The impact of direct health facility financing on MNCH service provision: results from a comparative, before-after study in Pwani Region, Tanzania

Abstract

Background Pwani Regional Secretariat in Tanzania implemented the Maternal, Neonatal, and Child Health Project (2016–2022) through Direct Health Facility Financing (DHFF), which allocates funds directly to health facilities. This study assessed the impact of the six-year DHFF project in Pwani region. Methods The study utilised District Health Information Software 2 data from 18 intervention health facilities in Pwani region. Control groups comprised an equal number of facilities from Pwani and Dodoma regions where the project was not implemented. Key indicators assessed included ‘ANC 4 + Rate (%)’, ‘Percentage of Mothers tested for Anaemia during ANC’, ‘Caesarean Section Delivery Rate (%)’, ‘Percentage of Mothers and Newborns receiving PNC services within 48 hours’, ‘Delivery Complication Rate (%)’, and ‘SBA Delivery Rate (%)’ which are associated with the project interventions. The impact of the project was analysed using a paired sample t-test comparing baseline and endline data. We evaluated the significance of the dependent variables using one-way ANOVA with control groups, with the Tukey-Kramer test for post hoc analysis. Chi-square test assessed the significance of Caesarean Section Delivery Rate and the relationship between variables and health facility conditions. Pearson correlation test was used for significance between funding size and the change of MNCH variables. Statistical significance at 0.05 was calculated. Results The project showed limited positive impacts, only in the ‘Percentage of Mothers tested for Anaemia during ANC’ (****p < 0.0001), ‘Percentage of Newborns receiving PNC within 48 hours’ (**p = 0.0095), and ‘SBA Delivery Rate’ (***p = 0.0043). The health facility assessment identified positively influencing factors on service delivery, such as facility type (*p = 0.0347), distance to the facility (****p < 0.0001), and internet connectivity (*p = 0.0186). We found that the project did not improve most MNCH indicators, including the CEmONC coverage (χ2 = 2.82, p = 0.2448, df = 2), which was known to be the leading outcome. Conclusion The project had limited impacts on MNCH outcomes due to various factors. While the health facility assessment highlighted positive influences on service delivery, significant areas for improvement remain, including referral systems and infrastructure. Operational research findings indicate that the effectiveness of the DHFF could be enhanced by refining its management and governance structures.