Evaluation of the Direct Health Facility Financing Program in Improving Maternal Health Services in Pangani District, Tanzania

Abstract

Background: Maternal morbidity and mortality remain significant public health concerns globally, with Tanzania reporting 398 deaths per 100,000 live births annually. While national level data provide some insights into the issue, a focus on sub-national levels is required because of differences in contexts such as rural-urban disparities in maternal mortality. This study examined Direct Health Facility Financing (DHFF) and its effects on the quality of maternal health services in Pangani, a rural district in Tanzania. Methods: This study was conducted in Pangani district of Tanga region in Tanzania. The study used both qualitative and quantitative methods, including 16 in-depth interviews with the council health management teams, facility in charges, maternity nurse in charge, and 5 focus group discussions with community health governing committee members. The number of deliveries that occurred in health facilities, as well as medical supplies, equipment, and reagents purchased by the facilities, were compared using descriptive statistics before and after the DHFF implementation. Results: Direct disbursement of funds from the central government through the Ministry of Finance and Planning to the primary health facilities reduced delays in procurement, improved community outreach services, and improved community leaders' engagements. Deliveries occurring at health facilities increased by 33.6% (p < 0.001) one year after the HDFF implementation. Various medicines, delivery kits, and some reagents increased significantly (p < 0.05). However, the lack of computers and poor internet connectivity, an insufficient supply of medical equipment and unstable stock of the Medical Stores Department increased the difficulty of obtaining the missed items from the selected prime vendor. Conclusion:Overall, this study shows a positive impact of the DHFF on maternal health service delivery in Pangani district. Specifically, an increase in the number of medical supplies, equipment, and reagents necessary to provide maternal health services contributed to the observed increase in facility deliveries by 33.6%. Moreover, the system minimizes unnecessary delays in the procurement processes of required drugs, supplies, and other facility reagents. To maximize the impact of the HDFF system, lack of computers, unstable internet, limited knowledge of the staff about the system, and inadequate health workforce should be addressed. Therefore, strengthening the DHFF system and staff training in-service and on the job is essential for smooth implementation.

Implementation of direct health facility financing in the Rural District of Kigoma in Western Tanzania

“…Therefore, despite the reforms and different strategies adopted for DHFF, primary health facilities have failed to improve service provision, thus challenging the realization of the health sector reforms goals [ 17 ]. As such The DHFF implementation program is designed to improve the quality of health services, improve efficiency, and mobilize health workers and community levels for improved health services.…”

Public Primary Health Facilities Autonomy: Findings from Tanzania Star Rating Assessment

“…In addition, DHFF has shown positive impact on maternal health service delivery in Pangani District [24]. Alongside the introduction of DHFF was introduction of Facility Financial Accounting and Reporting System (FFARS), which aims to improve facility financial management [25].…”

Perceived performance of health facility governing committees in overseeing healthcare services delivery in primary health care facilities in Tanzania

“…HFGCs are in charge of managing money, participating in planning and budgeting, and overseeing the use of funds in accordance with the health facility plan 27 ,. 28 However, it is not known how the empowered HFGCs currently performs under the DHFF context in public primary health facilities in Tanzania. Therefore, was conducted to assess the performance of HFGCs in accomplishing their devolved functions in primary health facilities implementing DHFF in Tanzania.…”