Fiscal Decentralisation and Public Health Service Delivery Outcomes: Evidences from Igunga and Kaliua Local Government Authorities in Tanzania

Rural local government authorities (LGAs) in Tanzania are facing challenges in Health Service Delivery characterized with low financing, uneven distribution of skilled medical professionals and high turnover, limiting the responsiveness and quality of healthcare available to the rural populations. In response to this, the study investigated the influence of Fiscal Decentralisation (FD) on Public Health Service Delivery (PHSD) outcomes in two LGAs of Tabora region. The study employed a mixed-methods approach with an analytical cross-sectional design. Quantitative data was collected from 385 health service users selected via multistage sampling and proportionately distributed between study LGAs for survey, while qualitative data was collected from ten interviews with Council Health Management Team (CHMT) members and two Heads of Planning and Coordination Divisions. Quantitative data were analysed using a Linear Mixed Model (LMM), Simple Linear Regression (SLR) followed by the analysis of variance (ANOVA). The findings reveal that FD has a positive significant influence (χ² = 25.72, p < 0.001) on PHSD outcomes in Igunga and Kaliua LGAs, with notable variation between wards. Locally generated revenue emerged as the most significant determinant, accounting for 35.2% of service delivery variation. ANOVA results confirm disparities in both locally generated revenue and PHSD performance across locations. While FD via local revenue boosts PHSD outcomes, differences in resources allocation and limitations in administrative capacity reduce its effectiveness. The study recommends for capacity-building strategies, improved local revenue generation, equitable resources allocation, and provision of incentives for health workforce retention to maximise FD’s impact on PHSD outcomes in Tanzania.