MANAGEMENT AND HEALTH-CARE REFORM IN SUB-SAHARAN AFRICA

Recent discussions of health care reform in sub-Saharan Africa have ce ntred on the potential of alternatives to public financing and provisi on of health care to address efficiency and resource weaknesses. This paper informs these discussions by reporting an overview of the findin gs of a detailed evaluation of the efficiency and quality of public an d non government primary level health services in Tanzania, a sub-Saha ran leader in health policy development since the 1960s and used here as an exemplar country for the region. The paper discusses the managem ent actions necessary to address the performance weaknesses identified and considers the possible contribution alternative financing strateg ies might make in addressing the weaknesses. However, financing reform s will not by themselves address the performance failures; health care reform packages must allow for financing, organizational and manageme nt development.