Assessing the effect of output-based health basket fund on the performance of health facilities and councils in Morogoro and Pwani Region 2013-2018

Abstract

ABSTRACT Background: The Government of Tanzania (GOT) introduced Health Basket Fund (HBF) in 1999/2000 as part of the health sector reform and sector wide approach (SWAP) for planning. The aim of HBF was to strengthen Tanzania’s health systems by providing additional funding to Central Ministries and Local Authorities. Due to lack of demonstrable progress over the past 15 years of the HBF’s implementation, the recommendation was made to introduce an output-based approach. The GOT and Development Partners contributing to the HBF designed a new performance based HBF in 2015 to support the fourth health sector strategic plan (HSSP IV) 2015 to 2020. In this approach, the funds are disbursed to the GOT following an attainment of agreed results at National, Regional and Council level. After several meetings the GOT decided to adopt an output-based approach on the health sector performance, specifically in councils and health facilities, because it was not practiced in Tanzania. Aim: This study assessed the effect of output-based HBF on the performance of the health facilities and councils. Methodology: The study used descriptive cross-sectional design, and employed mixed methods to enable data collection to attain the research objectives. It utilized an in-depth interview (IDI) to obtain qualitative data, while quantitative data was extracted from DHIS2 database. The study was conducted in Kibaha DC whereby two health facilities namely Ruvu Station and Disunyara dispensary were involved. In Morogoro MC, the study involved Sabasaba and Mafiga health centers. MS Excel was used to perform a trend analysis on the HBF indicators from quantitative data. A thematic approach using NVivo software version 12 was used to conduct data analysis for the qualitative part. Results: The findings obtained showed that, the use of the HBF funds has led to an improvement of the service delivery outputs and enhanced direct linkage/access for the members of the community, since the services are brought directly to them. Conclusions: All health facilities visited showed an increase in the star rating assessment from baseline to reassessment. This means that, staff in those health facilities took necessary steps to address the gaps found during the star rating assessments. Besides, the performance of the health facilities on service delivery and health system indicators, as described above, was in turn reflected in the performance of the respective LGA. Nevertheless, increasing availability and improvement of other sources of funding is quite critical in order to ensure that the achievement of HBF performance indicators is maintained. In addition, the introduction of DHFF has led to improvement of the service delivery and enhanced linkage/direct access for the community members. This is because, services are brought directly to the people, while the community members are directly participating in the decision-making process to determine their health-related needs.