Direct health facility financing and its influence on quality compliance in primary healthcare: evidence from Tanzania
Abstract Background Globally, health systems focus on improving the quality of healthcare services through policy changes. Sub-Saharan African countries have been enacting reforms to strengthen their primary healthcare and referral systems including devolution of authority to healthcare facilities....
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BMC
2025-06-01
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| Series: | Health Research Policy and Systems |
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| Online Access: | https://doi.org/10.1186/s12961-025-01361-5 |
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| author | Syabo M. Mwaisengela Patricia A. Materu Chrisogone J. German Novatus Tesha Raymond R. Kiwesa Joseph C. Hokororo Godfrey Kacholi Henry A. Mollel Stephen Kibusi Mackfallen G. Anasel Albino Kalolo Ntuli A. Kapologwe Eliudi S. Eliakimu George M. Ruhago |
| author_facet | Syabo M. Mwaisengela Patricia A. Materu Chrisogone J. German Novatus Tesha Raymond R. Kiwesa Joseph C. Hokororo Godfrey Kacholi Henry A. Mollel Stephen Kibusi Mackfallen G. Anasel Albino Kalolo Ntuli A. Kapologwe Eliudi S. Eliakimu George M. Ruhago |
| author_sort | Syabo M. Mwaisengela |
| collection | DOAJ |
| description | Abstract Background Globally, health systems focus on improving the quality of healthcare services through policy changes. Sub-Saharan African countries have been enacting reforms to strengthen their primary healthcare and referral systems including devolution of authority to healthcare facilities. Devolving health facility financing to primary healthcare providers is a crucial strategy to enhance autonomy in planning, management and resource utilization. In Tanzania, this strategy is called Direct Health Facility Financing (DHFF), and is envisaged to impact on the quality of health services in primary healthcare facilities. This study aimed to determine the effect of DHFF on quality of health services after 3 years of its implementation. Methods This study employed a before–after noncontrolled analysis of the quality scores by considering compliance of public primary health facilities with healthcare quality standards by using star rating assessment data before and after DHFF implementation. Quality scores were established by performance of service areas, namely organization of services, emergencies and referrals; infrastructure, infection prevention and control; clinical services; and clinical support services. Distribution normality of compliance scores was determined through the Shapiro–Wilk test for normal data and were observed to be non-normal. Median change in quality compliance scores were established, Wilcoxon matched pairs sum rank tests estimated probabilities of the change (α = 0.05) and Cohen’s d estimator (d) calculated the effect size of DHFF. Findings This study involved 1216 primary healthcare (PHC) facilities from 10 regions of Tanzania’s mainland, the majority of which were dispensaries (88.8%) and rurally located (86.3%). Findings showed significant positive median change in compliance with quality standards from 0.53 to 0.57 (P < 0.001). However, effect size of DHFF as an intervention is small (d = 0.27). Conclusions Direct health facility financing has impacted a small change in quality of health services. As evidenced by several studies, challenges regarding fidelity to its implementation process including lower spending on health commodities, dependence on and delayed disbursement of Health Sector Basket Funds (HSBF), poor facilities’ planning capacity and shortage of human resources for health must be addressed for it to yield its intended outcome. |
| format | Article |
| id | doaj-art-be216c6251ad4c32afd7873f6b5de4d8 |
| institution | Kabale University |
| issn | 1478-4505 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
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| series | Health Research Policy and Systems |
| spelling | doaj-art-be216c6251ad4c32afd7873f6b5de4d82025-08-20T03:27:11ZengBMCHealth Research Policy and Systems1478-45052025-06-0123111110.1186/s12961-025-01361-5Direct health facility financing and its influence on quality compliance in primary healthcare: evidence from TanzaniaSyabo M. Mwaisengela0Patricia A. Materu1Chrisogone J. German2Novatus Tesha3Raymond R. Kiwesa4Joseph C. Hokororo5Godfrey Kacholi6Henry A. Mollel7Stephen Kibusi8Mackfallen G. Anasel9Albino Kalolo10Ntuli A. Kapologwe11Eliudi S. Eliakimu12George M. Ruhago13Health Quality Assurance Unit, Ministry of HealthSchool of Nursing and Public Health, University of DodomaHealth Quality Assurance Unit, Ministry of HealthSchool of Public Health and Social Sciences, Muhimbili University of Health and Allied SciencesHealth, Social Welfare and Nutrition Services Division, Presidents’ Office Regional Administration and Local GovernmentHealth Quality Assurance Unit, Ministry of HealthDepartment of Health Systems Management, Mzumbe UniversityDepartment of Health Systems Management, Mzumbe UniversitySchool of Nursing and Public Health, University of DodomaDepartment of Health Systems Management, Mzumbe UniversityDepartment of Public Health, St. Francis University College of Health and Allied SciencesPreventive Services Division, Ministry of HealthHealth Quality Assurance Unit, Ministry of HealthSchool of Public Health and Social Sciences, Muhimbili University of Health and Allied SciencesAbstract Background Globally, health systems focus on improving the quality of healthcare services through policy changes. Sub-Saharan African countries have been enacting reforms to strengthen their primary healthcare and referral systems including devolution of authority to healthcare facilities. Devolving health facility financing to primary healthcare providers is a crucial strategy to enhance autonomy in planning, management and resource utilization. In Tanzania, this strategy is called Direct Health Facility Financing (DHFF), and is envisaged to impact on the quality of health services in primary healthcare facilities. This study aimed to determine the effect of DHFF on quality of health services after 3 years of its implementation. Methods This study employed a before–after noncontrolled analysis of the quality scores by considering compliance of public primary health facilities with healthcare quality standards by using star rating assessment data before and after DHFF implementation. Quality scores were established by performance of service areas, namely organization of services, emergencies and referrals; infrastructure, infection prevention and control; clinical services; and clinical support services. Distribution normality of compliance scores was determined through the Shapiro–Wilk test for normal data and were observed to be non-normal. Median change in quality compliance scores were established, Wilcoxon matched pairs sum rank tests estimated probabilities of the change (α = 0.05) and Cohen’s d estimator (d) calculated the effect size of DHFF. Findings This study involved 1216 primary healthcare (PHC) facilities from 10 regions of Tanzania’s mainland, the majority of which were dispensaries (88.8%) and rurally located (86.3%). Findings showed significant positive median change in compliance with quality standards from 0.53 to 0.57 (P < 0.001). However, effect size of DHFF as an intervention is small (d = 0.27). Conclusions Direct health facility financing has impacted a small change in quality of health services. As evidenced by several studies, challenges regarding fidelity to its implementation process including lower spending on health commodities, dependence on and delayed disbursement of Health Sector Basket Funds (HSBF), poor facilities’ planning capacity and shortage of human resources for health must be addressed for it to yield its intended outcome.https://doi.org/10.1186/s12961-025-01361-5Direct health facility financingStar rating assessmentHealthcare quality standardsAutonomyPrimary healthcare |
| spellingShingle | Syabo M. Mwaisengela Patricia A. Materu Chrisogone J. German Novatus Tesha Raymond R. Kiwesa Joseph C. Hokororo Godfrey Kacholi Henry A. Mollel Stephen Kibusi Mackfallen G. Anasel Albino Kalolo Ntuli A. Kapologwe Eliudi S. Eliakimu George M. Ruhago Direct health facility financing and its influence on quality compliance in primary healthcare: evidence from Tanzania Health Research Policy and Systems Direct health facility financing Star rating assessment Healthcare quality standards Autonomy Primary healthcare |
| title | Direct health facility financing and its influence on quality compliance in primary healthcare: evidence from Tanzania |
| title_full | Direct health facility financing and its influence on quality compliance in primary healthcare: evidence from Tanzania |
| title_fullStr | Direct health facility financing and its influence on quality compliance in primary healthcare: evidence from Tanzania |
| title_full_unstemmed | Direct health facility financing and its influence on quality compliance in primary healthcare: evidence from Tanzania |
| title_short | Direct health facility financing and its influence on quality compliance in primary healthcare: evidence from Tanzania |
| title_sort | direct health facility financing and its influence on quality compliance in primary healthcare evidence from tanzania |
| topic | Direct health facility financing Star rating assessment Healthcare quality standards Autonomy Primary healthcare |
| url | https://doi.org/10.1186/s12961-025-01361-5 |
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