Abstract:

Background: In 2017/2018, Tanzania introduced the Direct Health Facility Financing programme. The health facilities, in collaboration with Health Facility Governing Committee members as community representatives, were enabled to identify their local health problems, plan, budget and implement activities by using funds directly deposited in the facility’s bank accounts. Community awareness and participation are among important precursors toward achieving the goal of the programme. So far, magnitude of awareness and participation is not clearly known. This study focused on investigate the magnitude of community awareness and participation on the programme and its associated factors.

Methods: A cross-sectional study design was employed. A total of 450 participants were recruited, of which 66 were Health facility governing Committee members from community and 384bwere clients seeking health services. The committee members were interviewed from 22 health facilities randomly selected among 24 health facilities with committee established at least one year ago. Clients were systematic randomly distributed to the health facilities based on the volume of clients per facility. Data collected using questionnaires then analyzed using STATA 15 software. Logistic regression was used to determine the association between exposures and outcome of interest. The strength of association was expressed using odds ratio with their 95% confidence interval. All independent variables with p-value of ≤0.05 in multivariate analysis was consider to be statistically significant associated with the outcome of interest.

Results: Based on the ladder of citizen participation model, 27.73% of community representatives adequately participated in the programme and 77.27% moderately participated. Community representatives who were familiar with any Direct Health Facility Financing guideline had 9 times high odds of adequate participation, AOR=9.04, (95%CI=2.13, 20.43, p-value<0.0001) than those not familiar, those with secondary education had 3 times odds of adequate participation in the programme, AOR=3.12, (95%CI=0.04, 4.75, p-value=0.03) compared to those with primary education. Based on the Perceptual Awareness Scale, 4.95% of community members had moderate to adequate awareness and 95.02% had non to minimal awareness of the programme. Participants who had completed primary education had 93% fewer odds of moderate to adequate awareness on the programme AOR=0.07 (95% CI=0.01- 088, p-value=0.04) and Subsistent farmers had 86% fewer odds of moderate to adequate awareness on the programme AOR=0.14, (95%CI=0.02, 0.95, p-value0.04) as compared to their counterparts that is combination of traders, public servants and housewives.

Conclusion: All community representatives participated in the programme while community members’ awareness of the programme remained very low. Despite of it’s fairly participation, low level of education, lack of lack of training and minimum exposure to the programme’s guidelines among representatives found to hinder the level of participation. The fact that the majority of community representatives are male and the majority of health facility clients are female might compromise the true representativeness of client’s needs hence expose the broad community to low awareness on the programme. Also, the higher one education attainment among community members the less the awareness on the programme among them.