Promoting universal health coverage in Tanzania : towards improved health service quality and financial protection

Following the publication of the World Health Report 2010 and the formulation of the health-related Sustainable Development Goal 3, Universal Health Coverage (UHC) has gained high priority in many countries. UHC implies that everyone has access to needed health services of sufficient quality to be effective without incurring financial hardship. This emphasises that there is no benefit to UHC if poor quality of care leads to unsatisfactory outcomes and unwillingness of people to use services. This thesis intended to improve the understanding of how to promote UHC in Tanzania. The findings aimed to provide actionable evidence and recommendations to help move towards improved health service quality and financial protection in an equitable manner.
In the area of health service quality, we evaluated an approach to strengthen routine supportive supervision of healthcare providers through their Council Health Management Teams (CHMTs). Part of the approach was a systematic assessment of quality of primary care using an electronic tool called the “electronic Tool to Improve Quality of Healthcare (e-TIQH)”. In the first part of this research we described the methodology of the e-TIQH supportive supervision approach. Secondly, we assessed the appropriateness of the e-TIQH assessment tool to measure quality of primary care. Afterwards, we then investigated the contribution of the e-TIQH supportive supervision approach to increased quality of primary healthcare. Lastly, a comparison was made between the e-TIQH supportive supervision approach and routine CHMT supportive supervision. In the area of financial protection, we investigated reasons for differences in Community Health Fund (CHF) coverage, a voluntary health insurance scheme for the informal sector. To do this we undertook an in-depth analysis of the CHF administration and its interaction with other health financing mechanisms and policies.