提供者自主在坦桑尼亚工作得很好吗? 初级保健设施在直接设施融资下预算执行的前景以及影响辛吉达地区提供者自治的因素
Peter Binyaruka1, John Maiba1, Dastan Mshana2
1Department of Health System, Impact Evaluation, and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania.
Health systems and reform
|December 9, 2024
概括
坦桑尼亚的直接设施融资 (DFF) 赋予初级保健设施权力,但面临执行挑战. 延误,复杂的流程和支出限制阻碍了设施的自主性,尽管员工对财务管理有意识.
科学领域:
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
- 卫生系统研究 卫生系统研究
背景情况:
- 直接设施融资 (DFF) 是低收入和中等收入国家新兴的医疗融资模式.
- 坦桑尼亚实施了DFF以改善初级保健资源分配和设施自主性.
- 关于初级保健机构在执行DFF资金方面的自主权的证据有限.
研究的目的:
- 评估坦桑尼亚初级保健机构在执行直接设施融资 (DFF) 资金方面的自主性.
- 确定影响DFF下的初级保健设施自主性的因素.
- 提供证据,以改善DFF的实施和卫生融资.
主要方法:
- 采用采访和与卫生工作者,管理人员和社区代表进行小组讨论的定性研究.
- 从坦桑尼亚两个议会收集的数据.
- 用于探索影响预算执行自主性的因素的主题内容分析.
主要成果:
- 初级保健机构表现出对财务管理的认识,并拥有足够的自主权来执行DFF资金.
- 关键的约束包括资金支付延迟,复杂的采购/审批流程,严格的支出上限和重新分配限制.
- 财务管理能力的缺陷也被认为是瓶.
结论:
- 直接设施融资 (DFF) 对医疗融资充满希望,但面临着重大实施障碍.
- 前线服务提供商的自主性受到公共财务管理中的系统性问题的限制.
- 需要进行政策改革,以更好地使公共财政管理与卫生融资目标保持一致,以提高DFF的有效性.
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