The impact of direct health facility financing on MNCH service provision: results from a comparative, before-after study in Pwani Region, Tanzania.

Autor: Oh KK; Korea Foundation for International Healthcare (KOFIH) Tanzania Office, Dar es Salaam, Tanzania. kyoungkyun@kofih.org.; School of Health & Wellbeing, University of Glasgow, Glasgow, UK. kyoungkyun@kofih.org., Ferdinand JG; Korea Foundation for International Healthcare (KOFIH) Tanzania Office, Dar es Salaam, Tanzania., Kapologwe NA; Ministry of Health, Dodoma, Tanzania., Ngaiza BM; Regional Secretariat- Pwani Region, Regional Commissioner's Office, Pwani, Tanzania., Gordon JM; Regional Secretariat- Pwani Region, Regional Commissioner's Office, Pwani, Tanzania., Lim D; Han-a Urban Research Institute, Seoul, Korea., Ngowi AE; Regional Secretariat- Pwani Region, Regional Commissioner's Office, Pwani, Tanzania., Yusuph SA; Korea Foundation for International Healthcare (KOFIH) Tanzania Office, Dar es Salaam, Tanzania., Kim H; Korea Foundation for International Healthcare (KOFIH) Tanzania Office, Dar es Salaam, Tanzania., Park H; Korea Foundation for International Healthcare (KOFIH) Tanzania Office, Dar es Salaam, Tanzania., Ahn S; Korea Foundation for International Healthcare (KOFIH), Seoul, Korea., Nam BH; Korea Foundation for International Healthcare (KOFIH), Seoul, Korea., Kim CY; Graduate School of Public Health, Seoul National University, Seoul, Korea.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2024 Nov 18; Vol. 24 (1), pp. 1424. Date of Electronic Publication: 2024 Nov 18.
DOI: 10.1186/s12913-024-11917-w
Abstrakt: Background: Pwani Regional Secretariat in Tanzania implemented the Maternal, Neonatal, and Child Health Project (2016-2022) through Direct Health Facility Financing (DHFF), which allocates funds directly to health facilities. This study assessed the impact of the six-year DHFF project in Pwani region.
Methods: The study utilised District Health Information Software 2 data from 18 intervention health facilities in Pwani region. Control groups comprised an equal number of facilities from Pwani and Dodoma regions where the project was not implemented. Key indicators assessed included 'ANC 4 + Rate (%)', 'Percentage of Mothers tested for Anaemia during ANC', 'Caesarean Section Delivery Rate (%)', 'Percentage of Mothers and Newborns receiving PNC services within 48 hours', 'Delivery Complication Rate (%)', and 'SBA Delivery Rate (%)' which are associated with the project interventions. The impact of the project was analysed using a paired sample t-test comparing baseline and endline data. We evaluated the significance of the dependent variables using one-way ANOVA with control groups, with the Tukey-Kramer test for post hoc analysis. Chi-square test assessed the significance of Caesarean Section Delivery Rate and the relationship between variables and health facility conditions. Pearson correlation test was used for significance between funding size and the change of MNCH variables. Statistical significance at 0.05 was calculated.
Results: The project showed limited positive impacts, only in the 'Percentage of Mothers tested for Anaemia during ANC' (****p < 0.0001), 'Percentage of Newborns receiving PNC within 48 hours' (**p = 0.0095), and 'SBA Delivery Rate' (***p = 0.0043). The health facility assessment identified positively influencing factors on service delivery, such as facility type (*p = 0.0347), distance to the facility (****p < 0.0001), and internet connectivity (*p = 0.0186). We found that the project did not improve most MNCH indicators, including the CEmONC coverage (χ2 = 2.82, p = 0.2448, df = 2), which was known to be the leading outcome.
Conclusion: The project had limited impacts on MNCH outcomes due to various factors. While the health facility assessment highlighted positive influences on service delivery, significant areas for improvement remain, including referral systems and infrastructure. Operational research findings indicate that the effectiveness of the DHFF could be enhanced by refining its management and governance structures.
Competing Interests: Declarations Ethics approval and consent to participate Not applicable because the secondary data had no identifying information, and it was completely devoid of such information or was appropriately coded so that researchers did not have access to the codes. Competing interests The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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