The relationship between central organizations and local government and their influence on local planning process: A case of council health management team planning in Tanzania

Decentralisation was intended to promote local decision-making and make district health plans more responsive to local needs. However, there are factors hindering these achievements. Among these is confusion about accountability, local government capacity limitations, and infringement of local decisions space. This study aimed to gather new evidence and gain a theoretical understanding of how the relationships between central organisations and Council Health Management Teams (CHMT) influence Tanzania's local health planning process. The study was conducted in Ilala Municipal Council and Morogoro District Council in Tanzania. An exploratory, descriptive qualitative approach was employed where Policy triangle, Decision space, and decentralisation typology were used to inform the study conceptual framework. Document review and Key Informants Interviews were used to collect data, and framework analysis was employed. Generally, the findings suggest unequal space between the central and local governments concerning decision-making. Three primary forms of influences of central-local relations on health planning were identified. The influence on the responsiveness of local health plans to local needs, infringement of local decisions space, and influence on altering central arrangement leading to deviations between written intentions of decentralisation in the health planning process and the practice