Factors influencing implementation of the Community Health Fund in Tanzania

Kamuzora, Peter; Gilson, Lucy

doi:10.1093/heapol/czm001

Cited by 137 publications

(163 citation statements)

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“…There are however a few notable exceptions [19] and our paper contribute towards filling that empirical gap. We do this by focusing on how multiple sector responses to healthcare challenges in a resource-constrained environment are driven by and impact policy objectives.…”

Section: Archivos De Medicina Issn 1698-9465mentioning

confidence: 82%

Private Sector Participation in Health Care in Zimbabwe: What's the Value-Added?

Mugwagwa¹

2017

J Healthc Commun

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This paper analyses the private healthcare sector's role in Zimbabwe's health delivery system, especially after economic challenges reduced in real terms fiscal support for public health system funding. This paints a sharp contrast between practicalities of achieving affordable and accessible public healthcare on one hand, and the economic and social realities of underfunded and skills-constrained health systems. Using as empirical models and analytical lenses the country's 2009-2013 National Health Strategy and the WHO's health system building blocks, we examine the role played by private sector health delivery actors in the last 10 years and suggest that although the private sector added value, there is a bigger challenge of weak macro-level coordination and communication within the health sector which create problems for systemic design, strategy formulation and feedback mechanisms, important for institutional innovation and timely responses to changing dynamics. Macro-level coordination can be aided by documentation and standardisation of procedures, processes and approaches by different health delivery actors to align with national health delivery goals, allowing more predictable and measurable impact from interventions by different actors.

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Section: Archivos De Medicina Issn 1698-9465mentioning

confidence: 82%

Private Sector Participation in Health Care in Zimbabwe: What's the Value-Added?

Mugwagwa¹

2017

J Healthc Commun

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“…Nonetheless, 10 years after the introduction of the CHF, only 10 percent of Tanzanians were enrolled; one of the reasons cited was inability to pay (Kamuzora and Gilson, 2007). While CCT payments were made at the household level, conditions applied at the individual level.…”

Section: Health Care and Health In Rural Tanzaniamentioning

confidence: 99%

Cash Transfers and Health: Evidence from Tanzania

Evans¹,

Holtemeyer²,

Kosec³

2016

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How do conditional cash transfers impact health-related outcomes? This paper examines the 2010 randomized introduction of a program in Tanzania and finds nuanced impacts. An initial surge in clinic visits after 1.5 years-due to more visits by those already complying with program health conditions and by non-compliers-disappeared after 2.5 years, largely due to compliers reducing above-minimal visits. The study finds significant increases in take-up of health insurance and the likelihood of seeking treatment when ill.Health improvements were concentrated among children ages 0-5 years rather than the elderly, and took time to materialize; the study finds no improvements after 1.5 years, but 0.76 fewer sick days per month after 2.5 years, suggesting the importance of looking beyond short-term impacts. Reductions in sick days were largest in villages with more baseline health workers per capita, consistent with improvements being sensitive to capacity constraints. These results are robust to adjustments for multiple hypothesis testing.

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“…It emphasizes the power relationships among actors between and within organiza- [ 24 ], and of beneficiaries [ 25 ]. Environmental health officers in Ghana [ 26 ], for example, and community health workers in Brazil [ 27 ], exercised their power to support policy implementation; whereas in South Africa [ 28 ] and Tanzania [ 29 ] resistance from local level health workers and managers undermined the achievement of policy objectives. These two implementation models suggest, therefore, that policy implementation is a much more negotiated and contested process than that envisaged in the mechanical model.…”

Section: Understanding Policy Implementationmentioning

confidence: 99%

Health systems and institutions

Gilson¹

2011

Health Systems in Low- And Middle-Income Countries

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economic incentives); the normative pillar of norms and values that confer both responsibilities that constrain social behaviour, and rights that enable social action; and the cultural-cognitive pillar of shared routines, conceptions, and frames through which meaning is made [ 4 ]. Although institutions are fairly stable social structures they can and do change over time because there is a two-way process of influence: individual preferences and values are both shaped by, and shape, institutions [ 3 ]. Conceptualizing health 'systems'Five conceptual frameworks are discussed here, allowing examination of different and changing understandings of the nature of a health system, thus complementing Chapter 1. In order of chronological development, these are: Roemer's 1991 outline framework [ 5 ] A focus on health care or on health?Of these five frameworks, three focus squarely on health care and health services [5][6]8 ]. Only two encompass activities relevant to promoting, restoring, or maintaining health (but see also [ 9 ], discussed in Chapter 10). The Frenk framework [ 7 ], for example, includes other sectors and their production of services with health effects. It also gives the population, through community participation, a role in and influence over health care organizations, as well as recognizing its role in providing people, money, and data for the overall system. The broader focus of the WHO building block (WHO BB) framework [ 1 ] is more hidden. However, it describes the health information system as encompassing the collection and use of information on 'health determinants, health systems performance and health status', and notes that leadership/governance includes concern for the health-promoting actions of other government sectors. An inventory or relational approach?Both the WHO BB framework [ 1 ] and Roemer [ 5 ] appear to adopt an inventory approach [ 7 ] to understanding a health system: that is, they identify a set of core functions but do not specify the health system actors engaged in these functions nor the relationships among them. Figure 2.1 , thus, gives no sense of the interactions among health system building blocks, nor how they impact on performance outcomes. Similarly, although Figure 2.2 signals interactions

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Factors influencing implementation of the Community Health Fund in Tanzania

Cited by 137 publications

References 13 publications

Private Sector Participation in Health Care in Zimbabwe: What's the Value-Added?

Private Sector Participation in Health Care in Zimbabwe: What's the Value-Added?

Cash Transfers and Health: Evidence from Tanzania

Health systems and institutions

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