‘We do not do any activity until there is an outbreak’:

Background: Little is known about the barriers to disease prevention and health promotion at the community level within a decentralized health system. Objective: This paper, therefore, presents and discusses findings on barriers (and opportunities) for instituting disease prevention and health promotion activities. Design: The study was conducted in Kongwa District, Tanzania, using an explorative case study approach. Data were collected through document reviews and in-depth interviews with key informants at district, ward, and village levels. A thematic approach was used in the analysis of the data. Results: This study has identified several barriers, namely decision-makers at the national and district levels lack the necessary political will in prioritizing prevention and health promotion; the gravity of prevention and health promotion stated in the national health policy is not reflected in the district health plans; gross underfunding of community-level disease prevention and health promotion activities; and limited community participation. Conclusion: In this era, when Tanzania is burdened with both communicable and non-communicable diseases, prevention and health promotion should be at the top of the health care agenda. Despite operating in a neoliberal climate, a stronger role of the state is called for. Accordingly, the government should prioritize higher health-protecting physical, social, and economic environments. This will require a national health promotion policy that will clearly chart out how multisectoral collaboration can be put into practice