The functionality variation among health facility governing committees under direct health facility financing in Tanzania (original) (raw)
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2022
Background: Decentralization has dominated the agenda for the reforms of the organization of service delivery in Lower and Middle-Income Countries (LMICs). Decentralization faces a formidable challenge of fiscal decentralization in primary healthcare facilities. Of now, LMICs are implementing fiscal decentralization reforms to empower health facilities and their Health Facility Governing Committees (HFGCs). Given the paucity of the impact of fiscal decentralization, this study was conducted to assess the functionality of HFGCs and their associative factors in primary health care facilities implementing fiscal decentralization through Direct Health Facility Financing (DHFF) in Tanzania.Methods: A cross-sectional design was employed to gather both qualitative and quantitative data. The study was conducted in 32 selected primary health facilities implementing DHFF in Tanzania. Probability and nonprobability sampling procedures were employed, in which a multistage sampling procedure was...
2021
Users Committees such as Health Facility Governing Committees (HFGCs) are one of the popular mechanisms used to represent communities and civil societies in holding service providers into account. This study embarked on assessing the status of accountability of HFGCs under the DHFF context in Tanzania as experienced by the supply side (HFGCs members). A cross-sectional design was employed in collecting both qualitative and quantitative data at one point in time in 32 selected health facilities. A closed-ended questionnaire, in-depth interview and FGDs were employed to collect data. Data were analyzed through descriptive statistics and Multiple logistics regression, and thematic analyses. The study found high accountability of HFGCs by 78%. specifically, HFGCs have high accountability in mobilizing the community to join community health funds 99.71%, receiving medicines and medical commodities 88.57% and timely health services 84.29%. It was reviled that the accountability of the hea...
Background: Globally, good health system performance has resulted from continuous reform, including adaptation of Decentralisation by Devolution policies, for example, the Direct Health Facility Financing (DHFF). Generally, the role of decentralisation in the health sector is to improve efficiency, to foster innovations and to improve quality, patient experience and accountability. However, such improvements have not been well realised in most low-and middle-income countries, with the main reason cited being the poor mechanism for disbursement of funds, which remain largely centralised. The introduction of the DHFF programme in Tanzania is expected to help improve the quality of health service delivery and increase service utilisation resulting in improved health system performance. This paper describes the protocol, which aims to evaluate the effects of DHFF on health system performance in Tanzania. Methods: An evaluation of the effect of the DHFF programme will be carried out as part of a nationwide programme rollout. A before and after non-controlled concurrent mixed methods design study will be employed to examine the effect of the DHFF programme implementation on the structural quality of maternal health, health facility governing committee governance and accountability, and health system responsiveness as perceived by the patients' experiences. Data will be collected from a nationally representative sample involving 42 health facilities, 422 patient consultations, 54 health workers, and 42 health facility governing committees in seven regions from the seven zones of the Tanzanian mainland. The study is grounded in a conceptual framework centered on the Theory of Change and the Implementation Fidelity Framework. The study will utilise a mixture of quantitative and qualitative data collection tools (questionnaires, focus group discussions, in-depth interviews and documentary review). The study will collect information related to knowledge, acceptability and practice of the programme, fidelity of implementation, structural qualities of maternal and child health services, accountability, governance, and patient perception of health system responsiveness.
Background: In Tanzania, the introduction of Direct Health Facility Financing (DHFF) is viewed as one of the innovative health sector reform initiatives, with the main focus of improving quality of health services provision. DHFF empowers primary health care actors’ autonomy in decision making to improve health system performance in the stride forward to reach Universal Health Coverage (UHC). The purpose of this study was to assess the effect of DHFF on health system performance and how it is implemented in the Public Primary Health Facilities (PPHFs) in Tanzania.Methods: This study used a non-controlled before- after convergent mixed-method study design, with a process evaluation embedded at midline, in data collection and analysis. The study was conducted between January 2018 and September 2019. Quantitative data collection was done through administration of questionnaire to 844 existing patients and 238 Health care workers in 42 Public Primary Health Facilities of seven regions w...
Background: In early 1990s, Tanzania like other African countries, adopted health sector reform (HSR). The most strongly held centralisation system that informed the nature of services provision including health was, thus, disintegrated giving rise to decentralisation system. It was within the realm of HSR process, user fees were introduced in the health sector. Along with user fees, various types of health insurances, including the Community Health Fund (CHF), were introduced. While the country's level of enrolment in the CHF is low, there are marked variations among districts. This paper highlights the role of decentralised health management and leadership practices in the uptake of the CHF in Tanzania. Methods: A comparative exploratory case study of high and low performing districts was carried out. In-depth interviews were conducted with the members of the Council Health Service Board (CHSB), Council Health Management Team (CHMT), Health Facility Committees (HFCs), in-charges of health facilities, healthcare providers, and Community Development Officers (CDOs). Minutes of the meetings of the committees and district annual health plans and district annual implementation reports were also used to verify and triangulate the data. Thematic analysis was adopted to analyse the collected data. We employed both inductive and deductive (mixed coding) to arrive to the themes. Results: There were no differences in the level of education and experience of the district health managers in the two study districts. Almost all district health managers responsible for the management of the CHF had attended some training on management and leadership. However, there were variations in the personal initiatives of the top-district health leaders, particularly the district health managers, the council health services board and local government officials. Similarly, there were differences in the supervision mechanisms, and incentives available for the health providers, HFCs and board members in the two study districts. Conclusion: This paper adds to the stock of knowledge on CHFs functioning in Tanzania. By comparing the best practices with the worst practices, the paper contributes valuable insights on how CHF can be scaled up and maintained. The study clearly indicates that the performance of the community-based health financing largely depends on the personal initiatives of the top-district health leaders, particularly the district health managers and local government officials. This implies that the regional health management team (RHMT) and the Ministry of Health and Social Welfare (MoHSW) should strengthen supportive supervision mechanisms to the district health managers and health facilities. More important, there is need for the MoHSW to provide opportunities for the well performing districts to share good practices to other districts in order to increase uptake of the community-based health insurance. Implications for policy makers • The regional health management team (RHMT) and the Ministry of Health and Social Welfare (MoHSW) should strengthen supportive supervision mechanisms to the district health managers. • The MoHSW should provide opportunities for the well performing districts to share good practices to other districts in order to increase uptake of the community-based health insurance. • The MoHSW and the Ministry responsible for regional administration and local government need to make sure that incentives to the health providers, Health Facility Committees (HFCs) and board members are available and paid in time. Implications for the public In order to effectively implement community-based health insurance, there is need to actively engage all stakeholders, including the public in the implementation of policies at the local level. The public, through health facility (user) committees should actively participate in monitoring the availability of quality health services in the health facilities.
BMJ Global Health, 2021
The development of effective and inclusive health financing reforms is crucial for the progressive realisation of universal health coverage in low-income and middle-income countries. Tanzania has been reforming health financing policies to expand health insurance coverage and achieve better access to quality healthcare for all. Recent reforms have included improved community health funds (iCHFs), and others are underway to implement a mandatory national health insurance scheme in order to expand access to services and improve financial risk protection. Governance is a crucial structural determinant for the successful implementation of health financing reforms, however there is little understanding of the governance elements that hinder the implementation of health financing reforms such as the iCHF in Tanzania. Therefore, this study used the perspectives of health sector stakeholders to explore governance factors that influence the implementation of health financing reforms in Tanza...
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Background: Having a proper health system management with skilled health managers has been shown to be an important foundation for a high-quality health system. Primary Health Care (PHC) is important in ensuring the achievement of universal health coverage. To achieve this objective, it is important to strengthen the management of PHC facilities. This study aims at ascertaining the functionality of Health Facility Management Teams (HFMTs) in PHC facilities in the context of Star Rating Assessment (SRA) in Tanzania. Methods: This is a quantitative secondary data analysis using the SRA re-assessment data collected in the fiscal year 2017/18. HFMTs functionality was measured by the desirable performance of four indicators, namely availability of the HFMTs, formal appointment of HFMTs, regular meeting of HMT and quarterly meetings conducted. The proportions were compared by using proportion Z and chi-square tests. Results: This study involved 5933 PHC facilities, the majority of which were dispensaries (87.6%), rural located (78.3%
Public Primary Health Facilities Autonomy: Findings from Tanzania Star Rating Assessment
Background: In many countries, health facility autonomy has been a crucial component of health sector reform. Reducing direct government control over public health facilities and increasing their exposure to the market and market-like forces are part of this reform strategy. The degree of financial independence is a crucial characteristic that determines health facility financing and it has an impact on how well public health facilities function. This study aims at ascertaining Primary Health Facilities autonomy in the context of Star Rating Assessment (SRA) in Tanzania. Methods: This is a quantitative secondary data analysis using the SRA re-assessment data collected in the fiscal year 2017/18. Facility autonomy was measured by the desirable performance of six indicators, namely submission of a health facility plan,
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This study assessed the implementation of Direct Health Facility Financing (DHFF) on financial management among primary health facilities of Kaliua District Council. The assessment conducted because Kaliua District is the one among 184 councils where the government introduced DHFF; the study adopted case study design whereby, both qualitative and quantitative approaches were used. A structured questionnaire, Interview, FDGs, Documentary review were used in obtaining data which were classified into planning process, rate of fund utilization, adherence to financial management guidelines and perceptions of employees on fund utilization which were administered to 238 respondents who sampled through simple random and purposeful sampling techniques. Data analysed using excel and SPSS for quantitative data and content analysis for qualitative data. Study revealed that, planning process work in excellent way (72.9%); utilization capacity of funds disbursed has been acknowledged at 70%; Fund...
Science Journal of Public Health, 2017
The deterioration of health services provision in Tanzania from 1980s to 1990s made decentralization of health service provision through the Health Sector Reform (HSR) a necessity. HSR aimed at bringing better utilization of scarce resources, improved quality of health services, increasing user access and cutting rising costs. It is through HSR that health insurance schemes were introduced. Community Health Fund (CHF) came as a result of such efforts. The efficiency and effectiveness of CHF rests on district councils which are responsible for ensuring better performance of CHF. Although the Government of Tanzania targeted 85% of the population to be members of CHF, enrollment has remained as low as 9.2% by 2014. The most sticking problem is the variation in enrollment in different districts. There are districts with higher performance in CHF enrollment like Iramba (54%) and Bariadi (40.9%). Whereas, there are districts with very low enrollments in CHF like Liwale (8%), and Rungwe (6.5%). This paper is an effort to shed some light on this phenomenon ofperformance variation of CHF enrolment in districts. It argues that poor performing districts are constrained by their own weaknesses such as poor management and leadership capacities of Council Health Management Team (CHMT) and lack of motivation among health facility staff and allied health workers. Also, poor sensitization and mobilization of people to join CHF, as well as poor quality healthcare to people has deterred performance of CHF in some districts. The papers' conclusion apart from offering recommendation also adds to the broader ongoing debate of decentralization process mainly through health insurance.