Impact of Direct Health Facility Financing on Health Insurance Enrollment and Service Quality in Dodoma Region, Tanzania

Abstract

The National Health Insurance Fund (NHIF) and the Improved Community Health Fund (iCHF) are pre-payment schemes in Tanzania designed to achieve universal health coverage (UHC). Despite these efforts, public health facilities have historically struggled with poor-quality care. In response, the Direct Health Facility Financing (DHFF) mechanism was introduced in 2017, enabling health facilities to procure medicines and equipment directly from approved vendors when out-of-stock notifications are received from the Medical Store Department (MSD). This study evaluates the impact of DHFF on health insurance enrollment and service quality in the Dodoma Region. Utilizing a mixed-methods approach with an explanatory sequential design, a total of 35 respondents were involved in the proposed study, of which 30 were obtained from health insurance beneficiaries and 5 were from key informants. Results revealed increased health insurance enrollment for both NHIF and iCHF from 2018–2019 to 2019–2020, attributed to enhanced medicine availability, community education, and sensitization efforts. Beneficiaries reported significant improvements in health facilities, including better medicine availability, upgraded infrastructure, and improved attitudes from healthcare providers. Healthcare providers and authorities also noted improved service quality since DHFF's introduction. However, challenges remain, particularly with MSD's rigidity in notifying health facilities about out-of-stock items. Recommendations include enhancing the MSD's supply chain management to ensure timely notifications and deliveries. Future research should expand to multiple regions to account for cultural variations and additional factors influencing health insurance participation, enrollment, and service quality.