Weaknesses and strengths of the community health systems governing structures in Tanzania: A call for harmonisation

Introduction: Strong community health governance structures (CHGS) are essential for effective community health systems. In Tanzania, several governance structures exist at the village level; however, limited linkages between different structures have resulted in coordination challenges and fragmented efforts. We, therefore, conducted a study to explore stakeholders’ perspectives on the strengths and weaknesses of CHGS to inform future harmonisation efforts. Methods: An exploratory qualitative case study design was conducted in December 2021 in two selected regions of Tanzania. A total of 42 in-depth interviews were carried out with key stakeholders involved in community health governance, including members of Council Health Management Teams (CHMTs), health facility in-charges, chairpersons of Health Facility Governing Committees (HFGCs), Village and Ward Health Committees, district health system coordinators, and local government officials. Data were analysed using thematic analysis. Results: Key weaknesses identified included a lack of operational boundaries between committees, overlapping membership, inadequate financial support for committee operations, and a poor understanding of operational guidelines. Conversely, the existence of a defined committee structure and specified standards for operation were identified as strengths. Conclusion: Tanzania’s CHGS demonstrate several promising features; however, challenges such as overlapping memberships, unequal financial support, fragmented subcommittees, and inconsistent access to operational guidelines undermine their effectiveness. Addressing these gaps through harmonisation, equitable resource allocation, and targeted capacity-building is important to strengthen CHGS and enhance their responsiveness.