Utilization of cost sharing funds and its associated factors in procurement of medicines and supplies in public primary health facilities in Kyela district council

Abstract

Background. Shortage of essential medicines and supplies in most of public primary health facilities is among of the main challenges facing the health system in Tanzania. Shortages are mainly caused by limited budgets for health financing. In order to reduce budget gaps (Govt tax, donors), cost sharing schemes are used. Tanzania introduced cost sharing in 1993, aiming at generating revenues to complement government budget. In 1997, the Ministry of Health developed a cost sharing guideline which guides facilities on how to manage the funds. It requires facilities to spend at least 67% of funds for procuring medicines and supplies. Despite of guideline requirements, most public facilities have persistent shortage of medicines at an average of 40%. This has compromised the quality of health services provided to the community

Objective. Broadly, the objective of this study was to determine the extent of utilization of cost sharing fund and its associated factors in procurement of medicines and supplies in Kyela District, Tanzania. Materials and Methods: A facility based cross-sectional study using close-ended questionnaire was conducted in Kyela district in June 2013. The study involved 25 primary health facilities (24 dispensaries, one health centre) and seven CHMT members. Main respondent at the facility level was the facility in charge. The study obtained information on extent facilities utilized cost sharing fund for procuring medicines and other non-medical supplies. Challenges that were mainly encountered were explored. Results obtained were analysed by SPSS version 16 software. Cross-tabulations of results were done to obtain P values using Fischer’s exact test. Results: A total of 32 respondents were included in the study. According to the 25 in charges, it was found that, most of health facilities 23 (92%) utilized the fund for various activities, while 2 facilities (8%) did not utilize the fund for any activity in the past 12 months prior to this study. On the other hand, 17 (68%) of the facilities used cost sharing fund to procure medicines and supplies while 8 (32%) did not procure medicines and supplies regardless of the shortages they experienced. In general, most of facilities 14 (56%) spent less than 40% of cost sharing fund for procuring medicines, none spent cost sharing according to the guideline minimum requirement (67%) for medicines.

Conclusion. This study found that, in general most of public primary health facilities have cost sharing bank accounts, however utilization of funds poorly adhere to Cost Sharing Guideline. The main challenges reported to affect utilization of funds according to the guideline included: Inadequate financial management capacities at facility level (48%), long distance from health facility to the bank (24%), beaurocratic public procurement procedures (20%) and inadequate technical support from the council (8%).

Recommendations From findings of this study, it recommends that, with the current persistent shortage of medicines and supplies in most public primary health facilities, the Ministry of Health and Social Welfare should re- examine the impact of cost sharing fund in procurement of medicines and consider more effective alternative options. Key words: Cost sharing guideline, Cost sharing fund, utilization, shortage of medicines, knowledge of in charges, fund management, Kyela District Council.