Intervening to address constraints through health sector reforms in Tanzania: some gains and the unfinished business

This paper describes two projects designed to address health sector constraints. The Community Health Fund attempts to create a community-owned and community-managed prepayment scheme. Although membership growth has been disappointing, substantial funds have been mobilized and the scheme replicated in nine additional districts. The Dar Urban Health Project aimed to improve various dimensions of health service quality, and provides a model which can be replicated elsewhere. The two cases concentrated largely on relaxing constraints related to the availability of inputs, while leaving unresolved macrolevel general infrastructural and policy-related constraints. This omission partly explains the limited gains in relaxing constraints at the input level.