A Dissertation Submitted in Partial Fulfilment of the Requirements for the Degree of Master of Science in Public Health Research of the Nelson Mandela African Institution of Science and Technology
Maternal morbidity and mortality remain significant public health concerns globally, with
Tanzania reporting 524 deaths per 100 000 live births annually in 2022. While national level data
provide some insights into the issue, a focus on sub-national levels is required because of
differences in contexts such as rural-urban disparities in maternal mortality. This study examined
Direct Health Facility Financing (DHFF) and its effects on the quality of maternal health services
in Pangani, a rural district in Tanzania. The study used qualitative and quantitative methods.
Direct disbursement of funds from the central government through the Ministry of Finance and
Planning to the primary health facilities reduced delays in procurement, improved community
outreach services, and improved community leaders’ engagements. Deliveries occurring at health
facilities increased by 33.6% (p<0.001) one year after the DHFF implementation. Various
medicines, delivery kits, and some reagents increased significantly (p<0.05). However,
unavailability of computers and poor internet connectivity, insufficient supply of medical
equipment and stock out at Medical Stores Department increased the difficulty of obtaining the
missed items from the selected prime vendor. Overall, this study shows a positive impact of the
DHFF on maternal health service delivery in Pangani district. Specifically, increase in the number
of medical supplies, equipment, and reagents necessary to provide maternal health services
contributed to the observed increase in facility deliveries by a third. Moreover, the system
minimizes unnecessary delays in the procurement processes of required drugs, supplies, and other
facility reagents. To maximize the impact of the DHFF system, unavailability of computers,
unstable internet, limited knowledge of the staff about the system, and inadequate health
workforce should be addressed. Furthermore, training could include refreshers models on DHFF
implementation.