Ifakara Health Institute, Dar es Salaam, Tanzania.
Int J Health Policy Manag. 2022 Dec 19;11(12):3079-3089. doi: 10.34172/ijhpm.2022.6234. Epub 2022 Aug 1.
Strategic health purchasing in low- and middle-income countries has received substantial attention as countries aim to achieve universal health coverage (UHC), by ensuring equitable access to quality health services without the risk of financial hardship. There is little evidence published from Tanzania on purchasing arrangements and what is required for strategic purchasing. This study analyses three purchasing arrangements in Tanzania and gives recommendations to strengthen strategic purchasing in Tanzania.
We used the multi-case qualitative study drawing on the National Health Insurance Fund (NHIF), Social Health Insurance Benefit (SHIB), and improved Community Health Fund (iCHF) to explore the three purchasing arrangements with a purchaser-provider split. Data were drawn from document reviews and results were validated with nine key informant (KI) interviews with a range of actors involved in strategic purchasing. A deductive and inductive approach was used to develop the themes and framework analysis to summarize the data.
The findings show that benefit selection for all three schemes was based on the standard treatment guidelines issued by the Ministry of Health. Selection-contracting of the private healthcare providers are based on the location of the provider, the range of services available as stipulated in the scheme guideline, and the willingness of the provider to be contracted. NHF uses fee-for-service to reimburse providers. While SHIB and iCHF use capitation. NHIF has an electronic system to monitor registration, verification, claims processing, and referrals. While SHIB monitoring is done through routine supportive supervision and for the iCHF provider performance is monitored through utilization rates.
Enforcing compliance with the contractual agreement between providers-purchasers is crucial for the provision of quality services in an efficient manner. Investment in a routine monitoring system, such as the use of the district health information system which allows effective tracking of healthcare service delivery, and broader population healthcare outcomes.
随着各国旨在实现全民健康覆盖（UHC），通过确保公平获得高质量的卫生服务，同时避免陷入财务困境，中低收入国家的战略性卫生采购受到了广泛关注。坦桑尼亚在采购安排方面发表的证据很少，也没有关于战略采购所需条件的证据。本研究分析了坦桑尼亚的三种采购安排，并提出了加强坦桑尼亚战略采购的建议。
我们使用多案例定性研究，借鉴国家健康保险基金（NHIF）、社会健康保险福利（SHIB）和改进社区健康基金（iCHF），探索了三种购买安排，这些安排存在购买方和提供方的分离。数据来自文件审查，结果通过与九位关键信息提供者（KI）的访谈得到验证，这些 KI 涉及参与战略采购的各种角色。采用演绎和归纳的方法来开发主题和框架分析，以总结数据。
研究结果表明，所有三种方案的福利选择都基于卫生部发布的标准治疗指南。私营医疗机构的选择-承包基于提供者的位置、方案指南规定的可用服务范围以及提供者的承包意愿。NHF 采用按服务收费来向提供者报销。而 SHIB 和 iCHF 采用人头费。NHIF 有一个电子系统来监测注册、验证、理赔处理和转诊。而 SHIB 的监测是通过常规支持性监督进行的，对于 iCHF，提供者的绩效是通过利用率来监测的。
对提供者-购买者之间的合同协议的执行情况进行监督，对于以高效的方式提供优质服务至关重要。投资于常规监测系统，如使用地区卫生信息系统，这可以有效地跟踪医疗服务的提供情况以及更广泛的人口健康结果。
