Direct Health Facility Financing

Zuena Hussein Ismail with her baby attended by a health worker at Makole Health Centre in Dodoma.
Zuena Hussein Ismail with her baby attended by a health worker at Makole Health Centre in Dodoma. © FDFA

Together with the Tanzanian Government and development partners, Switzerland’s contribution to the reformed Health Basket Fund builds on positive results achieved so far and pursues to strengthen the health system that benefits 58 million inhabitants. Switzerland’s contribution will further expand effective decentralisation through the Direct Health Facility Financing mechanism to state and non-state primary health care providers, thus accelerating Tanzania’s progress towards universal health coverage and “Leaving no One Behind”.

Country/region Topic Period Budget
Health systems strengthening
Primary health care
01.09.2021 - 30.06.2026
CHF  15’140’000

In 1998, Switzerland jointly with other development partners and the Government of Tanzania launched the 'Health Sector Reform Programme' and the concurrent Health Basket Fund (HBF). The HBF existence for almost 20 years reflects a long lasting partnership within a Sector Wide Approach to cooperation at both technical and financial level. The HBF was established with the intention of strengthening decentralized health system in Tanzania Mainland through the provision of additional and relatively flexible funding to the central ministries, regions and local government authorities and with a clear focus of contributing to government efforts of ensuring primary health care to all.

During the 2015-2021 period, two parallel independent external Mid Term Reviews have been carried out. The HBF review has reported significant positive gains in most of the primary health care indicators and the general performance of the sector contributed to by the different reforms. The reforms aim at strengthening the health system with the intention of improving service delivery. The review pointed out on the inequalities that persist with regard to access to Primary Health Care between urban and rural populations, the poorest and richest households and regions.

Based on the recommendations of the Health Sector Strategic Plan (HSSP) IV external Mid-Term Review, a fifth health sector strategy (HSSP V 2021-2026) has been elaborated. The Memorandum of Understanding of the HBF between the Government of Tanzania and Development Partners to provide financial support towards implementation of this strategy has been finalized and endorsed. All eight contributing donors[1] have committed to continue to support the new HBF that has a strong focus on expanding the Direct Health Facility Funding mechanism as one of the most impactful reforms reported by the HBF mid-term review to improve access to quality primary health care services.

Objectives The overall goal of the program is to further expand equitable access and utilization of quality health services, and improve health financing through increased efficiency and effectiveness in allocation and use of resources by health facilities.
Target groups

Direct beneficiaries are the primary healthcare facilities (state and non-state) dispatched all over the country.

End beneficiaries are the entire population of Tanzania of approximately 58 million people who access primary health care facilities (70% of those who predominantly visit the public and faith based public health facilities are women and children)  

Medium-term outcomes
  1. Decentralization of domestic and external financing: increased autonomy for primary health facilities in planning, budgeting and expenditure of resources; greater engagement of communities in local health governance.
  2. Expansion of Universal health coverage: doubling of health facilities benefitting from direct financing through the HBF and preparedness of the health system for a Single National Health Insurance.
  3. Improved public financial management: expansion of digital management systems and community participation in local health governance for greater efficiency of resources.

Expected results:  

  • Policy dialogue takes place in the various committees of the new HBF.
  • Real time data at facility level are used to steer the implementation to ensure maximum impact.
  • Extension of the digitalization of the health system for planning, accounting and health insurance management systems at facility level.
  • Greater community participation in local health governance.
  • Technical assistance for the definition of a Minimum Benefit Package is provided in preparation of a future single national health insurance.
  • Lessons learnt and best practices are well documented and disseminated.

Results from previous phases:  

  • Improved health outcomes through provision of basic amenities to > 6,000 health facilities
  • Greater value for money, efficiency and equity of health financing through improved harmonization, coordination and decentralization of health sector financing
  • Evidence-based decision making through increased quality and usage of data
  • Increased accountability and transparency through additional scrutiny, controls, community engagement and performance monitoring
  • Improved staff satisfaction and staff retention by providing a conducive work environment as well as on-call and extra duty allowances
  • Increased community ownership and engagement in the Health Facility Governing Committee through the establishment of the Direct Health Facility Financing (DHFF)
  • Improved institutional management capacities at central, district and facility level

Directorate/federal office responsible SDC
Credit area Development cooperation
Project partners Contract partner
Private sector
Foreign state institution
United Nations Organization (UNO)
  • Central State of South East
  • Foreign private sector South/East
  • United Nations Children’s Fund
  • World Health Organization

Other partners
Ministry of Health, Community Development, Gender, Elderly and Children; President’s Office, Regional Administration, Local Governments; Canada, Denmark, Ireland, Korea, World Bank, UNFPA, UNICEF, The Global Fund
Coordination with other projects and actors
  • 7F-07381.03: Health Promotion and System Strengthening (HPSS) program
  • 7F-10425.01: Tanzania Social Action Fund (TASAF)
  • 7F-09283.01: Good Financial Governance (GFG) programme
  • 7F-06437.03: Social Accountability Programme (SAP)
  • Public Financial Management Reform Programme
  • USAID PS3 Programme
  • Health financing initiatives from the Global Program Health
Budget Current phase Swiss budget CHF    15’140’000 Swiss disbursement to date CHF    9’805’678
Project phases Phase 1 01.09.2021 - 30.06.2026   (Current phase)