The functionality of health facility governing committees and their associated factors in selected primary health facilities implementing direct health facility financing in Tanzania: a mixed‐method study
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Date
2022-03-22
Journal Title
Journal ISSN
Volume Title
Publisher
Wiley
Abstract
Background: In Lower and Middle‐Income Countries (LMICs), decentralization has
dominated the agenda for reforming the organization of service delivery (LMICs).
The fiscal decentralization challenge is a hard one for decentralization. As they strive
to make decisions and use health facility funding, primary healthcare facilities
encounter the obstacles of fiscal decentralization. LMICs are currently implementing
fiscal decentralization reforms to empower health facilities and their Health Facility
Governing Committees (HFGCs) to improve service delivery. Given the scarcity of
systematic evidence on the impact of fiscal decentralization, this study examined the functionality of HFGCs and their associated factors in primary healthcare facilities in
Tanzania that were implementing fiscal decentralization through Direct Health
Facility Financing (DHFF).
Methods: To collect both qualitative and quantitative data, a cross‐sectional
approach was used. The research was carried out in 32 primary healthcare facilities
in Tanzania that were implementing the DHFF. A multistage sample approach was
utilized to pick 280 respondents, using both probability and nonprobability sampling
procedures. A structured questionnaire, in‐depth interviews, and focus group
discussions were used to gather data. The functionality of HFGCs was determined
using descriptive analysis, and associated factors for the functioning of HFGCs
were determined using binary logistic regression. Thematic analysis was used to do
qualitative research.
Result: HFGC functionality under DHFF has been found to be good by 78.57%.
Specifically, HFGCs have been found to have good functionality in mobilizing
communities to join Community Health Funds 87.14%, participating in the
procurement process 85%, discussing community health challenges 81.43% and
planning and budgeting 80%. The functionality of HFGCs has been found to be
associated with the planning and budgeting aspects p value of 0.0011, procurement aspects p value 0.0331, availability of information reports p value 0.0007 and
Contesting for HFGC position p value 0.0187.
Conclusion: The study found that fiscal decentralization via DHFF increases the
functionality of HFGCs significantly. As a result, the report proposes that more effort
be placed into making financial resources available to health facilities.
Description
Research article
Keywords
Community participation, Fiscal decentralization, Functionality, Health facility governing committees, Lower‐Middle Income Countries, Primary healthcare facilities
Citation
DOI: 10.1002/hsr2.611