NDLI: The impact of direct health facility financing on MNCH service provision: results from a comparative, before-after study in Pwani Region, Tanzania

Content Provider	Springer Nature : BioMed Central
Author	Oh, Kyoung Kyun Ferdinand, Joy G. Kapologwe, Ntuli A. Ngaiza, Benedicto M. Gordon, Joyce M. Lim, Doowon Ngowi, Alfred E. Yusuph, Swabaha A. Kim, Hayoung Park, Hansol Ahn, Sooyoung Nam, Bok Hyun Kim, Chang-yup
Abstract	Background 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. Methods 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. Results 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. Conclusion 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.
Related Links	https://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-024-11917-w.pdf
Ending Page	17
Page Count	17
Starting Page	1
File Format	HTM / HTML
ISSN	14726963
DOI	10.1186/s12913-024-11917-w
Journal	BMC Health Services Research
Issue Number	1
Volume Number	24
Language	English
Publisher	BioMed Central
Publisher Date	2024-11-18
Access Restriction	Open
Subject Keyword	Public Health Health Administration Health Informatics Nursing Research Health System Strengthening Health Financing MNCH DHFF DHIS2 CEmONC ODA KOFIH Tanzania
Content Type	Text
Resource Type	Article
Subject	Health Policy

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

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