Changing Policies and Their Influence on Government Health Workers in Tanzania, 1967-2009: Perspectives from Rural Mbulu District

Abstract

Tanzania has experienced fundamental policy shifts during last forty to fifty years. This included experimentation with reforms based on socialism and neoliberalism, and involved powerful actors. Julius K. Nyerere, president of Tanzania from 1964 to 1985, was most influential individual with his development model Socialism or Ujamaa. In addition to Tanzanian government, World Bank, International Monetary Fund (IMF), and multi- and bi-lateral donor agencies have played prominent roles in formation of Tanzanian policies.The public health services have been one of main targets for policy and structural reforms, and staff on ground have had to cope with new measures under changing regimes. Historian Ann Beck, who did extensive research on development of biomedical services in East Africa from colonial times until 1970,1 argued that [s]ome of problems ... which later caused much frustration and harassment to medical officers in twentieth century were present at very beginning ... of British medical services in East Africa [the 1890s] ... Money was scarce ... [and] actual working conditions did not resemble Utopian plans.2 The history of African biomedical doctors in East Africa was published in collective biography East African Doctors: A History of Modern Profession after extensive research by historian John Iliffe. He argued that and state are in large measure symbiotic and that the weakening of state in face of population growth, economic crisis, [and] commersialisation, ... damaged power and status of East African doctors after independence.3 In ethnographic study in 2008 of a district hospital outside Arusha town, anthropologist Noelle Sullivan discussed development of Tanzanian health sector from colonial times, and hospital from 1968, until present.4 When arguing that an overarching continuity in history of biomedical institutions and professions in Tanzania has been considerable gap between ideals outlined in policy and realities of daily practice and interdependence between medical professionals and state, Sullivan followed up on reflections made by Beck and Iliffe.5Tanzanian government health worker perspectives were prominent in Iliffe' s and Sullivan's research. However, based on scarce written contemporary sources Iliffe found it hard to assess doctors'- predominantly male and urban based- reactions to socialist regime from 1967. He argued that few were dedicated and more were ambivalent. He also argued that protest and strikes by doctors from 1990 until 1992 accelerated change. Iliffe' s study ended in 1997, when health system was still in adjustment process to neoliberalism.6 Interviewees in Sullivan's study had negative memories of socialist period. However, earliest work experience was from 1977. Sullivan argued that hospital workers' performance as professionals was undermined due to lack of resources until late 1990s, when implementation of health sector reform improved hospital infrastructure considerably.7This article explores public health services in Tanzania mainland from 1967 to 2009 from a health worker perspective in order to further examine these issues.8 We address questions as to how shifting policies influenced government health workers in their daily work and how they perceived and responded to policies. Retrospective views from rural Mbulu District challenged perceptions in Iliffe' s and Sullivan's studies on some major policies and reforms that influenced government health workers. Interviewees in this study perceived working conditions in 1970s and after 2000 as better in comparison to other periods during years 1967-2009. This is probably due to implementation of policies during both periods aiming at providing health services to majority of population. …

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