@Article{info:doi/10.2196/38818,
author="Schuetze, Leon
and Srivastava, Siddharth
and Missenye, Abdallah Mtiba
and Rwezaula, Elizeus Josephat
and Stoermer, Manfred
and De Allegri, Manuela",
title="Factors Affecting the Successful Implementation of a Digital Intervention for Health Financing in a Low-Resource Setting at Scale: Semistructured Interview Study With Health Care Workers and Management Staff",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="6",
volume="25",
pages="e38818",
keywords="health financing; qualitative; digital health intervention; low-resource setting; strategic purchasing; scale; mobile phone",
abstract="Background: Digital interventions for health financing, if implemented at scale, have 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 (HCWs), questioning its potential to enable strategic purchasing and succeed at scale. Objective: This study aimed to understand why the adoption of the IMIS claim function by HCWs remained low in Tanzania and to assess implications for use at scale. Methods: We conducted 21 semistructured interviews with HCWs and management staff in 4 districts where IMIS was first implemented. We sampled respondents by using a maximum variation strategy. We used the framework method for data analysis, applying a combination of inductive and deductive coding to organize codes in a socioecological model. Finally, we related emerging themes to a framework for digital health interventions for scale. Results: Respondents appreciated IMIS's intrinsic software characteristics and technical factors and acknowledged IMIS as a valuable tool to simplify claim management. Human factors, extrinsic ecosystem, and health care ecosystem were considered as barriers to widespread adoption. Conclusions: Digital interventions for health financing, such as IMIS, may have the potential for scale if careful consideration is given to the environment in which they are placed. Without a sustainable health financing environment, sufficient infrastructure, and human capacity, they cannot unfold their full potential to improve health financing functions and ultimately contribute to universal health coverage. ",
issn="1438-8871",
doi="10.2196/38818",
url="https://www.jmir.org/2023/1/e38818",
url="https://doi.org/10.2196/38818",
url="http://www.ncbi.nlm.nih.gov/pubmed/36607708"
}