOs) likely to manage money records diligently and
present correct information to them regarding incomes and expenditures on healthcare. Only 10.57% believe community
representatives in health committees are there to protect interests of communities. The majority think VEOs are likely to
present to them information that is not correct and community representatives and community leaders are also accomplices
of the VEOs.
While there are dominant worries that money allocated for healthcare is at risk of being stolen, evidence of causes related to
stealing money were missing. Such worries were based on the general experiences that VEOs incomes appear to raise when
there are projects such as constructing dispensaries. In 2 of the 4 villages buying new properties such as motorcycles, land,
houses, and cattle was attributed to the use of money allocated for health (and education) projects. The other reason used
was that, VEOs and watu wao (their closest people) become bitter when people demand income and expenditure reports.

ACTIONS TO PREVENT MISUSE OF MONEY

Given the fact that community members are largely concerned about management of money for healthcare, they feel that
appropriate steps should be taken to prevent misuse of money. The majority, 52.12% think officials and health facility managers
who steal money should be terminated from their job, 35.06 thought they would be dealt with using traditional beliefs such as
cursing, 8.32% had view that such officials should be taken to court of law, while 4.5% thought nothing can be done against
them.
On side of community representatives, leaders, and organized community groups, it was cautioned that dealing with someone
who is in authority including VEOs, health facility managers, or health professionals was dangerous for any actor (including
NGOs, representatives, and average persons) as if such a person decides to deal you back your life may be in danger.

LESSONS
Anecdotes regarding misuse of money allocated for healthcare are wide spread in all the studied communities (which is likely
to be a case), but justification of such claims need evidences beyond doubt, which are hardly available for an average member
of a rural community given the communities social organization, civic competency level, and cultural norms. It is learnt that
unlike urban communities, in rural communities there are virtues where community actors are likely to opt remaining silent
even if collective wellbeing is at threat in order to protect the personality of those in authority. As a result, keeping silent even
where one knows that individuals in authority are embezzling resources of the community becomes the best option.

POLICY RECOMMENDATIONS
Recommendations to the Government of the United Republic of Tanzania
The study findings reveal that improving community-based governance of healthcare in general and healthcare financing needs
to be preceded with harmonization of community health governance structures with the general administrative structure of
the country. The study has revealed that the sense of collective identity as a community exists at village level. Thus, it is
imperative that each village should have its primary healthcare unit facility. This will stimulate a sense of conscious ownership
by community and responsibility of community representatives in financial oversight committees.
The government should review the guidelines that guide formulation, membership, and operations of Health Facility
Governance Committees so as to rationalize and ensure fair inclusion and empower community representatives to demand
information from officials and service providers on regular intervals.
Extensive awareness campaigns and capacity building interventions aimed at enhancing participation of an average rural
community member in prioritizing, planning, and monitoring of funds is needed prior to building capacity of the
representatives. Representatives feel empowered if communities place pressures on them to demand accountability.
Officers who are custodian of information as well as health services providers should be mandatorily required to publish
financial reports and feedback on regular intervals. This will give community members basis of demanding information.
Decentralization of auditing to the village level is important. Each district council should be required to conduct timed audits
on community projects.
Recommendations for Health Policy Makers in Other Countries, Development Partners, and Healthcare Stakeholders
Donors and DPs should devise mechanisms for ensuring that NGOs and CSOs are primarily accountable to communities and
play role of simplifying information so that it can be understood by an average community member.
Emphasis on investment in community healthcare should be twined with investment in community empowerment initiatives.
The design of community-based financial accountability for rural communities should pay special attention to the rural
context.
Recommended Citation: Shumbusho, R.D (2015), Money is There, but we are Dying because it Gets Stolen. Who is Stealing our Money?
Documenting Voices from Tanzanian Rural Communities, OMT Policy Brief, Dar es Salaam: Open Mind Tanzania