Stakeholders' perspectives on funding malaria, HIV/AIDS and tuberculosis services in Tanzania through domestic resources mobilisation: a qualitative study.

Background: Low-income and middle-income countries continue to face challenges in financing health programmes due to budgetary constraints and decreased donor funding. Off-budget financing has become crucial for controlling diseases like malaria, HIV/AIDS and tuberculosis (TB). However, there is limited evidence on alternative domestic funding approaches to support implementation of healthcare programmes in Tanzania.

Objective: The study explored stakeholder perspectives on alternative domestic funding approaches to support malaria, HIV/AIDS and TB services in Tanzania.

Methods: A qualitative descriptive design was employed to gather insights from 76 purposely selected stakeholders, including policymakers, programme managers, regional health managers, district health managers and healthcare workers. Data were managed and analysed thematically.

Results: Four major themes emerged: current sources of funds, financial resources needed, proposed alternative domestic funding mobilisation strategies to support implementation of malaria, HIV/AIDS and TB and challenges of implementing the proposed strategies. Current major sources of funds included multilateral donors, development partners, the central government and internal sources. There was a consensus on a decrease in donor funding due to the COVID-19 pandemic. The proposed alternative domestic funding strategies included establishing universal health insurance, reducing beneficiaries of service exemptions, establishment of disease-specific funds and taxation of certain products. Implementation challenges for the proposed strategies included poor awareness, conflicting political promises and accountability issues.

Conclusions: The financing gap for malaria, HIV/AIDS and TB services is significant due to decreasing donor funding. Strategies such as strengthening insurance schemes, reducing exemption groups and taxation could help, but community sensitisation and improved fund accountability are crucial.