%0 Journal Article
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e38818
%T 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
%A Schuetze,Leon
%A Srivastava,Siddharth
%A Missenye,Abdallah Mtiba
%A Rwezaula,Elizeus Josephat
%A Stoermer,Manfred
%A De Allegri,Manuela
%+ Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany, 49 0931 201 31141, leon.schuetze@uni-heidelberg.de
%K health financing
%K qualitative
%K digital health intervention
%K low-resource setting
%K strategic purchasing
%K scale
%K mobile phone
%D 2023
%7 6.1.2023
%9 Original Paper
%J J Med Internet Res
%G English
%X 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. 
%M 36607708
%R 10.2196/38818
%U https://www.jmir.org/2023/1/e38818
%U https://doi.org/10.2196/38818
%U http://www.ncbi.nlm.nih.gov/pubmed/36607708