The interplay between the state and non-state actors in healthcare provision in Tanzania, 1960s–2020s
Discoursing the sweat in the midst of sweet
Bibliographic Data
| ID | 22204359 |
|---|---|
| Authors | Shakila Halifan Mteti (0000-0003-1737-4423, University of Dar es Salaam, corresponding author), Chakupewa Joseph Mpambije (0000-0001-9906-8301, University of Dar es Salaam) |
| Year | 2026 |
| Volume | 13 |
| Pages | 102510 |
| Publication date | 2026-06-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Social Sciences & Humanities Open (JOURNAL) |
| Journal identifiers | ISSN: 2590-2911 • E-ISSN: 2590-2911 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.ssaho.2026.102510 |
| OpenAlex | W7127089789 |
| Language | EN |
| References cited | 23 |
Provision of affordable, quality healthcare has been a central priority of the Tanzanian state, and this has been pursued in part through public–private partnerships (PPPs).While PPPs are often framed as complementary arrangements, their implementation over six decades reveals shifting relationships between state and non-state service providers. This study examines historical constraints in Tanzania's health sector from the 1960s to the 2020s using a framework that views complementation and competition as a policy-mediated spectrum shaped by governance, financing, and professional jurisdiction. Qualitative data were collected through interviews with 72 participants from five District-Designated Hospitals (DDHs) in Iringa, Morogoro, Singida, Lindi, and Tanga regions, including current and retired officials, CHMT members, and local elders. Further information was collected form archival and secondary sources. Findings show that PPPs initially fostered complementarity through shared service provision and role differentiation. Over time, however, weaknesses in governance coordination, fragmented financing, and contested professional jurisdiction shifted relationships toward competition. These tensions culminated in in reduced government support, disputes over user fees and exemptions, complaints about service quality and affordability, and institutional frustrations with inconsistent regulation. Policy reforms and fiscal pressures further reconfigured incentives and power relations, producing cyclical movements between collaboration and contestation. Despite these constraints, DDHs achieved modest improvements in service delivery, with some transitioning to voluntary health agency models to sustain service provision. By situating the Tanzania's PPP experience within a dynamic complementation–competition framework, this study highlights the conditions under which PPPs succeed or falter. The findings underscore the need for coherent governance, aligned financing, and negotiated professional roles to stabilize complementarities and enhance the long-term effectiveness of PPPs in low-income health systems
Health care · Pandemic · Public health · Global Maternal and Child Health · Healthcare Systems and Reforms · Social and Economic Development in India
Public–private partnerships
Neoliberalism, state intervention and the quest for public-private partnerships in Tanzanian Healthcare
Public–private partnerships in practice
Historical Institutionalism in Comparative Politics
The Iron Cage Revisited
Increasing Returns, Path Dependence, and the Study of Politics
Analyzing the decentralization of health systems in developing countries
| Citation velocity | historical |
|---|---|
| Highly cited | No |