Implementation evaluation of direct health facility financing at lower health facilities in Tanzania: A case study of Dodoma city council
| dc.contributor.author | Bura, Joseph M. | |
| dc.date.accessioned | 2026-11-02T06:01:45Z | |
| dc.date.issued | 2019 | |
| dc.description | A dissertation submitted partial fulfillment of the requirements for award of the degree of Masters of Science in Health Monitoring and Evaluation to the School of Public Administration and Management of Mzumbe University | |
| dc.description.abstract | Introduction: The Direct Health Facility Financing meant to ensure directly disbursing funds to the lower level health facilities and enabling them together with communities set their own health priorities so as to improve delivery of health services to achieve Universal Health Coverage (UHC). The main focus of the evaluation was implementation of Direct health facility financing in lower facilities in Tanzania, specifically it looked at Disbursement of funds,human resources availability and their capacity in implementation of DHFF, community participation and how social demographic affect the implementation ot DHFF. Methodology: This process evaluation study was conducted in Dodoma City Council and applied the descriptive cross-sectional design. There were 99 Questionnaires, 12 in-depth interviews, 6 focused group discussions, and documentary review. A total of 22 health managers and 32 HFGC participated in an in-depth interview and Focused Group Discussions. Quantitative Data were imported to STATA 13 to run test statistics such as the logistic regression statistical test and chi-square statistical test that was used to assess the relationship and association between the dependent and independent variable respectively. While for qualitative data were transcribed read and re-read for completeness, and then uploaded in Atlas ti 7 to assist the data analysis process. The analysis was assisted by quere tool report. Results: It was found that DHFF funds were disbursed very late from Central Government to facility account. Human resources for health number and their attitude is negatively affecting implementation of DHFF by 74 Percent and 96 Percent respectively, so there is critical shortage of health care providers and unpleasant attitude with insufficient capacity toward users of services. There is observed improvement in motivation due to autonomies in managing facilities funds by health care providers and improved financial fast-tracking of payments due DHFF programme being free from higher-level bureaucracies. Community participation is very low, only 14 Percent of the general population is aware on participation in the planning. It was found that social demographic factors like education, for example, none educated community 75 Percent attend tradition healing compared to the remaining 25 Percent who first attend facility services when they fall sick. Poverty, distance to the facility and local belief were important factor that is affecting implementation DHFF. Conclusion: DHFF Funds are disbursed into the facility account untimely so resulting in an occasional shortage of essential commodities. There is critical of human resources shortage for health that affect implementation of DHFF. There is low community involvement in the implementation of DHFF and social demographic factors such as literacy, economy and distance to facilities is negatively vii affecting implementation of DHFF. We recommend the government to timely disburse funds, recruit human resources for health in the required number, sensitise community participation by preparing simple to understand manuals and advocate health promotion to enhance care seeking behaviours to the communities. Conclusion: Unreliable funds, lack of awareness on SWASH project, poor sectorial coordination and non-consideration of MHHM issues as vital are major challenges impinging smooth implementation of SWASH project. Considerable measures are to viii be taken by government and project designers in areas of scale up, implementation and progress monitoring so as to ensure achievement of envisioned outcomes. recording and data reporting tools in the health facilities, despite that tools are available but still the quality of data remained doubtful due to data disparities observed in the documentary review across different level of response. Family planning data quality assessment is only performed at the District and in the Region level but rarely and improperly conducted at facility levels due to some observed challenges like inadequate knowledge for FP DQA, lack of skilled team, lack of standardized data quality assessment tools, mistrust of data collectors at different levels, data manipulation to fulfil donors requirements, parallel reporting and report overburden at the health facilities. | |
| dc.description.sponsorship | Private | |
| dc.identifier.citation | APA | |
| dc.identifier.uri | https://scholar.mzumbe.ac.tz/handle/123456789/2264 | |
| dc.language.iso | en | |
| dc.publisher | Mzumbe University | |
| dc.subject | Direct Health Facility Financing | |
| dc.subject | Health Facility Autonomy | |
| dc.subject | Community Participation in facility plans. | |
| dc.title | Implementation evaluation of direct health facility financing at lower health facilities in Tanzania: A case study of Dodoma city council | |
| dc.type | Dissertation |