Tanzania has been reforming health financing policies to expand health insurance coverage and achieve better access to quality healthcare for all. Recent reforms have included improved community health funds (iCHFs). Other reforms that are underway include the implementation of a mandatory national health insurance scheme in order to expand access to services and improve financial risk protection. Governance is a crucial structural determinant for the successful implementation of the health financing reforms. The authors in this study interviewed 36 stakeholders including implementers of health financing reforms, policymakers, and health insurance beneficiaries in the regions of Dodoma, Dar es Salaam and Kilimanjaro to understand governance factors that influence the successful implementation of health financing reforms in Tanzania. Both opportunities and challenges existed for governance and implementation. Opportunities included a shared strategic vision for a single mandatory health insurance, community engagement and collaboration with diverse stakeholders in the implementation of health financing policies and enhanced monitoring of iCHF enrolment due to digitisation of registration process. Whereas the challenges that emerged included lack of transparency, limited involvement of the private sector in service delivery, weak accountability for revenues generated from community level and limited resources due to iCHF design. The authors suggested the need to address the identified governance factors that hinder implementation of health financing reforms in order for the current efforts to expand health insurance coverage to succeed.
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