https://orcid.org/0000-0002-6997-0211
Abstract
Background
Maternal morbidity and mortality remain significant public health concerns globally, with Tanzania reporting 398 deaths per 100,000 live births annually. While national level data provide some insights into the issue, a focus on sub-national levels is required because of differences in contexts such as rural-urban disparities in maternal mortality. This study examined Direct Health Facility Financing (DHFF) and its effects on the quality of maternal health services in Pangani, a rural district in Tanzania.
Methods
This study was conducted in Pangani district of Tanga region in Tanzania. The study used both qualitative and quantitative methods, including 16 in-depth interviews with the council health management teams, facility in charges, maternity nurse in charge, and 5 focus group discussions with community health governing committee members. The number of deliveries that occurred in health facilities, as well as medical supplies, equipment, and reagents purchased by the facilities, were compared using descriptive statistics before and after the DHFF implementation.
Results
Direct disbursement of funds from the central government through the Ministry of Finance and Planning to the primary health facilities reduced delays in procurement, improved community outreach services, and improved community leaders’ engagements. Deliveries occurring at health facilities increased by 33.6% (p < 0.001) one year after the HDFF implementation. Various medicines, delivery kits, and some reagents increased significantly (p < 0.05). However, the lack of computers and poor internet connectivity, an insufficient supply of medical equipment and unstable stock of the Medical Stores Department increased the difficulty of obtaining the missed items from the selected prime vendor.
Conclusion
Overall, this study shows a positive impact of the DHFF on maternal health service delivery in Pangani district. Specifically, an increase in the number of medical supplies, equipment, and reagents necessary to provide maternal health services contributed to the observed increase in facility deliveries by 33.6%. Moreover, the system minimizes unnecessary delays in the procurement processes of required drugs, supplies, and other facility reagents. To maximize the impact of the HDFF system, lack of computers, unstable internet, limited knowledge of the staff about the system, and inadequate health workforce should be addressed. Therefore, strengthening the DHFF system and staff training in-service and on the job is essential for smooth implementation.
Abbreviations
CHGCM, Community Health Governing Committee Members; CHMT, Council Health Management Team; DHFF, direct health facility financing; DMO, District Medical Officer; FGDs, focus group discussions; HFI, health facility in charge; IDIs, in-depth interviews; P4P, pay for performance; RCH, reproductive and child health; SDGs, sustainable development goals; TBAs, traditional birth attendants; UHC, universal health coverage; MSD, Medical Stores Department.
Data Sharing Statement
Data were obtained from the Pangani district hospital, Mwera health centre and three dispensaries which were Masaika, Kwakibuyu, and Mkalamo. The datasets used and/or analyzed during the current study are available from the corresponding author on request.
Ethics Approval and Consent to Participate
Ethical clearance was obtained from the Ifakara Health Institute’s Institutional Review Board (IRB) with reference number IHI/IRB/No: 01-2019. Consent to participate in the study was requested from the study participants each of whom signed the consent form before participating in the study. Confidentiality of all the study participants’ information was observed and maintained. The Pangani district authority was informed for approval and support. This manuscript was permitted to be published by the National Institute for Medical Research in Tanzania with reference permission number NIMR/HQ/P.12 VOL XXXIII/63.
Acknowledgments
We acknowledge the help of Pangani district administration, Council Health Management Team, Health facility in charges, Community health governing members, and maternal health beneficiaries from each study facility for their participation in the study. We are grateful for the contribution made by Hajirani Msuya and August Joachim Kuwawenaruwa in this study. Amon Exavery from Pact Tanzania is acknowledged for his technical review and organization of the manuscript.
Author Contributions
All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, agreed to the submitted journal, and agreed to be accountable for all aspects of the work.
Disclosure
The authors declare that they have no conflicts of interest for this work.