A collaboration between Tanzania's Ministry of Health and Canada's International Development Research Centre (IDRC), TEHIP was established to test innovations in planning, priority setting, and resource allocation at the district level, in the context of the reform and decentralisation of Tanzania's health care system. A heavily indebted country with a per capita income of $290 that spends $8 a year on the health of each of its citizens, Tanzania was seeking ways to improve the health of its citizens on a small budget. In two rural districts, Rufiji and Morogoro, TEHIP worked to:

• strengthen district-level capacity to plan and set priorities using locally obtained burden of disease and cost-effectiveness considerations
• increase district-level capacity to effectively deliver selected health interventions
• assess and document lessons learned in district health planning and management systems/processes
• measure the overall impact of delivering health interventions in terms of burden of disease and per capita cost.

Average clinic visits per child increased from 2.8 to 5.8 a year. More children were treated for malaria, more early cases of worms were spotted, more eye infections were caught, more AIDS messages were shared, and more mothers had exposure to family planning information.

Child mortality fell in the 2 districts by more than 40% over the 5 years of implementation. Adult mortality dropped by about 20%, even as AIDS was beginning to spread. During this period, districts not using the TEHIP plan experienced virtually no change in their death rates.

In accomplishing the above, the districts were able to use just 30 cents out of TEHIP's promised $2 increase the first year. (The figure increased to 89 cents in the second year, and $1.37 in the third.)