Dissertation (MSc Public Health)
Background: Direct Health Facility Financing (DHFF) is meant to improve quality of health services and brings more autonomy while promoting accountability at Public Primary Health Facilities (PPHFs). This study aimed at establishing the influence of DHFF on perceived status of health service satisfaction and health system responsiveness among clients at PPHFs. Also it established perceived internal and external accountability among Health Care Workers (HCWs) and members of HFGCs respectively. Methodology: A cross sectional analytical study of 23 randomly selected PPHFs, 113 HCWs, 101 members of HFGCs and 521 clients in two randomly selected regions at central zone of Tanzania. Adopted standardized interviewer administered questionnaires namely SEVQUAL and WHO framework were used. Descriptive analysis was used to identify status of service satisfaction, health system responsiveness, internal and external accountability. Multiple logistic regression analysis was used to determine predictors and association between variables (Chisquire and AOR at p< 0.05 was used as significance level).
Results: Half of HCWs perceived the existence of strong internal accountability in PPHFs being predicted by availability of DHFF guidelines (AOR=14.628, p< 0.01), working experience (AOR=7.494, p=0.023) and training (AOR=6.713, p< 0.01). More than half (55.4%) of members of HFGCs perceived existence of strong external accountability in PPHF, being influenced by availability of working guidelines (AOR=2.355, p=0.057) and membership experience (AOR=0.0553, p=0.059). The general performance of clients perception on service satisfaction was poor (39%) as compared to perception on health system responsiveness (55.9%) in PPHFs.
Conclusion: DHFF improved internal and external accountability and health system responsiveness but not service satisfaction. While Internal and External accountability had no significant influence on health system responsiveness, external accountability significantly influenced service satisfaction.