Evaluation of the direct health facility financing program in improving maternal health services in Pangani district, Tanzania

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 TechnologyMaternal 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