Do Management and Leadership Practices in the Context of Decentralisation Influence Performance of Community Health Fund? Evidence From Iramba and Iringa Districts in Tanzania.

Chakupewa Joseph,Stephen Oswald Maluka

doi:10.15171/ijhpm.2016.130

Abstract

Background: In early 1990s, Tanzania like other African countries, adopted health sector reform (HSR). The most strongly held centralisation system that informed the nature of services provision including health was, thus, disintegrated giving rise to decentralisation system. It was within the realm of HSR process, user fees were introduced in the health sector. Along with user fees, various types of health insurances, including the Community Health Fund (CHF), were introduced. While the country’s level of enrolment in the CHF is low, there are marked variations among districts. This paper highlights the role of decentralised health management and leadership practices in the uptake of the CHF in Tanzania. Methods: A comparative exploratory case study of high and low performing districts was carried out. In-depth interviews were conducted with the members of the Council Health Service Board (CHSB), Council Health Management Team (CHMT), Health Facility Committees (HFCs), in-charges of health facilities, healthcare providers, and Community Development Officers (CDOs). Minutes of the meetings of the committees and district annual health plans and district annual implementation reports were also used to verify and triangulate the data. Thematic analysis was adopted to analyse the collected data. We employed both inductive and deductive (mixed coding) to arrive to the themes. Results: There were no differences in the level of education and experience of the district health managers in the two study districts. Almost all district health managers responsible for the management of the CHF had attended some training on management and leadership. However, there were variations in the personal initiatives of the top-district health leaders, particularly the district health managers, the council health services board and local government officials. Similarly, there were differences in the supervision mechanisms, and incentives available for the health providers, HFCs and board members in the two study districts. Conclusion: This paper adds to the stock of knowledge on CHFs functioning in Tanzania. By comparing the best practices with the worst practices, the paper contributes valuable insights on how CHF can be scaled up and maintained. The study clearly indicates that the performance of the community-based health financing largely depends on the personal initiatives of the top-district health leaders, particularly the district health managers and local government officials. This implies that the regional health management team (RHMT) and the Ministry of Health and Social Welfare (MoHSW) should strengthen supportive supervision mechanisms to the district health managers and health facilities. More important, there is need for the MoHSW to provide opportunities for the well performing districts to share good practices to other districts in order to increase uptake of the community-based health insurance.

Highlights

In early 1990s, Tanzania like other African countries, adopted health sector reform (HSR)
This paper was meant to explore the role of decentralised district health management and leadership practices on the uptake of community health insurance in Tanzania
The paper adds to the stock of knowledge on Community Health Fund (CHF) functioning in Tanzania where the practice is still relatively new compared to other countries in Africa and elsewhere

Summary

Introduction

In early 1990s, Tanzania like other African countries, adopted health sector reform (HSR). CBHI schemes are noted for the principal role of a community’s involvement in raising, pooling, allocating, purchasing, and supervision of the health financing arrangement Their beneficiaries are individuals with no form of financial protection or ability to cover the cost of healthcare services and the schemes are voluntary in nature.[6] While CBHI schemes are criticised for the limited extent of resource generation and pooling, they have been shown to facilitate and improve access to healthcare services, especially among children and pregnant women[7,8] as well as the rural poor and informal workers.[9] Based on the potential benefits of the CBHI scheme, the government of Tanzania officially introduced Community Health Fund (CHF) through Act No 1 of 2001.10 According to the CHF Act, the objectives of the fund are to: mobilise financial resources from the community for provision of healthcare services to its members; provide quality and affordable healthcare services; and improve healthcare services management in the communities.[10] The scheme started operating in 1996 as a pilot study in Igunga district. The ministry responsible for health and the ministry responsible for local government are required to provide advice and technical support to the fund and monitor and evaluate the activities of the fund.[10]

Methods

Results

Discussion

Conclusion