Kapologwe Ntuli A, Marwa Boniphace, Marwa Heri, Kebby Ally, Kengia James Tumaini, Ruhago George, Kibusi Stephen M, Mboya Innocent B, Mtei Gemini, Kalolo Albino
Department of Health, Social Welfare and Nutrition Services, President's Office Regional Administration and Local Government (PORALG), P.O. Box 1923, Dodoma, Tanzania.
Regional Medical Officer, Simiyu, Bariadi, Tanzania.
Cost Eff Resour Alloc. 2024 Nov 12;22(1):80. doi: 10.1186/s12962-024-00571-y.
Scaling up public health interventions in the health systems of resource poor settings come with technical and operational challenges. Little is documented on scaling up complex health financing interventions and their related outcomes, especially the voluntary health insurance schemes. This study aimed to analyse the scale-up steps, successes and challenges of the improved community health fund (iCHF), a voluntary health insurance scheme in Tanzania, METHODS: In this paper, guided by the Expand Net framework (a scale-up framework for health system interventions), we present a systematic analysis of countrywide scale-up of the iCHF that started in 2019 and implemented in partnership between the government and development partners. We systematically collected information on the scale-up steps and the success and challenges. The collected data was analysed using descriptive statistics.
The scale-up involved multiple steps and actions at different levels of the health system. The initial step involved gathering stakeholders' views on scale-up options and strategies. The subsequent steps focused on mobilizing resources for scale-up, advocacy and promotion of the scheme through media, community leaders and role models, capacity building to implementing organs, institutionalizing the scale-up processes, intensifying the scale-upscale-up activities for expansion and spontaneous scale-up and technical backstopping to lower levels of the health system on the scale-up process. We found success and challenges as the scale-upscale-up progressed to mature stages. The success included acceptability and institutionalization of the scale-up activities and growing enrolments and funds in the scheme. The challenges included: the costs to sustaining advocacy and enrolments, equity in scale-upscale-up activities across regions, relying on top-down scale-upscale-up approaches, influence of contextual factors and lack of implementation research alongside the scale-upscale-up process.
This paper underscores the scale up steps and success and challenges of scaling-up a voluntary health insurance scheme in a resource-constrained health system. Sustaining the scale-upscale-up gains will require utilizing program data and experiences to sustainably improve the scheme performance while also harnessing support from stakeholders. Further research is needed to assess equity and quality of outcomes of the scale up.
在资源匮乏地区的卫生系统中扩大公共卫生干预措施面临技术和操作方面的挑战。关于扩大复杂的卫生筹资干预措施及其相关成果，尤其是自愿医疗保险计划的文献记载很少。本研究旨在分析坦桑尼亚一项自愿医疗保险计划——改进型社区卫生基金（iCHF）的扩大步骤、成功经验和挑战。方法：在本文中，以扩展网络框架（一种卫生系统干预措施的扩大框架）为指导，我们对2019年启动并由政府与发展伙伴合作实施的iCHF在全国范围内的扩大情况进行了系统分析。我们系统地收集了关于扩大步骤以及成功经验和挑战的信息。使用描述性统计方法对收集到的数据进行了分析。
扩大涉及卫生系统不同层面的多个步骤和行动。初始步骤包括收集利益相关者对扩大选项和战略的意见。随后的步骤集中于为扩大筹集资源、通过媒体、社区领袖和榜样宣传推广该计划、对实施机构进行能力建设、将扩大过程制度化、加强扩大活动以实现扩展和自发扩大以及在扩大过程中为卫生系统较低层面提供技术支持。随着扩大进展到成熟阶段，我们发现了成功经验和挑战。成功经验包括扩大活动的可接受性和制度化以及该计划中参保人数和资金的增加。挑战包括：维持宣传和参保的成本、各地区扩大活动的公平性、依赖自上而下的扩大方法、背景因素的影响以及在扩大过程中缺乏实施研究。
本文强调了在资源有限的卫生系统中扩大一项自愿医疗保险计划的步骤、成功经验和挑战。要维持扩大成果，需要利用项目数据和经验来可持续地改善该计划的绩效，同时还要利用利益相关者的支持。需要进一步研究来评估扩大的公平性和成果质量。
