In Tanzania, health facility managers have strongly endorsed Direct Health Facility Financing (DHFF), reporting more control, less paperwork, and better service delivery. This DHFF model has shown strong early results, confirmed by recent research published on PLOS Global Public Health.

The study, led by Tanzanian and Swiss researchers, including experts from the Ifakara Health Institute, reveals encouraging progress in Tanzania’s health sector reforms through the DHFF system — an approach introduced in 2017/18 to improve how funds are managed at the local level.

Health facility managers in the Kilimanjaro and Morogoro regions have strongly endorsed DHFF, saying they feel “empowered to manage their budgets autonomously”. By transferring funds directly to health facilities rather than through multiple government layers, DHFF enables faster, more efficient planning, budgeting, and spending tailored to the actual needs of each facility.

Study insights from Kilimanjaro, Morogoro
The study, which involved 348 healthcare managers from public health facilities and Council Health Management Teams (CHMTs) in Kilimanjaro and Morogoro regions, found that DHFF has helped reduce administrative burdens, increased financial autonomy, and improved resource mobilization.

These improvements are believed to have contributed to greater operational efficiency within health facilities, marking an important milestone in Tanzania’s ongoing health reforms.

Training and support key to making DHFF work
Despite only 23% of health facility in-charges receiving formal DHFF training in the past year, 76% reported that DHFF was routinely addressed during supervisory visits. This integration of DHFF principles in day-to-day operations appears to play a role in reinforcing DHFF principles and practices.

Less paperwork, more control
One significant finding from the study was the reported decrease in administrative workload, with many health managers saying DHFF is helping them do their jobs better. Over 92% of CHMT members and 80% of facility managers said their paperwork and bureaucratic tasks had lessened since DHFF was introduced; instead, they’re focusing more on delivering care rather than paperwork.

Moreover, healthcare managers expressed high levels of satisfaction with the increased autonomy over how to use to plan, budget, and manage their funds. Nearly 90% of facility in-charges and 95% of CHMT members felt empowered to make financial decisions that directly affect their facilities.

Urban advantage and the role of education
The study also found that managers with higher educational degrees viewed DHFF governance more positively and believed the reforms helped increase their financial resources. Additionally, urban health facilities were more likely to report stronger DHFF governance than those in rural areas. This shows that more support is needed in remote areas to make sure no one is left behind.

Training is still needed
Despite the progress, the low rate of formal training (23%) remains a concern. However, the consistent inclusion of DHFF in supervisory visits is helping bridge the gap. Many staff members reported that the more they were exposed to DHFF principles, the more they developed a deeper understanding of both the benefits and challenges, suggesting that continuous training helps managers make more informed decisions.

What this means for Tanzania’s health sector
These findings suggest that DHFF is giving health workers more say in how to manage their clinics. By giving health facilities greater control over their finances and reducing administrative bottlenecks, DHFF could lead to better resource use and ultimately improve patient care in Tanzania.

However, for DHFF to work across the country, the study’s authors emphasize the importance of scaling up formal training, particularly in rural areas; providing ongoing support to health workers and managers; and ensuring equitable investment by government and partners to strengthen DHFF implementation nationwide.

Ifakara, Swiss TPH scientists contributed the study
This study was led by Ifakara Health Institute scientist Kassimu Tani (lead author) and co-authored by Sally Mtenga, also from Ifakara, together with Swiss TPH scientists Günther Fink and Fabrizio Tediosi.

Read the publication here.