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.
The Shared Socioeconomic Pathways (SSPs) provide valuable insights to understand how future socioeconomic changes could alter the magnitude and pattern of climate-related risks across sectors, which might facilitate or hinder adaptation and mitigation responses. Many sectors have created SSP narrative extensions to specify insights for their domains. In this Viewpoint, we created health narrative extensions for the SSPs, considering socioeconomic and demographic drivers and population health and health-system drivers. The projected health-relevant trajectories diverge substantially over the course of the 21st century. The SSP3 and SSP4 narratives detail changes that could contribute considerable risks to health, whereas the SSP1 and SSP5 narratives highlight the role of effective governance and adequate resourcing in reducing climate-sensitive population health outcomes and health-system drivers. Given that climate forcing is considered exogenous to these narrative extensions, SSP5's favourable health driver paths do not account for the potential adverse impacts of this high-emissions pathway. The narratives elaborate population health drivers that can improve the policy relevance of population health and health-system risk projections associated with climate change across a range of possible pathways, and link these drivers with relevant cross-sectoral issues (eg, water and energy). Further research is required to quantify key drivers of population health and health-system risks at global to local scales.