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Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders’ perspectives

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 t...

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Autores principales: Osei Afriyie, Doris, Hooley, Brady, Mhalu, Grace, Tediosi, Fabrizio, Mtenga, Sally M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8378361/
https://www.ncbi.nlm.nih.gov/pubmed/34413077
http://dx.doi.org/10.1136/bmjgh-2021-005964
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author Osei Afriyie, Doris
Hooley, Brady
Mhalu, Grace
Tediosi, Fabrizio
Mtenga, Sally M
author_facet Osei Afriyie, Doris
Hooley, Brady
Mhalu, Grace
Tediosi, Fabrizio
Mtenga, Sally M
author_sort Osei Afriyie, Doris
collection PubMed
description 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.
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spelling pubmed-83783612021-09-02 Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders’ perspectives Osei Afriyie, Doris Hooley, Brady Mhalu, Grace Tediosi, Fabrizio Mtenga, Sally M BMJ Glob Health Original Research 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. BMJ Publishing Group 2021-08-19 /pmc/articles/PMC8378361/ /pubmed/34413077 http://dx.doi.org/10.1136/bmjgh-2021-005964 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Osei Afriyie, Doris
Hooley, Brady
Mhalu, Grace
Tediosi, Fabrizio
Mtenga, Sally M
Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders’ perspectives
title Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders’ perspectives
title_full Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders’ perspectives
title_fullStr Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders’ perspectives
title_full_unstemmed Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders’ perspectives
title_short Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders’ perspectives
title_sort governance factors that affect the implementation of health financing reforms in tanzania: an exploratory study of stakeholders’ perspectives
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8378361/
https://www.ncbi.nlm.nih.gov/pubmed/34413077
http://dx.doi.org/10.1136/bmjgh-2021-005964
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