Dar es Salaam. A new study has revealed that civil society and citizens are often sidelined in decision-making processes under Tanzania’s Global Financing Facility (GFF), limiting accountability and inclusivity in shaping national health priorities.
The research found that global actors frequently influence which issues receive funding and whose voices are heard, raising concerns about equitable health outcomes.
The study, titled “Who is at the table and who has the power? Case study analysis of decision-making processes for the Global Financing Facility (GFF) in Tanzania”, was published in Global Health Action. It is the first power analysis of its kind in the country, examining how funding decisions are made, whose interests are prioritised, and the implications for strengthening services for mothers, children, and adolescents.
Speaking to The Citizen, Dr Donat Shamba, lead researcher at the Ifakara Health Institute (IHI), said the study sought to unpack the power dynamics surrounding the development of Tanzania’s GFF planning documents.
“The key takeaway from the study shows that the GFF mechanism enabled efficient planning for reproductive, maternal, newborn, child, and adolescent health services,” he said.
“However, going forward, a focus on holistic systems and inclusive involvement of all stakeholders from the start is required. Intentional attention to power dynamics is needed to challenge the status quo.”
Launched in July 2015, the GFF is a global partnership that aligns financing for reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N). It provides countries, including Tanzania, with funding, technical guidance, and performance-based incentives to strengthen health services.
The study was co-authored by IHI research scientists Jitihada Baraka and Georgina Msemo, alongside collaborators from South Africa and the United Kingdom.
It describes Tanzania’s GFF mechanism as a complex interplay of government leadership, stakeholder engagement, and global policymaking influences in women’s and children’s health.
Ms Baraka noted that while national priorities are respected, decision-making power remains uneven.
“Government authorities hold visible power, while the World Bank and development partners wield substantial influence at the global level because of their financial contributions and technical expertise,” she explained.
The study also found that vulnerable populations, including adolescents and marginalised groups, were often excluded from priority setting.
While the GFF is designed to be inclusive, civil society participation was described as low and largely powerless. Critical issues such as stillbirths were only indirectly considered, while adolescent health received minimal attention.
Despite these challenges, the research noted improvements over time. It highlighted a shift from a closed, consultant-driven approach in the first round of GFF investment planning to more inclusive mechanisms in the second round.
This, the authors argue, broadened participation, strengthening both the legitimacy and effectiveness of the GFF process.
The researchers emphasised the need for stronger dialogue platforms and feedback mechanisms to ensure that citizens—the intended beneficiaries—have a meaningful say in decisions.
They concluded that while the GFF has the potential to support Tanzania’s health goals, achieving balance between donor influence, government leadership, and community participation will be key to improving maternal, newborn, child, and adolescent health outcomes.
The Tanzania case highlights that while the GFF’s country-led model can align with national strategies, there is further room to improve the meaningful inclusion of civil society, communities, and marginalised groups, building on the progress made.
“Policymakers should invest in strengthening inclusive engagement platforms – especially for underserved groups – throughout the investment case and PAD development, ensuring transparency and feedback loops,” it stated.
According to the study, safeguards are needed to ensure domestic priorities are not overshadowed by donor agendas, while embedding adaptive learning across funding phases to strengthen ownership, accountability, and equity in RMNCAH-N outcomes.
It emphasises that future policy design should also balance performance-based financing with investments in systems components to deliver on longer term goals. They should also explicitly include targets and funding lines for vulnerable groups and high burden issues, such as stillbirth and adolescents.
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