Assessment of Strategic Healthcare Purchasing Arrangements and Functions Towards Universal Coverage in Tanzania

Abstract

Background: Strategic health purchasing in low and middle-income countries has received substantial attention as countries aim to achieve universal health coverage, by ensuring equitable access to quality health services without the risk of financial hardship. There is little evidence published from Tanzania on purchasing arrangements and what is required for strategic purchasing. This study analyses three purchasing arrangements in Tanzania and gives recommendations to strengthen strategic purchasing in Tanzania. Methods: We used the multi-case qualitative study drawing on the National Health Insurance Fund (NHIF), Social Health Insurance Benefit (SHIB), and improved Community Health Fund (iCHF) to explore the three purchasing arrangements with a purchaser-provider split. Data were drawn from document reviews and results were validated with nine key informant interviews with a range of actors involved in strategic purchasing. A deductive and inductive approach was used to develop the themes and framework analysis to summarize the data. Results: The findings show that benefit selection for all three schemes was based on the standard treatment guidelines issued by the Ministry of Health. Selection-contracting of the private healthcare providers are based on the location of the provider, the range of services available as stipulated in the scheme guideline, and the willingness of the provider to be contracted. NHF uses fee-for-service to reimburse providers. While SHIB and iCHF use capitation. NHIF has an electronic system to monitor registration, verification, claims processing, and referrals. While SHIB monitoring is done through routine supportive supervision and for the iCHF provider performance is monitored through utilization rates. Conclusion: Enforcing compliance with the contractual agreement between providers-purchasers is crucial for the provision of quality services in an efficient manner. Investment in a routine monitoring system, such as the use of the district health information system which allows effective tracking of healthcare service delivery, and broader population healthcare outcomes.

Analysis on the equity differential on household healthcare financing in developing countries: empirical evidence from Tanzania, East Africa

“…To reduce the household level burden due to these health service schemes, the government initiated several programs and policy options intending to increase accessibility to health care services, reducing inequities in health and widening citizens' ability to access healthcare services in their residential areas [12]. Despite Tanzania's government investment in different health strategies, -equity in healthcare financing has been a nightmare and many studies have shown that these strategies have been deepening the problem instead of lessening it [13][14][15][16][17]. Hence, a large burden has been placed on poor households in rural and urban areas due to insufficient government healthcare financing.…”

Sustainable financing for vaccination towards advancing universal health coverage in the WHO African region: The strategic role of national health insurance

“…Channeling the revenues that are generated through contributions (i.e., pooled funds) for national health insurance to vaccination will require a set of policy levers collectively known as strategic health purchasing to be operationalized. 44 Strategic health purchasing is not a new concept in Africa, as there is evidence to suggest that national health insurance schemes in countries like Cote D’Ivoire, 45 Gabon, 46 Ghana, 47 , 48 Kenya, 9 , 49–53 Rwanda, 11 , 54 Nigeria, 10 , 55 , 56 Tanzania, 57 and Zambia 58 are using it to achieve their objectives of improving access to quality health care services. These policies are required to enable the purchaser (national health insurance) to determine the services to buy (e.g.…”

“…For services like malaria or diarrhea, schemes have contracting arrangements in place with selected providers to offer the needed care as specified in their benefit packages. 47 , 53 , 57 These providers can then source for the medicines and other consumables that are required to offer quality services. However, vaccines, which is the main input for vaccination services, are procured in bulk for the country and distributed to health care providers through the immunization program.…”

Assessment of strategic healthcare purchasing and financial autonomy in Tanzania: the case of results-based financing and health basket fund

“…SHP is increasingly recognized as an important tool to enhance the use and equitable allocation of resources, which is especially important in resource-constrained health systems in low and middle-income countries (LMICs) (2,6,7). SHP could potentially enhance provider responsiveness and efficiency toward enhancing overall health system performance (8)(9)(10).…”

“…In sub-Saharan African (SSA) countries, there is a growing interest in assessing SHP arrangements in health financing and the degree to which they have enhanced progress towards UHC and offer autonomy to providers. However, much of the existing research has focused on health insurance [in Kenya (12) and Tanzania (9)], and government purchasing arrangements [in Nigeria (13) and Uganda (14)]. However, there is only one study in SSA that assessed the SHP of donor-funding mechanisms and compared different donor-funded purchasing arrangements in Uganda (14).…”