Understanding the implementation of Direct Health Facility Financing and its effect on health system performance in Tanzania: a non-controlled before and after mixed method study protocol

Autor: Anna Nswilla, Zainab Chaula, Stephen M. Kibusi, Ntuli A. Kapologwe, Kyaw Myint Aung, Thomas Teuscher, Josephine Borghi, Albino Kalolo
Rok vydání: 2018
Předmět:
medicine.medical_specialty
Financial Management
Maternal-Child Health Services
health system performance
Tanzania
Health administration
03 medical and health sciences
Study Protocol
0302 clinical medicine
Health facility
Health care
medicine
Healthcare Financing
Humans
primary healthcare facilities
030212 general & internal medicine
Developing Countries
Direct Health Facility Financing
Health policy
Quality of Health Care
Finance
implementation fidelity
Social Responsibility
business.industry
030503 health policy & services
Health Policy
Public health
lcsh:Public aspects of medicine
Politics
Health services research
lcsh:RA1-1270
Theory of change
health system responsiveness
Quality Improvement
Government Programs
Patient Satisfaction
Research Design
Accountability
Health Facilities
0305 other medical science
business
Delivery of Health Care
structural quality of healthcare
Program Evaluation
Zdroj: Health Research Policy and Systems
Health Research Policy and Systems, Vol 17, Iss 1, Pp 1-13 (2019)
ISSN: 1478-4505
Popis: Background Globally, good health system performance has resulted from continuous reform, including adaptation of Decentralisation by Devolution policies, for example, the Direct Health Facility Financing (DHFF). Generally, the role of decentralisation in the health sector is to improve efficiency, to foster innovations and to improve quality, patient experience and accountability. However, such improvements have not been well realised in most low- and middle-income countries, with the main reason cited being the poor mechanism for disbursement of funds, which remain largely centralised. The introduction of the DHFF programme in Tanzania is expected to help improve the quality of health service delivery and increase service utilisation resulting in improved health system performance. This paper describes the protocol, which aims to evaluate the effects of DHFF on health system performance in Tanzania. Methods An evaluation of the effect of the DHFF programme will be carried out as part of a nationwide programme rollout. A before and after non-controlled concurrent mixed methods design study will be employed to examine the effect of the DHFF programme implementation on the structural quality of maternal health, health facility governing committee governance and accountability, and health system responsiveness as perceived by the patients’ experiences. Data will be collected from a nationally representative sample involving 42 health facilities, 422 patient consultations, 54 health workers, and 42 health facility governing committees in seven regions from the seven zones of the Tanzanian mainland. The study is grounded in a conceptual framework centered on the Theory of Change and the Implementation Fidelity Framework. The study will utilise a mixture of quantitative and qualitative data collection tools (questionnaires, focus group discussions, in-depth interviews and documentary review). The study will collect information related to knowledge, acceptability and practice of the programme, fidelity of implementation, structural qualities of maternal and child health services, accountability, governance, and patient perception of health system responsiveness. Discussion This evaluation study will generate evidence on both the process and impact of the DHFF programme implementation, and help to inform policy improvement. The study is expected to inform policy on the implementation of DHFF within decentralised health system government machinery, with particular regard to health system strengthening through quality healthcare delivery. Health system responsiveness assessment, accountability and governance of Health Facility Government Committee should bring autonomy to lower levels and improve patient experiences. A major strength of the proposed study is the use of a mixed methods approach to obtain a more in-depth understanding of factors that may influence the implementation of the DHFF programme. This evaluation has the potential to generate robust data for evidence-based policy decisions in a low-income setting. Electronic supplementary material The online version of this article (10.1186/s12961-018-0400-3) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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