Improving Access to Health Services Through Decentralised Decision-Making: Insights from Makambako Town Council, Tanzania

This study assessed the influence of decentralised decision-making on accessibility to health services within the framework of Tanzania’s health sector reforms, a case study of Makambako Town Council. Using Bossert’s decision-making space theory, the study assessed varying levels of decision-making in a context where PEPFAR-HIV/AIDS interventions are implemented. Quantitative data were collected from 503 household surveys, and qualitative data were gathered through focus group discussions, interviews, and documentary reviews. The study applied descriptive statistics and binary logistic regression for quantitative data and thematic analysis for qualitative data. The findings reveal that decision-making aspects, such as prioritising community needs, utilising facility funds, and procurement, are less frequently practised, indicating a narrow decision-making space. Regression results demonstrated a significant relationship between wide decision-making and improved health service accessibility (OR = 5.84, p < .001). The study recommends enhancing community participation frameworks, expanding administrative discretion, and conducting comparative studies to inform future reforms.