Title
Health services at the district level in Tanzania. Services through-put and resource levels: the gap between expectations and performance

Abstract
This thesis reviewed the performance of District Health Care Services in the Muheza District, Tanzania. The objective was to appraise the performance of District Health Services with regard to service throughput and the intended health outcomes as well as contributing research information to the health sector reform process currently underway in Tanzania and other countries with similar background. The effectiveness analysis approach was used to review structural, process, and some health outcome aspects of the existing District Health Services.

The thesis consists of six chapters. The first chapter provides the background for the study and framework of analysis. The issues discussed in chapter one are complemented by a literature review in Chapter 2, which focuses on the evolution of the concept of "Health District" within Primary Health Care. The context and complexities of effectiveness analysis and measurement are also described. Chapter 3 describes in detail the Heath Care System in Tanzania providing the context in which the study findings should be interpreted and understood. The fourth chapter describes the evaluation methods used in this study and their justifications. Sampling procedure and study area are also described in this chapter. Chapter 5 presents the study findings on the basis of organization of data gathered. The first part presents the findings on structural aspects of DHS including facilities and personnel allocation within the district. The second part presents the findings on process aspects of DHS including service provision and utilization. Part two also include findings on the effectiveness of DHS on malaria. The third part of chapter 5 presents the findings on outcome aspects of DHS. The results include the data on malaria, verbal autopsy questionnaire results and selected health status indicators (maternal mortality, infant mortality, and child mortality). Each of the three parts in chapter 5 form an integral element of the DHS effectiveness assessment in this study. The last chapter (6) summarises the issues discussed in the thesis and presents same implications of the study findings and conclusions.

Supervisor(s)
Ib C. Bygbjerg, Department of International Health, Institute of Public Health, University of Copenhagen
Allan Krasnik, Institute of Public Health, University of Copenhagen

Correspondence