Implementation of direct health facility financing in Kigoma District Council, Tanzania

Abstract

Background: In 2016 Tanzania adopted direct health facility financing (DHFF) aiming at improving efficiency, foster innovations, and improve the quality of health services and its delivery; enhance accountability; increase service utilization and enhance community ownership of health services through improved joint priority setting, planning, monitoring, and resource mobilization. Since the program started, the assessment of implementation on whether actors align with the program guidelines has limitedly been conducted. Objective: To explore experiences on the implementation of the program at primary health facilities in the Kigoma district council. Method: This was a process evaluation that adopted a cross-sectional exploratory study using key informant interviews guided by a semi-structured interview guide. Key informants were selected among the DHFF program implementers at Kigoma primary health facilities. Qualitative content analysis was adopted for data analysis. Results: Most of the respondents reported using the DHFF program guidelines, all facilities had program planning guidelines, HFGCs were actively involved in planning for and use of the funds; and the procurement procedures were followed. Some implementers received training on how to implement the program-related activities while others were not, and implementers received regular supportive supervision from the CHMTs. The persisted barriers included; lack of program ownership, delays in receiving funds, shortage of key implementers, also, low allowances to the committee members, internet network problems, inadequate funding, lack of meals and transport allowances, the complexity of the program rules and regulation, inadequate knowledge on the program implementation, and interferences from community leaders found to negatively affect the program implementation. Conclusion: Generally, the implementation of the program was as per guidelines as it was experienced by implementers and the strategies used to implement the program. However, there were critical barriers experienced by program implementers which impeded the program implementation that needs to be dealt with by relevant authorities to ensure program sustainability and acquire targeted outcomes. To mitigate these impediments, the district officials need to ease the procurement process, budget comprehensively into the CHOP, and create awareness about the program among key actors and the community.