The development of effective and inclusive health financing reforms is crucial for the progressive realisation of universal health coverage in low-income and middle-income countries. 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), and others are underway to implement 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 health financing reforms, however there is little understanding of the governance elements that hinder the implementation of health financing reforms such as the iCHF in Tanzania. Therefore, this study used the perspectives of health sector stakeholders to explore governance factors that influence the implementation of health financing reforms in Tanzania. We interviewed 36 stakeholders including implementers of health financing reforms, policymakers and health insurance beneficiaries in the regions of Dodoma, Dar es Salaam and Kilimanjaro. Normalisation process theory and governance elements guided the structure of the in-depth interviews and analysis. Governance factors that emerged from participants as facilitators 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. Governance factors that emerged as barriers to the implementation were a 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. If stakeholders do not address the governance factors that hinder the implementation of health financing reforms, then current efforts to expand health insurance coverage are unlikely to succeed on their own. Data are available upon reasonable request. According to the institutional review board of IHI, we are not allowed to make the data publicly available. Interested researchers should contact the corresponding author.

中文翻译：

---

影响坦桑尼亚卫生筹资改革实施的治理因素：利益相关者观点的探索性研究

开展有效和包容性的卫生筹资改革对于在低收入和中等收入国家逐步实现全民健康覆盖至关重要。坦桑尼亚一直在改革医疗融资政策，以扩大医疗保险覆盖面，让所有人更好地获得优质医疗保健服务。最近的改革包括改进社区医疗基金 (iCHF)，其他正在实施强制性国家医疗保险计划，以扩大获得服务的机会并改善财务风险保护。治理是成功实施卫生筹资改革的关键结构性决定因素，但人们对阻碍卫生筹资改革实施的治理要素知之甚少，例如坦桑尼亚的 iCHF。所以，本研究从卫生部门利益相关者的角度探讨了影响坦桑尼亚卫生筹资改革实施的治理因素。我们采访了 36 位利益相关者，包括多多马、达累斯萨拉姆和乞力马扎罗地区的卫生筹资改革实施者、政策制定者和医疗保险受益人。规范化过程理论和治理要素指导了深入访谈和分析的结构。参与者作为促进者提出的治理因素包括单一强制性健康保险的共同战略愿景、社区参与以及与不同利益相关者在实施健康融资政策方面的合作以及由于注册过程的数字化而加强对 iCHF 注册的监测。成为实施障碍的治理因素包括缺乏透明度、私营部门在服务提供方面的参与有限、对社区层面产生的收入问责不力以及 iCHF 设计导致的资源有限。如果利益相关者不解决阻碍卫生筹资改革实施的治理因素，那么目前扩大医疗保险覆盖面的努力靠自己是不可能成功的。可应合理要求提供数据。根据 IHI 的机构审查委员会，我们不允许公开数据。有兴趣的研究人员应与通讯作者联系。由于 iCHF 的设计，社区层面产生的收入和资源有限的问责制薄弱。如果利益相关者不解决阻碍卫生筹资改革实施的治理因素，那么目前扩大医疗保险覆盖面的努力靠自己是不可能成功的。可应合理要求提供数据。根据 IHI 的机构审查委员会，我们不允许公开数据。有兴趣的研究人员应与通讯作者联系。由于 iCHF 的设计，社区层面产生的收入和资源有限的问责制薄弱。如果利益相关者不解决阻碍卫生筹资改革实施的治理因素，那么目前扩大医疗保险覆盖面的努力靠自己是不可能成功的。可应合理要求提供数据。根据 IHI 的机构审查委员会，我们不允许公开数据。有兴趣的研究人员应与通讯作者联系。根据 IHI 的机构审查委员会，我们不允许公开数据。有兴趣的研究人员应与通讯作者联系。根据 IHI 的机构审查委员会，我们不允许公开数据。有兴趣的研究人员应与通讯作者联系。