Korea Foundation for International Healthcare (KOFIH) Tanzania Office, Dar es Salaam, Tanzania.
School of Health & Wellbeing, University of Glasgow, Glasgow, UK.
BMC Health Serv Res. 2024 Nov 18;24(1):1424. doi: 10.1186/s12913-024-11917-w.
Pwani Regional Secretariat in Tanzania implemented the Maternal, Neonatal, and Child Health Project (2016-2022) through Direct Health Facility Financing (DHFF), which allocates funds directly to health facilities. This study assessed the impact of the six-year DHFF project in Pwani region.
The study utilised District Health Information Software 2 data from 18 intervention health facilities in Pwani region. Control groups comprised an equal number of facilities from Pwani and Dodoma regions where the project was not implemented. Key indicators assessed included 'ANC 4 + Rate (%)', 'Percentage of Mothers tested for Anaemia during ANC', 'Caesarean Section Delivery Rate (%)', 'Percentage of Mothers and Newborns receiving PNC services within 48 hours', 'Delivery Complication Rate (%)', and 'SBA Delivery Rate (%)' which are associated with the project interventions. The impact of the project was analysed using a paired sample t-test comparing baseline and endline data. We evaluated the significance of the dependent variables using one-way ANOVA with control groups, with the Tukey-Kramer test for post hoc analysis. Chi-square test assessed the significance of Caesarean Section Delivery Rate and the relationship between variables and health facility conditions. Pearson correlation test was used for significance between funding size and the change of MNCH variables. Statistical significance at 0.05 was calculated.
The project showed limited positive impacts, only in the 'Percentage of Mothers tested for Anaemia during ANC' (****p < 0.0001), 'Percentage of Newborns receiving PNC within 48 hours' (**p = 0.0095), and 'SBA Delivery Rate' (***p = 0.0043). The health facility assessment identified positively influencing factors on service delivery, such as facility type (*p = 0.0347), distance to the facility (****p < 0.0001), and internet connectivity (*p = 0.0186). We found that the project did not improve most MNCH indicators, including the CEmONC coverage (χ2 = 2.82, p = 0.2448, df = 2), which was known to be the leading outcome.
The project had limited impacts on MNCH outcomes due to various factors. While the health facility assessment highlighted positive influences on service delivery, significant areas for improvement remain, including referral systems and infrastructure. Operational research findings indicate that the effectiveness of the DHFF could be enhanced by refining its management and governance structures.
坦桑尼亚的巴尼亚地区秘书处在 2016 年至 2022 年期间通过直接卫生机构供资（DHFF）实施了孕产妇、新生儿和儿童健康项目，该项目将资金直接分配给卫生机构。本研究评估了该项目在巴尼亚地区六年的影响。
该研究利用了来自巴尼亚地区 18 个干预卫生机构的地区卫生信息软件 2 数据。对照组由来自巴尼亚和多多马地区的同等数量的设施组成，这些地区没有实施该项目。评估的关键指标包括“ANC 4+率（%）”、“ANC 期间接受贫血检测的母亲比例（%）”、“剖宫产分娩率（%）”、“48 小时内接受 PNC 服务的母亲和新生儿比例（%）”、“分娩并发症率（%）”和“SBA 分娩率（%）”，这些指标与项目干预措施相关。使用配对样本 t 检验比较基线和终线数据来分析项目的影响。我们使用单因素方差分析（ANOVA）评估对照组中因变量的显著性，并使用 Tukey-Kramer 检验进行事后分析。卡方检验评估剖宫产分娩率的显著性以及变量之间的关系和卫生机构条件。Pearson 相关检验用于检验资金规模与 MNCH 变量变化之间的显著性。计算 0.05 水平的统计学显著性。
该项目仅在“ANC 期间接受贫血检测的母亲比例（****p<0.0001）”、“48 小时内接受 PNC 服务的新生儿比例（**p=0.0095）”和“SBA 分娩率（***p=0.0043）”方面显示出有限的积极影响。卫生机构评估确定了对服务提供有积极影响的因素，例如设施类型（*p=0.0347）、距离设施的距离（****p<0.0001）和互联网连接（*p=0.0186）。我们发现该项目并没有改善大多数母婴健康指标，包括孕产妇基本急救能力（CEmONC）覆盖率（χ2=2.82，p=0.2448，df=2），这是主要的结果。
由于各种因素，该项目对母婴健康结果的影响有限。虽然卫生机构评估突出了对服务提供的积极影响，但仍有重大的改进领域，包括转诊系统和基础设施。运营研究结果表明，通过改进直接卫生机构供资的管理和治理结构，可以提高其效果。
