Public public sector this resulted to the country

service organisation in many developed and developing countries have been
reported to undertake changes after the Second World War. The changes was in
order to implement public service management reform which was focused on
various sectors such as defence, administrative, political, judiciary and
economic. The reform facilitated changes in the government institutional of
many countries in terms of the function to be performed by the organisation,
Structure to be followed, policies to be implemented, and accountability of the
service rendered.  (Pollitt etal, 2004:9-18)


introduction of Structural Adjustment Program (SAPs) in African countries by
World Bank in 1980s was the cornerstone for the changes in many African
countries. The restructuring of the public sector in terms of procedures,
regulations, laws and structures took place in order to facilitate
implementation of the program which was target to the entire population through
donor assistance. (WB,2006).

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in the last two decades experiences various reforms in a public sector this
resulted to the country politically, economically and administratively.  The restructuring of government institutions,
Agency has been facilitated by the need of delivering quality service to the
entire country by the public sector whereby the changes and performance of the
institution or organization are anticipated. (URT,2005)


notable reform in Tanzania occurred immediately after independence was the
adaptation of nationalistic approach whereby the country nationalised all major
means of economy and the government become the major provider of all social
services, decolonisation of administrative system, and declaration of one party
state under TANU in 1965.Impementation of the Arusha Declaration of 1967 up to
the late 1980s which emphases on the socialism and
self-reliance (REFERENCE


government of Tanzania prioritized the reform of the Civil Service the program
launched in 1991 with the focus of restructuring government organs in order to
establish and control all system of delivery of the services and anticipate the
size that needed to perform the function of the state. It has been reported by
Mutahaba etal 2002 that the Civil Service Reform Program facilitated the
government to undertake various actions toward 
managing  the provision of service,
introduces of Regulation and set of procedure to be followed by public  institutions.


reforms were targeted to be implemented in three distinct phases. The first
phase involves the installation of Performance Management Systems (PMS) in all
Ministries, Departments and Agencies; Regions and Local Government Authorities.
The objective of this phase was to improve accountability, transparency and
resource management for efficient and effective delivery of quality services to
the public.


(2005) explained that the aim of reform  was to implement a shift from the state
centred management approach to market economy and  re-organize the government by changing its
past practice of directly involving itself in the management of the economy to
that of regulating the economy, supervising the market , managing the social
affairs and providing efficient public services.

The reforms also targeted to make changes and formulate new institutions
with system and structures featuring standard legalized behaviour, coordinated
operation, fairness, transparency, honesty and high efficiency for improved
public social service delivery, management and hence promote sustainable economic
growth. According to March and Olsen,(1989) revealed that the Rational Choice institutionalism  emphases that the rules of the game are
distinguished from the actual game where by the institution like the government
its operation are arranged rules and incentives. Therefore the changes occurred
in the institutions included not limited to; First a shift from discretionary
administration to service oriented administration by government improving
legislation and push forward the effort to put the government work under the
control of law and to establish improved social services; Second a shift from
administrative control system to law-ruling and regulatory administration
system. (ibid)

The reforms in Tanzania as the approach of institutionalism included
Local Government Reform Programme – for quality services delivery in the local
Authorities, Public Financial Management Reforms – to ensure efficient use of
resources in spite of resource constraints, Legal Sector Reform Programme- to
ensure rule of law and human rights are observed within public institutions and
Other Sectoral reform Programs such as Education, Agricultural, Health,
security, economic etc were undertaken so that they can complement each other
in service delivery to the public.


The main objective of desk review is to explore the process and
experience of institutionalism approaches, Factors influencing health institution
reforms, Process of reforms and how the public and workers perceived the
changes made after and before the reform.


The researcher use desk review whereby different
books were consulted such as Institutional Theory in Political Science by B.
Guy Peter (1998). (TO ADD FROM GMAIL) and March
and Oslen including




According to the Hall and Taylor (1996) explained
that new institutionalism involves three school of thought which are historical
institutionalism, rational choice institutionalism and social institutionalism,
this  approaches for institutionalism
have been elaborated by Guy Peter (1998) when he argued on the issue of the
development of historical institutionalism during 1970s and the assumption of
the interesting groups for scarce resource where by the need to formulate an
define clearly procedures, norms, regulation  whether formal or not but the institutions
should be guided in order to produce the desired objectives.

According to oliver and Mossialos (2005)
argued that the historical intuitionalist concentrate on how the power and
authority of the institution are distributed differently in the group within
the organisation, the focus was the reason was why some individual within the
institution are given power to decide what will affect the whole institution.

Hacker (2002) argues that historical
institutionalism or path dependency is improved through when the following are
indicated;  (a) past policies have
created large institutions with substantial set-up, (b) institutions benefit
important organized interest groups where by the large number of veto points
are considered hence the changes of the policies may occurred (Immergut 1992;
Rittberger 2003),  (c) institution should
represent  long term commitment (d)  institutions replicate the broader cultural
and economic values of the society; (e)conditions put barriers in the path of


Rothstein (1996) argued that historical
institutionalists tend to believe that the development of the institutional mainly
depends on the path which was the result of long term policy plan within the
institution. The institutions are not one night event for its occurrences it
has to take time to build it step by step in a proper way.


According to Hall and Taylor (1996)
explained that rational Choice is derived from the modern welfare economic this
is the result of the understanding of the decision making and it is supported
by the game theory. Furthermore, it was revealed this approach was firstly observed
during the study of American congressional behaviour and views politics as a
series of collective-action dilemmas. The rational institutionalist was
revealed to apply a fixed and pre-defined set of preference which guides them
to in attainment of the specified target of the institution. The achievement of
the institution objectives are characterised by different intervention within
the organisation.


and Olsen (1984) argued that rational approach has some features which distinguish
it with other approaches  for the point
of view the following are their opinions (a) Contextualism which emphases more
on the society perspective where by the central role are shifted from the state
to the society this is where the slogan 
of ‘bringing the State Back in’ can in from various scholars (b) Reductionism
the argue here is there must be reduction of collective behaviour to individual
once within the institution and this was emphasized on the approach of
behaviour and rational choice where by individual within the institution are influenced
by norms, values and rules of institutions (c) Utilitarianism explained that
this is concerned  the tendency whereby
the decision made for individual on what they produce are valued compared to
the inherent representation(d) Functionalism  March and Olsen indicated how this features had
come with the critics of the history aspect in institutionalisms where by the
assumption was made that  the society are
moving from the lower to the higher forms thus structural functionalism must be
observed also students institution was given (e) Instrumentalism this emphases on
the domination of process, identity and socio-political values where by the
action and process are conducted under the public sector umbrella rather than considering
political process by itself .







The health Sector as an institution
underwent various changes after independence which facilitated the
implementation of Reform in 1994. 
Officially, public sector reform in Tanzania was launched in 1991. The
reform as echoed from institutionalism in public sector was targeted five key
areas which are Micro-economic reforms, Public
Finance Management reforms, Sectorial Reforms (health sector inclusive), Local
Government reform and Public Service reform (URT, 1994). The reform mentioned
above was carried out by existed government machinery which insisted on achieving
Economic Growth and Quality public service to the citizen.

under POPSM  elaborated that reform in
public institution  aimed to implement a transfer
or shift of the state to centralise the all management issues and give power
and authority to the lower level to perform as per the directives whereby the
essence of market economy and efficiency can be realised. This also have been
supported by the adoption of path dependency approach to the public institutions
which argues on historical analysis of the institutions as they failure to
produce to the expectation of the community hence the changes was inevitable.



changes in health sector delivery in Tanzania have long history thus why the
concept of institutionalism of the reforms to the health sector machinery was easily
practiced. The propose for the reform on the service delivery in health sector