Understanding the experience, preferences and effects of provider payment mechanisms in Tanzania

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Many health systems in low and middle income countries (LMICs) have are financing through multiple sources (taxes, insurance, donor support) and providers are paid through multiple methods (e.g. capitation, fee-for-service, salary). So, health providers are faced with multiple flow of funds, and each source has a different payment modality. Since providers can respond differently depending on which payment method are facing, it is important to implement a payment method that will stimulate providers' productivity to increase and minimise unintended responses. Tanzania, like other developing countries, is currently planning to harmonise the health financing sources (by introducing a single national health insurance) and use a harmonised/ unified provider payment mechanism. The harmonisation of funding sources and unified provider payment mechanisms are key steps towards universal health coverage. In this study, therefore, I propose to better understand providers experience, responses, and preferences for provider payment mechanisms, and also identify the effect of each payment method on service quality, coverage and equity. To know how they perceive available payment methods, how they respond differently, and which attributes they prefer most. Also, to know the varied provider responses to service quality, coverage and equity. This study will also generate policy-relevant recommendation to inform the ongoing planning of designing optimal and feasible provider payment mechanisms in Tanzania. The findings might still be relevant to other settings planning to reform their provider payment mechanisms. Understanding what provider prefer most in terms of payment method attributes, will help design a payment method that can easily be acceptable among providers and response positively to improve service delivery.The research questions will be tackled through multiple sources of data using both qualitative and quantitative data. Data will capture the perspectives and information from health providers, patients, health purchasers, and policy makers. Quantitative data will come from 120 patients exiting care from 2 districts and 240 health workers from 6 districts eliciting the preferences. An 'action-based' dissemination workshop will be conducted to provide key stakeholders with an opportunity to reflect on the key findings, develop priorities, and plans to optimally design practice, feasible and efficient provider payment methods in Tanzania.