Effect of direct health facility financing on the availability of diabetic and hypertensive health commodities in primary health facilities in Dodoma region, Tanzania

Abstract

ABSTRACT Background: In 2017, the Government of Tanzania launched Direct Health Facility Financing (DHFF) reforms, among others, aimed at enhancing the quality of health services in primary healthcare facilities and increasing the availability of essential health commodities. With the growing prevalence of Non-Communicable Diseases (NCDs), it became essential to examine the effect of DHFF on the availability of health commodities for diabetes and hypertension in these facilities. This study assessed how DHFF influenced the availability of diabetic and hypertensive health commodities in rural and urban primary healthcare facilities in the Dodoma Region. Methods and Materials: A cross-sectional analytical study design using a quantitative approach was conducted in two selected districts of the Dodoma region, with both rural and urban representation. Budget, allocation, and expenditure data were extracted from the financial systems covering three (3) years to establish a trend concerning NCDs. In addition, data on the availability of hypertensive and diabetic health commodities were extracted from the electronic Logistic Management Information System (eLMIS). Financial data were analyzed by using Microsoft Excel. Budget, allocation, and expenditure data were disaggregated by level of healthcare facility and fund sources. These data constituted the essential/tracer commodities used in managing NCDs and were disaggregated further by the level of health facilities, source, and geographical location. Results: The overall availability trends for hypertensive and diabetic commodities have generally improved over the years with an increase from 86% to 93% for 2021 to 2023, respectively. The overall availability of diabetic health commodities was higher compared to the hypertensive commodities, except for the fiscal years 2020/21. There was a significant difference in the availability of diabetic commodities between urban and rural areas each year, with rural areas consistently having higher availability compared to urban areas (p-value < 0.05). For the availability of Hypertensive health commodities, there was a significant difference in the year 2022/2023 between urban and rural (p-value <0.008), with urban areas having higher availability. The overall budget for health commodities has seen a consistent increase over the years. Specifically, in the fiscal year 2021/22 the total budget allocated was 979,778,729 TZS, out vi of which only 0.6% was allocated for NCD health commodities. The following year, 2022/23, showed an increase in both overall health commodities and NCD-specific allocation by 1.94%. However, in 2023/24, while the total budget for health commodities rose to 1,294,916,732 TZS, the total funds dedicated to NCDs decreased to 14,019,911 TZS. With regards to expenditure, in the fiscal year 2020/21, the total expenditure on health commodities was contributed by different funding sources that are Improved Health Insurance (iCHF), Health Sector Basket Fund (HSBF), and National Health Insurance Fund (NHIF) and User fees. The iCHF contributed 21,790,818 TZS, HSBF - 182,625,199 TZS, NHIF - 35,433,772 TZS, and User Fees - 93,681,451 TZS. Conclusion: The findings from this study suggest an overall increase in the availability of NCDs (diabetic and hypertensive) health commodities is contributed by DHFF reforms implementation by primary health facilities. Also, the study found disparities in the availability of NCD health commodities between facilities located in rural and urban areas with better availability in urban.