Albino Kalolo|Lara Gautier|Ralf Radermacher|Siddharth Srivastava|Menoris Meshack|Manuela De Allegri
Factors influencing variation in implementation outcomes of the redesigned community health fund in the Dodoma region of Tanzania: a mixed-methods study
McGill University|Swiss Tropical and Public Health Institute|University Hospital Heidelberg|Heidelberg University
abstract introduction microhealth insurance mhi identified possible interim solution foster progress towards universal health coverage uhc low middle income countries lmics still mhi schemes suffer chronically low penetration rates especially subsaharan africa initiatives promote sustain enrolment yielded limited effect yet little effort channelled towards understanding initiatives implemented aimed fill gap knowledge examining heterogeneity implementation outcomes moderating factors within context redesigned community health fund dodoma region tanzania methods adopted mixedmethods design examine implementation outcomes defined adoption fidelity implementation foi well moderating factors survey questionnaire collected individual level data document review checklist indepth interview guide collected district level data relied descriptive statistics chi square test thematic analysis analyse data results review district level data revealed high adoption 78 foi 77 supported also qualitative interviews contrast survey participants reported relatively low adoption 55 foi 58 heterogeneity adoption foi observed across districts attributed organisational weakness strengths communication facilitation strategies resource availability fiscal capacity human resources materials reward systems number stakeholders leadership engagement implementers skills individual level heterogeneity adoption foi scheme components explained survey participants level education occupation years stay district duration working scheme example adoption job description statistically associated occupation p 0001 wworking scheme 20 months marginal significant association foi p 004 conclusion study demonstrates assessing implementation processes helps detect implementation weaknesses therefore address weaknesses interventions implemented rolled settings attention contextual individual implementer elements paid advance adjust implementation strategies ensure greater adoption fidelity implementation