Ruhago George M, Ngalesoni Frida N, Kapologwe Ntuli A, Kengia James T, Ngocho James, Kabusi Stephen M, Kalolo Albino, Kitali Erick J, Rwamiago Elisa, Mtei Gemini
Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
Amref Health Africa, Dar Es Salaam, Tanzania.
Front Health Serv. 2023 Jan 9;2:787940. doi: 10.3389/frhs.2022.787940. eCollection 2022.
Universal coverage remains a challenging pursuit around the world, even among the highest-income countries. Strengthening financial management capacity is essential towards attaining the three universal health coverage (UHC) goals, namely, expanded coverage, quality service, and financial protection. In this regard, Tanzania introduced the Facility Financial Accounting and Reporting System (FFARS) in line with the introduction of the Direct Health Facility Financing (DHFF) initiative in primary health care (PHC) in 2017-2018. We aim to assess the functionality of the FFARS in management, accounting, and reporting funds received and disbursed in the stride forward strengthening public financial management in PHC facilities towards UHC.
The study applied implementation research using a concurrent convergent mixed-methods design to assess sources of revenue, expenditure priorities, and changes of revenues and to explore the usability and benefits of FFARS in improving facility finance and reporting systems in more than 5,000 PHC facilities in Tanzania. Quantitative methods assessed the changes in revenues and expenditure between the financial years (FYs) 2017-2018 and 2018-2019, while the qualitative part explored the usability and the benefits FFARS offers in improving facility finances and reporting systems. Data analysis involved a thematic and descriptive analysis for qualitative and quantitative data, respectively.
Of the 5,473 PHC facilities, 88% were in rural areas; however, the annual average revenue was higher in urban facilities in FYs 2017-2018 and 2018-2019. Overall, district hospitals showed an increase whereas health centers reported a decline of more than 40% in revenue. The user fee was the predominant source of revenue, particularly in urban facilities, while revenue from health insurance was not among the top three highest sources of revenue. Expenditure priorities leaned more towards drugs and supplies (25%) followed by allowances and training (21%); these did not differ by facility geographies. In health centers, expenditure on facility infrastructure was predominant. Key Informant Interviews revealed an overall satisfaction and positive experiences related to the system.
The implementation of FFARS in Tanzania demonstrated its high potential in improving facility financial management, including its ability to track revenue and expenditure at PHC facilities. Staffing shortages, ICT infrastructure, and limited opportunities for capacity building could be the limiting factors to reaching the potential of the implementation of FFARS and the attainment of its full impact on Tanzania's pursuit for UHC.
全球普及医疗覆盖仍是一项具有挑战性的工作，即使在高收入国家也是如此。加强财务管理能力对于实现全民健康覆盖（UHC）的三个目标至关重要，这三个目标分别是扩大覆盖范围、提高服务质量和提供财务保护。在这方面，坦桑尼亚于2017 - 2018年在初级卫生保健（PHC）中引入直接卫生机构融资（DHFF）倡议的同时，引入了机构财务会计和报告系统（FFARS）。我们旨在评估FFARS在管理、会计以及报告初级卫生保健机构为实现全民健康覆盖而在加强公共财务管理进程中所接收和支出资金方面的功能。
本研究采用实施研究，运用同步收敛混合方法设计，以评估收入来源、支出重点以及收入变化情况，并探讨FFARS在改善坦桑尼亚5000多家初级卫生保健机构的机构财务和报告系统方面的可用性和益处。定量方法评估了2017 - 2018财年和2018 - 2019财年收入和支出的变化，而定性部分则探讨了FFARS在改善机构财务和报告系统方面的可用性和益处。数据分析分别对定性和定量数据进行了主题分析和描述性分析。
在5473家初级卫生保健机构中，88%位于农村地区；然而，在2017 - 2018财年和2018 - 2019财年，城市机构的年平均收入更高。总体而言，地区医院收入有所增加，而卫生中心报告收入下降超过40%。使用者付费是主要收入来源，特别是在城市机构，而医疗保险收入并非三大最高收入来源之一。支出重点更多地倾向于药品和用品（25%），其次是津贴和培训（21%）；这些在不同地理位置的机构之间没有差异。在卫生中心，机构基础设施支出占主导。关键信息人访谈显示对该系统总体满意且有积极体验。
FFARS在坦桑尼亚的实施显示出其在改善机构财务管理方面的巨大潜力，包括其追踪初级卫生保健机构收入和支出的能力。人员短缺、信息通信技术基础设施以及能力建设机会有限可能是限制FFARS实现其实施潜力以及对坦桑尼亚追求全民健康覆盖产生全面影响的因素。
