在坦桑尼亚西部基戈马农村地区实施卫生设施直接融资

Flora Joram, Jairos Hiliza, Sirili Nathanael, Amani Anaeli
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引用次数: 0

摘要

坦桑尼亚通过权力下放实行权力下放,从而能够在这些设施中实施直接卫生设施融资方案。虽然据报告,在dhf下取得了大量成果,但在改善保健服务提供方面也有明显的失败。本研究旨在探讨在基戈马区议会农村地区实施DHFF方案的经验。在基戈马地区议会的初级保健设施中进行了一项探索性质的研究。采用了有目的的抽样技术,抽取了21名关键举报人,其中包括卫生设施负责人和卫生设施管理委员会成员。关键信息访谈(KII)用于向研究参与者征求信息。采用内容分析技术对研究参与者收集的数据进行分析。我们的研究结果提出了实施DHFF的推动因素和障碍。由于提供了正式培训和支持性监督、遵守了DHFF准则、卫生机构提供了规划准则、HFGC的运作以及遵守了采购程序,DHFF得以成功实施。规划的主人主人感低、延迟和资金支付不足、卫生工作者短缺以及对DHFF规划实施的了解不足成为阻碍规划成功实施的障碍。评估DHFF方案的实施经验要求国家一级的决策者设计一种及时支付资金的机制,加强能力建设,以增加卫生设施在日常业务中的自主权。此外,结构和操作障碍需要进一步的操作和实施研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Implementation of direct health facility financing in the Rural District of Kigoma in Western Tanzania
The adoption of decentralization by devolution in Tanzania has enabled the implementation of a Direct Health Facility Financing (DHFF) program in the facilities. While copious gains have been reported under DHFF, there are also notable failures to improve health service provision. This study aims to explore the experience of implementing the DHFF program in the rural areas of the Kigoma District Council. An exploratory qualitative study was conducted in Primary Health Care (PHC) facilities of the Kigoma District Council. A purposive sampling technique was used to draw 21 Key Informants including leaders of health facilities and members of the Health Facility Governing Committees (HFGC). Key Informant Interviews (KII) were used to solicit information from the study participants. Content analysis technique was used to analyze data collected from study participants. Our findings present enablers and barriers in the implementation of DHFF. Successful implementation of DHFF was enabled by the availability of formal training and supportive supervision, adherence to DHFF guidelines, availability of planning guidelines at the health facility, functionality of the HFGC, and adherence to the procurement process. A low sense of ownership of the program, delays and insufficient fund disbursement, shortage of health workers, and inadequate knowledge of DHFF program implementation emerged as the barriers that impeded successful program implementation. Evaluating the implementation experience of the DHFF program requires policymakers at the national level to devise a mechanism for the timely disbursement of funds, reinforcing capacity building to increase the autonomy of health facilities in their daily operations. Furthermore, structural and operational barriers warrant further operational and implementation research.
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