Midline evaluation of the Tanzania public sector system strengthening program : final report

Abstract

Th e Public Sector System Strengthening (PS3) project, funded by the United States Agency for International

Development (USAID), supports the Government of Tanzania (GOT) in strengthening the public-sector

system to promote the delivery, quality and use of public services. Th is report presents the fi ndings of a

midline performance evaluation of PS3 conducted by MEASURE Evaluation which examined time trends

and pre- and post-program inception changes in the uptake of health services as well as in fi nancial and

human resources indicators in PS3 regions and in other regions of the country. Th e evaluation also used

qualitative methods to examine the perceptions from program implementers, community members, and

other stakeholders about the adoption and performance of the PS3 intervention, its strengths and remaining

challenges, and the stakeholders? recommendations on ways to address those challenges.

PS3 works across national, regional, and local government levels. Th e implementation strategy seeks to

strengthen each of the fi ve component areas, while working across all sectors and levels of public governance.

Th e expectation is that strengthening systems at all levels will result in improved service delivery at the lowest

level?the service provider?which will lead to higher public service utilization by the population and better

health outcomes. At the national level, emphasis is placed on providing support for key policies and strategies

as well as strengthening the national system to foster improvements in service delivery at lower government

levels. At the regional and LGA levels, the PS3 program facilitates the understanding and implementation

of national policies and guidelines as well as providing targeted assistance to improve the management and

strengthening of systems and resources.

Th is midline evaluation undertook an outcome evaluation to understand how system-level indicators related

to human resources, fi nancial resources, and health service utilization changed over time in PS3 and in

other (non-PS3) regions of the country. Data from national routine information systems formed the basis for

quantitative measurements. Adapted diff erence-in-diff erences models were used to examine time trends before

PS3 and during the time PS3 has been active, changes in those trends, and to examine diff erences between PS3

regions and other regions of the country. Potential diff erences between Phase 1 and Phase 2 PS3 LGAs were

also examined. In addition, qualitative methods provided a more in-depth understanding of the performance

of the PS3 intervention in human resources, fi nance, and system strengthening, captured unintended, indirect

eff ects of the intervention, illuminated the process of change, and examined the quality and character of

the intervention implementation. Th e qualitative component also captured the stakeholders? perceptions of

pending challenges in system functioning and community engagement and their recommendations on how to

address them.

The fi ndings of this evaluation will contribute to USAID?s portfolio of projects focused on public-sector

strengthening while informing PS3?s continued program implementation. Th is evaluation was performed at

about the mid-point of PS3, three years after the project?s inception.