Afya Pamoja: Using citizen e-health feedback to improve health services in Tanzania

Adverse health outcomes in the Global South can often be prevented by greater uptake and better delivery of health services. This partly reflects the limited information possessed by local authorities about citizen priorities and experiences in health clinics. To help bureaucrats and politicians monitor frontline service providers, we propose a pilot study of an e-health initiative that integrates SMS-based feedback from citizens into Tanzania’s public health system. The Afya Pamoja system addresses concerns about traditional feedback mechanisms by providing rapid, credible, and low-cost feedback. We further examine whether such feedback is most effectively delivered to bureaucrats or politicians (or both), and thus evaluate whether bureaucratic or electoral information transmission and accountability mechanisms – at the level of the principal – are more effective in Tanzania’s competitive authoritarian regime. We use administrative, survey, and audit data to measure service utilization and quality as well as health outcomes six months into the pilot. The quantitative results and qualitative findings of our pilot will inform the design and feasibility of a full study that we intend to conduct in partnership with Tanzania’s Ministry of Health.