TY  - JOUR
AU  - Schuetze, Leon
AU  - Srivastava, Siddharth
AU  - Missenye, Abdallah Mtiba
AU  - Rwezaula, Elizeus Josephat
AU  - Stoermer, Manfred
AU  - De Allegri, Manuela
PY  - 2023
DA  - 2023/1/6
TI  - 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
JO  - J Med Internet Res
SP  - e38818
VL  - 25
KW  - health financing
KW  - qualitative
KW  - digital health intervention
KW  - low-resource setting
KW  - strategic purchasing
KW  - scale
KW  - mobile phone
AB  - 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. 
SN  - 1438-8871
UR  - https://www.jmir.org/2023/1/e38818
UR  - https://doi.org/10.2196/38818
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36607708
DO  - 10.2196/38818
ID  - info:doi/10.2196/38818
ER  -