Affiliations 

  • 1 Health Systems Department, Ifakara Health Institute, Dar es Salaam, Tanzania
  • 2 United Nations University's International Institute for Global Health (UNU-IIGH), UNU-IIGH Building, UKM Medical Centre, Kuala Lumpur, Malaysia
  • 3 Department of Health, Social Welfare and Nutrition Services, Institute of Development Studies, University of Dar es Salaam, Dar es Salaam, Tanzania
  • 4 President's Office-Regional Administration and Local Government (PO-RALG) Dodoma, Dodoma, Tanzania
PMID: 30461049 DOI: 10.1002/hpm.2702

Abstract

Health care financing reforms are gaining popularity in a number of African countries to increase financial resources and promote financial autonomy, particularly at peripheral health care facilities. The paper explores the establishment of facility bank accounts at public primary facilities in Tanzania, with the intention of informing other countries embarking on such reform of the lessons learned from its implementation process. A case study approach was used, in which three district councils were purposively sampled. A total of 34 focus group discussions and 14 in-depth interviews were conducted. Thematic content analysis was used during analysis. The study revealed that the main use of bank account revenue was for the purchase of drugs, medical supplies, and minor facility needs. To ensure accountability for funds, health care facilities had to submit monthly reports of expenditures incurred. District managers also undertook quality control of facility infrastructure, which had been renovated using facility resources and purchases of facility needs. Facility autonomy in the use of revenue retained in their accounts would improve the availability of drugs and service delivery. The experienced process of opening facility bank accounts, managing, and using the funds highlights the need to strengthen the capacity of staff and health-governing committees.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.