Governance factors that affect the implementation of health financing reforms in Tanzania

An exploratory study of stakeholders’ perspectives

Datos Bibliográficos

ID21880486
AutoresDoris Osei Afriyie (0000-0002-9062-7506, Swiss Tropical and Public Health Institute), Brady Hooley (0000-0003-1948-9654, Swiss Tropical and Public Health Institute, autor de correspondencia), Grace Mhalu (0000-0002-0417-3027, Ifakara Health Institute), Fabrizio Tediosi (0000-0001-8671-9400, Swiss Tropical and Public Health Institute), Sally Mtenga (0000-0001-6100-7562, Ifakara Health Institute), Sally M Mtenga (Health Systems, Impact Evaluation and Policy Group, Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of)
Año2021
Volumen6
Número8
Páginase005964
Fecha de publicación2021-08-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaBMJ Global Health (JOURNAL)
Identificadores de la revistaISSN: 2059-7908 • E-ISSN: 2059-7908
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2021-005964
PMID34413077
OpenAlexW3194677418
IdiomaEN
Citas recibidas11
Referencias citadas30

The development of effective and inclusive health financing reforms is crucial for the progressive realisation of universal health coverage in low-income and middle-income countries. Tanzania has been reforming health financing policies to expand health insurance coverage and achieve better access to quality healthcare for all. Recent reforms have included improved community health funds (iCHFs), and others are underway to implement a mandatory national health insurance scheme in order to expand access to services and improve financial risk protection. Governance is a crucial structural determinant for the successful implementation of health financing reforms, however there is little understanding of the governance elements that hinder the implementation of health financing reforms such as the iCHF in Tanzania. Therefore, this study used the perspectives of health sector stakeholders to explore governance factors that influence the implementation of health financing reforms in Tanzania. We interviewed 36 stakeholders including implementers of health financing reforms, policymakers and health insurance beneficiaries in the regions of Dodoma, Dar es Salaam and Kilimanjaro. Normalisation process theory and governance elements guided the structure of the in-depth interviews and analysis. Governance factors that emerged from participants as facilitators included a shared strategic vision for a single mandatory health insurance, community engagement and collaboration with diverse stakeholders in the implementation of health financing policies and enhanced monitoring of iCHF enrolment due to digitisation of registration process. Governance factors that emerged as barriers to the implementation were a lack of transparency, limited involvement of the private sector in service delivery, weak accountability for revenues generated from community level and limited resources due to iCHF design. If stakeholders do not address the governance factors that hinder the implementation of health financing reforms, then current efforts to expand health insurance coverage are unlikely to succeed on their own

Accountability · Business · Corporate governance · Economic growth · Economics · Health care · Political science · Socioeconomics · Tanzania · Global Maternal and Child Health · Healthcare Systems and Reforms · HIV/AIDS Impact and Responses · Finance · Health Policy