Abstract
BackgroundIn 1995, Tanzania introduced the voluntary Community Health Fund (CHF) with the aim of ensuring universal health coverage by increasing financial investment in the health sector. The uptake of the CHF is low, with an enrolment of only 6% compared to the national target of 75%. Mandatory models of community health financing have been suggested to increase enrolment and financial capacity. This study explores communities’ views on the introduction of a mandatory model, the Compulsory Community Health Fund (CCHF) in the Liwale district of Tanzania.MethodsA cross-sectional study which involved 387 participants in a structured face to face survey and 33 in qualitative interviews (26 in focus group discussions (FGD) and 7 in in-depth interviews (IDI). Structured survey data were analyzed using SPSS version 16 to produce descriptive statistics. Qualitative data were analyzed using content analysis.Results387 people completed a survey (58% males), mean age 38 years. Most participants (347, 89.7%) were poor subsistence farmers and 229 (59.2%) had never subscribed to any form of health insurance scheme. The idea of a CCHF was accepted by 221 (57%) survey participants. Reasons for accepting the CCHF included: reduced out of pocket expenditure, improved quality of health care and the removal of stigma for those who receive waivers at health care delivery points. The major reason for not accepting the CCHF was the poor quality of health care services currently offered. Participants suggested that enrolment to the CCHF be done after harvesting when the population were more likely to have disposable income, and that the quality care of care and benefits package be improved.ConclusionsThe CHF is acceptable to the most of study participants and feasible in rural Tanzania as an alternative mechanism to finance health care for the rural poor. Community members are willing to join the scheme provided they are well informed, involved in the design and implementation, and assured quality health care. Strong political will and a supportive environment are key ingredients for the success of the CCHF.
Highlights
In 1995, Tanzania introduced the voluntary Community Health Fund (CHF) with the aim of ensuring universal health coverage by increasing financial investment in the health sector
The majority of participants had heard about the CHF (89.4%) and had an adequate level of knowledge about the CHF (54.9%)
The findings revealed that the Compulsory Community Health Fund (CCHF) is feasible and is supported by the majority poor subsistence farmers
Summary
In 1995, Tanzania introduced the voluntary Community Health Fund (CHF) with the aim of ensuring universal health coverage by increasing financial investment in the health sector. Mandatory models of community health financing have been suggested to increase enrolment and financial capacity. The main sources of health care financing at district level in Tanzania are government block grants, donor funds (health sector basket funds), reimbursements from NHIF and user fees/out of pocket payments [6]. The CHF Act of 2001 stipulates that each district sets premiums depending on the local economy and benefits are limited to dispensaries, which are at the lowest level of care [1]. Since 2001 Local government is required by National Health Policy to take care of the vulnerable such as those over the age of 60, the very poor, the disabled, the chronically ill and orphans [4,5]
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