Neoliberalism, state intervention and the quest for public-private partnerships in Tanzanian Healthcare: A historical discourse analysis, 1960s–2020s

After gaining independence in 1961, Tanzania faced challenges in improving health services due to limited funds, a weak health system, and a growing population. To address this, public–private partnerships (PPPs) were introduced, converting many faith-based organisation (FBO) hospitals into district-designated hospitals (DDHs). Although this approach has been widely discussed, scholars remain uncertain if it has fully achieved its intended goals. Based on a historical analysis using qualitative data particularly oral and archival source from Iringa, Morogoro, Singida, Lindi, and Tanga regions of Tanzania, it is argued that the objectives of the PPP were moderately achieved. Data revealed that service users from Tosamaganga, St. Francis, Kilimatinde, St. Augustine, and St. Walburg’s DDHs, were contented with improved provision of healthcare. It was also revealed that the DDHs reduced the government’s financial burden, and the money saved was redirected to improve other important community services. The DDHs also strengthened their partnership with the government by renovating and improving health system infrastructure, while the government’s payments to staff helped reduce turnover. This arrangement minimized bureaucracy and boosted operational efficiency, which in turn increased community trust in the services offered. Given the socio-economic and political context that prevailed in Tanzania, it was necessary to introduce and implement PPP to ensure that healthcare provision continued for community survival. These findings emphasise the importance of enhancing PPPs include FBOs to improve healthcare infrastructure and service delivery in Tanzania. Policymakers and practitioners can use this information to develop more effective collaborative strategies that increase access to quality healthcare.