JMIR Publications

ABSTRACT

Background:

Digital interventions for health financing, if implemented at scale, bear the potential to improve health system performance by reducing transaction costs and improving data-driven decision making. However, many interventions never reach sustainability and evidence on success factors for scale is scarce. The Insurance Management Information System (IMIS) is a digital intervention for health financing, designed to manage an insurance scheme and already implemented on a national scale in Tanzania. A previous study found that the IMIS claim function was poorly adopted by health care workers, questioning its potential to enable strategic purchasing and succeed at scale.

Objective:

This study aimed to understand why adoption of the IMIS claim function by health care workers remained low in Tanzania and to assess implications for use at scale.

Methods:

We conducted 21 semi-structured interviews with health care workers and management staff in 4 districts where IMIS was first implemented. We sampled respondents using a maximum variation strategy. We used the framework method for data analysis, applying a mixture of inductive and deductive coding to organize codes in a socio-ecological model. Finally, we related emerging themes to the framework for digital health interventions for scale developed by Labrique et al.

Results:

Respondents appreciated IMIS’ intrinsic software characteristics and technical factors and acknowledged IMIS as a valuable tool to simplify claim management. Human factors (e.g., training, workload, support), the extrinsic ecosystem (e.g., internet availability), and the healthcare ecosystem (e.g., financial sustainability of the insurance scheme, stewardship), were considered barriers to widespread adoption.

Conclusions:

Digital interventions for health financing like IMIS might have the potential for scale if careful consideration is given to the environment in which they are placed. Without a sustainable healthcare (financing) environment, sufficient infrastructure, and human capacity, they cannot unfold their full potential to improve health financing functions and ultimately contribute to UHC.