Peter Binyaruka
Biographic Data
| ID | 1735069 |
|---|---|
| NAME | Peter Binyaruka |
| GIVEN NAMES | Peter |
| FAMILY NAME | Binyaruka |
| SIGNATURE | BINYARUKA P |
| AFFILIATIONS | Ifakara Health Institute |
| ORCID | 0000-0002-1892-7985 |
| VERIFIED | Yes |
| TOTAL WORKS | 20 |
| TOTAL CITATIONS | 8 |
| AUTHOR COUNT | 20 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2018 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 2 |
Time to fully account for cost in monitoring financial protection and universal health coverage in low- and middle-income settings
Financial protection is a core pillar of universal health coverage (UHC), yet current monitoring approaches in low- and middle-income countries (LMICs) largely focus on direct medical costs, neglecting direct transport costs and indirect time costs lost when seeking care. This commentary highlights the importance of fully accounting for these often-excluded costs, which disproportionately affect poorer and rural populations and can significantly …
Socio-structural and direct health challenges related to illness management among patients with type 2 diabetes in Kenya and Tanzania during the Covid-19 pandemic
During COVID-19, people with type 2 diabetes (T2D) experienced increased vulnerability, including severe COVID-19 complications, disruptions in diabetes management, and social isolation. These aspects were heightened in many sub-Saharan African countries, such as Kenya and Tanzania, where healthcare systems already face critical challenges in coping with increasing non-communicable diseases (NCDs). Little is known about how people with T2D in the…
It is because we women do not have a voice to be heard” - perceptions of gender-based discrimination and its relevance to health
Gender-based discrimination (GBD) remains a pervasive determinant of health inequity for women globally, yet its systemic and culturally embedded forms in low- and middle-income countries are underexplored. This study explores women’s lived experiences of GBD in Burkina Faso, Ghana and Tanzania, highlighting how intersecting social and institutional norms influence access to health care, education, employment, financial resources and the resultin…
Agent-Based Modeling as an Evaluation Tool to Understand the Mechanisms of a Financial Incentives Scheme for Maternal and Child Health in Tanzania
Agent-based models (ABMs) offer a robust mechanism for modeling dynamic health systems and their responses to reforms, capturing vital feedback loops between agents, and incorporating agent heterogeneities.We constructed an ABM to investigate the effects of a supply-side payment-for-performance (P4P) scheme for childbirth care in Tanzania, specifically focusing on its impact on demand-side behaviours.Three classes of agents were included in the m…
Impact of the Covid-19 pandemic on type 2 diabetes care and factors associated with care disruption in Kenya and Tanzania
Background The COVID-19 pandemic affected healthcare delivery globally, impacting care access and delivery of essential services.Objectives We investigated the pandemic’s impact on care for patients with type 2 diabetes and factors associated with care disruption in Kenya and Tanzania.Methods A cross-sectional study was conducted among adults diagnosed with diabetes pre-COVID-19. Data were collected in February–April 2022 reflecting experiences a…
Catastrophic health care spending in managing type 2 diabetes before and during the Covid-19 pandemic in Tanzania
COVID-19 disrupted health care provision and access and reduced household income. Households with chronically ill patients are more vulnerable to these effects as they access routine health care. Yet, a few studies have analysed the effect of COVID-19 on household income, health care access costs, and financial catastrophe due to health care among patients with type 2 diabetes (T2D), especially in developing countries. This study fills that knowl…
Developing the improved Community Health Fund in Tanzania
Tanzania developed its 2016–26 health financing strategy to address existing inequities and inefficiencies in its health financing architecture. The strategy suggested the introduction of mandatory national health insurance, which requires long-term legal, interministerial and parliamentary procedures. In 2017/18, improved Community Health Fund (iCHF) was introduced to make short-term improvements in coverage and financial risk protection for the…
Assessing equity and efficiency of health financing towards universal health coverage between regions in Tanzania
How to do (or not to do)…using causal loop diagrams for health system research in low and middle-income settings
Causal loop diagrams (CLDs) are a systems thinking method that can be used to visualize and unpack complex health system behaviour. They can be employed prospectively or retrospectively to identify the mechanisms and consequences of policies or interventions designed to strengthen health systems and inform discussion with policymakers and stakeholders on actions that may alleviate sub-optimal outcomes. Whilst the use of CLDs in health systems res…
Long-term effects of payment for performance on maternal and child health outcomes
BACKGROUND: The success of payment for performance (P4P) schemes relies on their ability to generate sustainable changes in the behaviour of healthcare providers. This paper examines short-term and longer-term effects of P4P in Tanzania and the reasons for these changes. METHODS: We conducted a controlled before and after study and an embedded process evaluation. Three rounds of facility, patient and household survey data (at baseline, after 13 m…
Falling aid for reproductive, maternal, newborn and child health in the lead-up to the Covid-19 pandemic
box Greater investment in reproductive, maternal, newborn and child health (RMNCH) is needed to mitigate the negative effects of COVID-19 and avoid a reversal of recent gains in RMNCH coverage and outcomes. Aid for RMNCH as a whole fell by 6% between 2017 and 2018 and only increased by 2% in 2019; over the same 2-year period, aid for the reproductive health of non-pregnant women fell by 25%. Volatile and falling aid for RMNCH may have rendered RM…
Supply-side factors influencing informal payment for healthcare services in Tanzania
Informal payments for healthcare are widespread in sub-Saharan Africa. They are often regressive, potentially limiting access to quality healthcare, particularly for the most vulnerable, and can have catastrophic consequences for households. Yet there is little empirical research that uses theory-driven hypotheses to explore what influences informal payments and, especially, from health workers’ perspectives. Consequently, we have explored the ch…
Understanding the maternal and child health system response to payment for performance in Tanzania using a causal loop diagram approach
Pay-for-performance reduces bypassing of health facilities
Many patients and expectant mothers in low-income countries bypass local health facilities in search of better-quality services. This study examines the impact of a payment-for-performance (P4P) scheme on bypassing practices among expectant women in Tanzania. We expect the P4P intervention to reduce incidences of bypassing by improving the quality of services in local health facilities, thereby reducing the incentive to migrate. We used a differe…
Evaluating performance-based financing in low-income and middle-income countries
Over the last decade, performance-based financing (PBF) has gained momentum as a health financing innovation, which combines linking healthcare payments to performance with increased provider autonomy and supervision. 1 2 The combination of these elements is expected to boost supply-side efforts towards increasing quantity and quality of service provision, triggering a demand-side response towards improved service utilisation.1 3 4 A recent paper…
Understanding efficiency and the effect of pay-for-performance across health facilities in Tanzania
BACKGROUND: Ensuring efficient use and allocation of limited resources is crucial to achieving the UHC goal. Performance-based financing that provides financial incentives for health providers reaching predefined targets would be expected to enhance technical efficiency across facilities by promoting an output-oriented payment system. However, there is no study which has systematically assessed efficiency scores across facilities before and after…
Thank You to Reviewers 2019
Implementation and effectiveness of free health insurance for the poor pregnant women in Tanzania
Who benefits from increased service utilisation? Examining the distributional effects of payment for performance in Tanzania
P4P can enhance equitable healthcare access and use especially when the demand-side barriers to access care such as user fees associated with drug purchase due to stock-outs have been reduced
Does payment for performance increase performance inequalities across health providers? A case study of Tanzania
The impact of payment-for-performance (P4P) schemes in the health sector has been documented, but there has been little attention to the distributional effects of P4P across health facilities. We examined the distribution of P4P payouts over time and assessed whether increased service coverage due to P4P differed across facilities in Tanzania. We used two service outcomes that improved due to P4P [facility-based deliveries and provision of antima…
Understanding the maternal and child health system response to payment for performance in Tanzania using a causal loop diagram approach
Pay-for-performance reduces bypassing of health facilities
Many patients and expectant mothers in low-income countries bypass local health facilities in search of better-quality services. This study examines the impact of a payment-for-performance (P4P) scheme on bypassing practices among expectant women in Tanzania. We expect the P4P intervention to reduce incidences of bypassing by improving the quality of services in local health facilities, thereby reducing the incentive to migrate. We used a differe…
Implementation and effectiveness of free health insurance for the poor pregnant women in Tanzania
Does payment for performance increase performance inequalities across health providers? A case study of Tanzania
The impact of payment-for-performance (P4P) schemes in the health sector has been documented, but there has been little attention to the distributional effects of P4P across health facilities. We examined the distribution of P4P payouts over time and assessed whether increased service coverage due to P4P differed across facilities in Tanzania. We used two service outcomes that improved due to P4P [facility-based deliveries and provision of antima…
Who benefits from increased service utilisation? Examining the distributional effects of payment for performance in Tanzania
P4P can enhance equitable healthcare access and use especially when the demand-side barriers to access care such as user fees associated with drug purchase due to stock-outs have been reduced
Does payment for performance increase performance inequalities across health providers? A case study of Tanzania
The impact of payment-for-performance (P4P) schemes in the health sector has been documented, but there has been little attention to the distributional effects of P4P across health facilities. We examined the distribution of P4P payouts over time and assessed whether increased service coverage due to P4P differed across facilities in Tanzania. We used two service outcomes that improved due to P4P [facility-based deliveries and provision of antima…
Implementation and effectiveness of free health insurance for the poor pregnant women in Tanzania
Evaluating performance-based financing in low-income and middle-income countries
Over the last decade, performance-based financing (PBF) has gained momentum as a health financing innovation, which combines linking healthcare payments to performance with increased provider autonomy and supervision. 1 2 The combination of these elements is expected to boost supply-side efforts towards increasing quantity and quality of service provision, triggering a demand-side response towards improved service utilisation.1 3 4 A recent paper…
Understanding efficiency and the effect of pay-for-performance across health facilities in Tanzania
BACKGROUND: Ensuring efficient use and allocation of limited resources is crucial to achieving the UHC goal. Performance-based financing that provides financial incentives for health providers reaching predefined targets would be expected to enhance technical efficiency across facilities by promoting an output-oriented payment system. However, there is no study which has systematically assessed efficiency scores across facilities before and after…
Thank You to Reviewers 2019
Long-term effects of payment for performance on maternal and child health outcomes
BACKGROUND: The success of payment for performance (P4P) schemes relies on their ability to generate sustainable changes in the behaviour of healthcare providers. This paper examines short-term and longer-term effects of P4P in Tanzania and the reasons for these changes. METHODS: We conducted a controlled before and after study and an embedded process evaluation. Three rounds of facility, patient and household survey data (at baseline, after 13 m…
Falling aid for reproductive, maternal, newborn and child health in the lead-up to the Covid-19 pandemic
box Greater investment in reproductive, maternal, newborn and child health (RMNCH) is needed to mitigate the negative effects of COVID-19 and avoid a reversal of recent gains in RMNCH coverage and outcomes. Aid for RMNCH as a whole fell by 6% between 2017 and 2018 and only increased by 2% in 2019; over the same 2-year period, aid for the reproductive health of non-pregnant women fell by 25%. Volatile and falling aid for RMNCH may have rendered RM…
Supply-side factors influencing informal payment for healthcare services in Tanzania
Informal payments for healthcare are widespread in sub-Saharan Africa. They are often regressive, potentially limiting access to quality healthcare, particularly for the most vulnerable, and can have catastrophic consequences for households. Yet there is little empirical research that uses theory-driven hypotheses to explore what influences informal payments and, especially, from health workers’ perspectives. Consequently, we have explored the ch…
Understanding the maternal and child health system response to payment for performance in Tanzania using a causal loop diagram approach
Pay-for-performance reduces bypassing of health facilities
Many patients and expectant mothers in low-income countries bypass local health facilities in search of better-quality services. This study examines the impact of a payment-for-performance (P4P) scheme on bypassing practices among expectant women in Tanzania. We expect the P4P intervention to reduce incidences of bypassing by improving the quality of services in local health facilities, thereby reducing the incentive to migrate. We used a differe…
How to do (or not to do)…using causal loop diagrams for health system research in low and middle-income settings
Causal loop diagrams (CLDs) are a systems thinking method that can be used to visualize and unpack complex health system behaviour. They can be employed prospectively or retrospectively to identify the mechanisms and consequences of policies or interventions designed to strengthen health systems and inform discussion with policymakers and stakeholders on actions that may alleviate sub-optimal outcomes. Whilst the use of CLDs in health systems res…
Catastrophic health care spending in managing type 2 diabetes before and during the Covid-19 pandemic in Tanzania
COVID-19 disrupted health care provision and access and reduced household income. Households with chronically ill patients are more vulnerable to these effects as they access routine health care. Yet, a few studies have analysed the effect of COVID-19 on household income, health care access costs, and financial catastrophe due to health care among patients with type 2 diabetes (T2D), especially in developing countries. This study fills that knowl…
Developing the improved Community Health Fund in Tanzania
Tanzania developed its 2016–26 health financing strategy to address existing inequities and inefficiencies in its health financing architecture. The strategy suggested the introduction of mandatory national health insurance, which requires long-term legal, interministerial and parliamentary procedures. In 2017/18, improved Community Health Fund (iCHF) was introduced to make short-term improvements in coverage and financial risk protection for the…
Assessing equity and efficiency of health financing towards universal health coverage between regions in Tanzania
Impact of the Covid-19 pandemic on type 2 diabetes care and factors associated with care disruption in Kenya and Tanzania
Background The COVID-19 pandemic affected healthcare delivery globally, impacting care access and delivery of essential services.Objectives We investigated the pandemic’s impact on care for patients with type 2 diabetes and factors associated with care disruption in Kenya and Tanzania.Methods A cross-sectional study was conducted among adults diagnosed with diabetes pre-COVID-19. Data were collected in February–April 2022 reflecting experiences a…
Socio-structural and direct health challenges related to illness management among patients with type 2 diabetes in Kenya and Tanzania during the Covid-19 pandemic
During COVID-19, people with type 2 diabetes (T2D) experienced increased vulnerability, including severe COVID-19 complications, disruptions in diabetes management, and social isolation. These aspects were heightened in many sub-Saharan African countries, such as Kenya and Tanzania, where healthcare systems already face critical challenges in coping with increasing non-communicable diseases (NCDs). Little is known about how people with T2D in the…
It is because we women do not have a voice to be heard” - perceptions of gender-based discrimination and its relevance to health
Gender-based discrimination (GBD) remains a pervasive determinant of health inequity for women globally, yet its systemic and culturally embedded forms in low- and middle-income countries are underexplored. This study explores women’s lived experiences of GBD in Burkina Faso, Ghana and Tanzania, highlighting how intersecting social and institutional norms influence access to health care, education, employment, financial resources and the resultin…
Agent-Based Modeling as an Evaluation Tool to Understand the Mechanisms of a Financial Incentives Scheme for Maternal and Child Health in Tanzania
Agent-based models (ABMs) offer a robust mechanism for modeling dynamic health systems and their responses to reforms, capturing vital feedback loops between agents, and incorporating agent heterogeneities.We constructed an ABM to investigate the effects of a supply-side payment-for-performance (P4P) scheme for childbirth care in Tanzania, specifically focusing on its impact on demand-side behaviours.Three classes of agents were included in the m…
Time to fully account for cost in monitoring financial protection and universal health coverage in low- and middle-income settings
Financial protection is a core pillar of universal health coverage (UHC), yet current monitoring approaches in low- and middle-income countries (LMICs) largely focus on direct medical costs, neglecting direct transport costs and indirect time costs lost when seeking care. This commentary highlights the importance of fully accounting for these often-excluded costs, which disproportionately affect poorer and rural populations and can significantly …
Global Maternal and Child Health (15 works) · Economics (14 works) · Medicine (14 works) · Environmental health (13 works) · Tanzania (13 works) · Business (12 works) · Socioeconomics (12 works) · Health care (11 works) · Healthcare Systems and Reforms (11 works) · Economic growth (9 works)