Participation of Community Governance Structures in the Governance of Strategic Purchasing at the Primary Health Care under Fiscal Decentralization context in Tanzania; A Quantitative Study

Abstract

Fiscal decentralisation reforms in lower and middle-income countries are believed to accelerateUniversal Health Coverage (UHC) development. Implementing UHC requires health financing reform.Strategic purchasing is a vital component of health finance that enhances primary healthcare deliveryand improves health system performance. Community participation in strategic purchasing at theirfacilities through local governance structures holds service providers more accountable for implementing strategic purchasing that places the community at the centre of service delivery, thereby improving responsiveness, equity, and financial protection. This study examined how Tanzanian community governance structures under Direct Health Facility Financing (DHFF) participate in the procurement process within health facilities. A cross-sectional design was employed to collect both qualitative and quantitative data from four regions—Mbeya, Kilimanjaro, Ruvuma, and Songwe—chosen based on their 2018-star ratings. Data were gathered through structured questionnaires from 280 respondents who were members of health facility governing committees. Descriptive and multivariate logistic regression analyses were used for the quantitative data. The study found that members of governance structures participate actively in the strategic purchasing of their health facilities under the DHFF arrangement.Members are highly involved in authorising and reviewing health commodities and services for purchase.However, governance structures are less engaged in evaluating, selecting, debating, and awarding bids.Participation of governance members is associated with age, availability of information reports, and themethod of member selection. DHFF enables community members to procure health commodities basedon population needs. To ensure that community governance structures effectively address elements thatsignificantly enhance community access to healthcare, additional efforts are necessary.