PMID- 38035157
OWN - NLM
STAT- MEDLINE
DCOM- 20231204
LR  - 20240210
IS  - 1937-8688 (Electronic)
VI  - 46
DP  - 2023
TI  - Implementation of direct health facility financing in the rural District of 
      Kigoma in Western Tanzania.
PG  - 19
LID - 10.11604/pamj.2023.46.19.41052 [doi]
LID - 19
AB  - The adoption of decentralization by devolution in Tanzania has enabled the 
      implementation of a Direct Health Facility Financing (DHFF) program in the 
      facilities. While copious gains have been reported under DHFF, there are also 
      notable failures to improve health service provision. This study aims to explore 
      the experience of implementing the DHFF program in the rural areas of the Kigoma 
      District Council. An exploratory qualitative study was conducted in Primary 
      Health Care (PHC) facilities of the Kigoma District Council. A purposive sampling 
      technique was used to draw 21 key informants including leaders of health 
      facilities and members of the Health Facility Governing Committees (HFGC). Key 
      Informant Interviews (KII) were used to solicit information from the study 
      participants. Content analysis technique was used to analyze data collected from 
      study participants. Our findings present enablers and barriers in the 
      implementation of DHFF. Successful implementation of DHFF was enabled by the 
      availability of formal training and supportive supervision, adherence to DHFF 
      guidelines, availability of planning guidelines at the health facility, 
      functionality of the HFGC, and adherence to the procurement process. A low sense 
      of ownership of the program, delays and insufficient fund disbursement, shortage 
      of health workers, and inadequate knowledge of DHFF program implementation 
      emerged as the barriers that impeded successful program implementation. 
      Evaluating the implementation experience of the DHFF program requires 
      policymakers at the national level to devise a mechanism for the timely 
      disbursement of funds, reinforcing capacity building to increase the autonomy of 
      health facilities in their daily operations. Furthermore, structural and 
      operational barriers warrant further operational and implementation research.
CI  - Copyright: Flora Joram et al.
FAU - Joram, Flora
AU  - Joram F
AD  - Department of Development Studies, School of Public Health and Social Sciences, 
      Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania.
FAU - Hiliza, Jairos
AU  - Hiliza J
AD  - World Health Organization, Kigoma Field Office, Kigoma, Tanzania.
FAU - Nathanael, Sirili
AU  - Nathanael S
AD  - Department of Development Studies, School of Public Health and Social Sciences, 
      Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania.
FAU - Anaeli, Amani
AU  - Anaeli A
AD  - Department of Development Studies, School of Public Health and Social Sciences, 
      Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania.
LA  - eng
GR  - 001/WHO_/World Health Organization/International
PT  - Journal Article
DEP - 20230914
PL  - Uganda
TA  - Pan Afr Med J
JT  - The Pan African medical journal
JID - 101517926
SB  - IM
MH  - Humans
MH  - Tanzania
MH  - *Health Facilities
MH  - Qualitative Research
PMC - PMC10683170
OTO - NOTNLM
OT  - Health financing
OT  - Western Tanzania
OT  - health governance
OT  - primary health care
COIS- The authors declare no competing interests.
EDAT- 2023/11/30 18:45
MHDA- 2023/12/04 12:42
PMCR- 2023/09/14
CRDT- 2023/11/30 17:45
PHST- 2023/07/12 00:00 [received]
PHST- 2023/08/23 00:00 [accepted]
PHST- 2023/12/04 12:42 [medline]
PHST- 2023/11/30 18:45 [pubmed]
PHST- 2023/11/30 17:45 [entrez]
PHST- 2023/09/14 00:00 [pmc-release]
AID - PAMJ-46-19 [pii]
AID - 10.11604/pamj.2023.46.19.41052 [doi]
PST - epublish
SO  - Pan Afr Med J. 2023 Sep 14;46:19. doi: 10.11604/pamj.2023.46.19.41052. 
      eCollection 2023.