Institutional arrangements and sustainable health service delivery in council-designated hospitals in Tanzania’s Lake Zone

Robert Alila; Paulin Paul; Nicodemus Mwakilema

doi:10.51867/AQSSR.3.3.38

Authors

Robert Alila Tanzania Institute of Accountancy (TIA) Author https://orcid.org/0009-0004-4788-1818
Paulin Paul Moshi Co-operative University (MoCU) Author https://orcid.org/0009-0005-5662-4503
Nicodemus Mwakilema Moshi Co-operative University (MoCU) Author https://orcid.org/0009-0005-5662-4503

DOI:

https://doi.org/10.51867/AQSSR.3.3.38

Keywords:

Council Designated Hospitals (CDHs), Institutional Arrangements (IAs), Sustainable Health Service Delivery (SHSD), Tanzania

Abstract

This study investigates the impact of Institutional Arrangements (IAs) on Sustainable Health Service Delivery (SHSD) in Council Designated Hospitals (CDHs) within Tanzania’s Lake Zone, focusing on partnerships between local governments and faith-based organisations. Guided by Agency Theory (AT) and Resource-Based Theory (RBT), the research conceptualises IAs as both external governance and internal resource management mechanisms influencing SHSD. A cross-sectional survey design was used, targeting clients aged 15 years and above who had attended CDHs at least twice during 2022–2023. The sampling frame consisted of ward-level client lists maintained by each CDH. Three wards with the highest client volumes were purposively selected per CDH to ensure representation of primary catchment areas. From these lists, respondents were randomly sampled using Cochran’s formula, resulting in 384 valid responses from 430 distributed questionnaires (an 89% response rate). Respondents completed the Institutional Arrangements Clients Questionnaire (IACQ), which included socio-demographic questions and 37 IA-related indicators mapped to 8 latent variables. Data were analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM). Results showed that institutional arrangements explained about 69% of the variance in SHSD (R² = 0.6892), with process management emerging as the strongest predictor (β = 0.3698, T = 6.5007, P < 0.001). The findings indicated that process, and resource management exert the most substantial positive effects on health service delivery, whereas hospital workforce practices and the learning environment do not demonstrate significant direct impacts, impliedly the influence may be indirect or emerge over time. Based on these results, it is recommended that CDHs prioritise the optimization of process and resource management within their operations and reinforce both client–institution interaction and organisational culture. Additionally, Local Government Authorities (LGAs) should focus on strengthening financial planning, while Faith-Based Organizations (FBOs) are encouraged to critically reassess management practices and invest in workforce development to foster long-term improvements in service delivery.

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