Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 12 2022 07 16 Assessment of Strategic Healthcare Purchasing Arrangements and Functions Towards Universal Coverage in Tanzania 3079 3089 4294 10.34172/ijhpm.2022.6234 EN August Kuwawenaruwa Ifakara Health Institute, Dar es Salaam, Tanzania 0000-0001-8459-443X Suzan Makawia Ifakara Health Institute, Dar es Salaam, Tanzania Peter Binyaruka Ifakara Health Institute, Dar es Salaam, Tanzania 0000-0002-1892-7985 Fatuma Manzi Ifakara Health Institute, Dar es Salaam, Tanzania Journal Article 2021 04 14 Background Strategic health purchasing in low- and middle-income countries has received substantial attention as countries aim to achieve universal health coverage (UHC), by ensuring equitable access to quality health services without the risk of financial hardship. There is little evidence published from Tanzania on purchasing arrangements and what is required for strategic purchasing. This study analyses three purchasing arrangements in Tanzania and gives recommendations to strengthen strategic purchasing in Tanzania. Methods We used the multi-case qualitative study drawing on the National Health Insurance Fund (NHIF), Social Health Insurance Benefit (SHIB), and improved Community Health Fund (iCHF) to explore the three purchasing arrangements with a purchaser-provider split. Data were drawn from document reviews and results were validated with nine key informant (KI) interviews with a range of actors involved in strategic purchasing. A deductive and inductive approach was used to develop the themes and framework analysis to summarize the data. Results The findings show that benefit selection for all three schemes was based on the standard treatment guidelines issued by the Ministry of Health. Selection-contracting of the private healthcare providers are based on the location of the provider, the range of services available as stipulated in the scheme guideline, and the willingness of the provider to be contracted. NHF uses fee-for-service to reimburse providers. While SHIB and iCHF use capitation. NHIF has an electronic system to monitor registration, verification, claims processing, and referrals. While SHIB monitoring is done through routine supportive supervision and for the iCHF provider performance is monitored through utilization rates. Conclusion Enforcing compliance with the contractual agreement between providers-purchasers is crucial for the provision of quality services in an efficient manner. Investment in a routine monitoring system, such as the use of the district health information system which allows effective tracking of healthcare service delivery, and broader population healthcare outcomes.

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