Understanding the implication of direct health facility financing on health commodities availability in Tanzania

Abstract

The Government of Tanzania (GoT) has in the last decade made progress in strengthening the health system financing with progress towards Universal Health Coverage (UHC). The major reforms includes development of the health financing strategy, reforming the Community Health Fund (CHF) and introduction of the Direct Health Facility Financing (DHFF). DHFF was introduced in all district councils in the 2017/18 financial year. One of the anticipated goals of DHFF is to improve availability of health commodities. The objective of this study is to assess the effect of DHFF in improving the availability of health commodities in primary health care facilities. This study employed cross sectional study design, using quantitative techniques to analyze data related to expenditures and availability of health commodities at the primary health care facilities in Tanzania mainland. Secondary data was extracted from Electronic Logistics Management Information System (eLMIS) and Facility Financial Accounting and Reporting System (FFARS). Descriptive analysis was used to summarize the data using Microsoft Excel (2021) and inferential analysis was done using Stata SE 16.1. There has been an increase in allocation of funds for health commodities over the past three years. The Health Basket Funds (HBFs) accounted for an average of 50% of all health commodities expenditures. The complimentary funds (user fees and insurance) contributed about 20%, which is less than the 50% required by the cost sharing guideline. There is potentiality in DHFF improving visibility and tracking of health commodities funding. Implementation of DHFF has increased the amount of funding for health commodities at health facilities. The visibility and tracking of health commodity funding has improved. There is a scope of increasing health commodity funds at health facilities since the expenditures on health commodities is lower than what is indicated in the cost sharing collection and use guideline.

Health research evidence: its current usage in health planning, determinants and readiness to use knowledge translation tools among health planning teams in Tanzania—an exploratory mixed-methods study protocol

“…It includes the construction of infrastructures, human resources for health, health commodities and supplies, health information systems and research. [34][35][36][37] The use of evidence-based planning will lead to good utilisation of the available resources from the government and health stakeholders that subsequently will result in the provision of quality health services and improve the quality of life.…”

Do community health committees participate in governing health workers in primary healthcare facilities under fiscal decentralization?—An explanatory qualitative study from Tanzania

“…The DHFF arrangement involves direct depositing of health facility funds from different sources such as Basket funds, Ministry of Finance (Intergovernmental transfer), user fees and funds from different insurance schemes 24 . In this arrangement community governance structures, which in Tanzania are known as HFGCs are assigned fiscal powers and responsibilities of participating in planning and budgeting financial management and procurement which they to use in accomplishing their core functions which one of them is participating in managing and governing facility health workers 16,25 . Therefore, under DHFF context it is expected that HFGCs would have such fiscal power in making significant decisions about the management of health workers at their facilities.…”

“…However, there is little information on the extent to which community governance structures or HFGCs participate in managing and governing health workers in many developing countries. The available empirical evidence on fiscal decentralization has focused on the functionality of HFGCs under fiscal decentralization, the accountability of HFGCs under fiscal decentralization, the acceptability of the DHFF approach to service users, and the breadth of HFGC role and functionality 24,25,27 . The purpose of this study was to determine the level of participation of HFGCs in health worker management functions in public PHC facilities that were implementing DHFF.…”

“… 24 In this arrangement community governance structures, which in Tanzania are known as HFGCs are assigned fiscal powers and responsibilities of participating in planning and budgeting financial management and procurement which they to use in accomplishing their core functions which one of them is participating in managing and governing facility health workers. 16 , 25 Therefore, under DHFF context it is expected that HFGCs would have such fiscal power in making significant decisions about the management of health workers at their facilities. Before the DHFF in Tanzania, different assessments empirical evidence suggests that HFGCs had poor functionality, including in managing health workers, because they had limited fiscal powers, among other things.…”

The effects of decentralized financing and funding levels on the breadth and quality of services provided in primary health facilities in Nigeria

“…16 Previous studies have shown that incremental funding, such as that provided under PBF and DFF, can sometimes improve structural quality, process of care, and increases in service utilization. [17][18][19][20] However, the evidence for effects on health outcomes is mixed and inequalities can persist. 18,[21][22][23][24] For example, increasing skilled birth attendance does not guarantee a reduction in maternal mortality, as was seen in Liberia and Ethiopia.…”