Funded Community Health Research Articles

Potential Gaps in Eye Care Based on Evaluation of Federally Qualified Health Centers

Federally qualified health centers (FQHCs) are federally funded community health clinics that provide comprehensive care to underserved populations, making them potential opportunities to offer eye care and address unmet health care needs. Evaluating the presence of eye care services at FQHCs in Florida is important in understanding and addressing possible gaps in care for the state's large uninsured and underserved populations. To determine whether FQHCs in Florida are currently offering eye care services, where they are available, what services are being offered, and who provides them. This study used a cross-sectional design conducted within 1 year (from November 2023 to February 2024). FQHCs listed in the US Health Resources and Services Administration database were contacted by telephone to inquire about the presence of eye care services. The FQHCs were located in both urban and rural areas in Florida to assess accessibility of eye care services in the state. School-based health centers and nonophthalmic specialty care health centers were excluded. A total of 437 FQHCs were included. Primary outcomes included the presence of eye care services, types of services offered, clinician type (optometrists or ophthalmologists), frequency of services, and availability of pediatric services. Among 437 FQHCs contacted, only 39 (8.9%) reported offering eye care services. These services primarily included vision examinations, glasses prescriptions, and dilated eye examinations. Optometrists were the primary providers of services at all clinics, with no clinics reporting care by ophthalmologists. The frequency of services varied considerably, ranging from daily to bimonthly. Thirty-seven (94.9%) of the 39 clinics offered pediatric eye care services. The low prevalence of FQHCs with eye care services and the absence of ophthalmologist-provided care highlight a gap in access to eye care for underserved populations in Florida. These findings support investigations into implementing eye care services and interventions at FQHCs that might enhance access and equity in eye care.

Impact of Direct Health Facility Financing on Health Insurance Enrollment and Service Quality in Dodoma Region, Tanzania

The National Health Insurance Fund (NHIF) and the Improved Community Health Fund (iCHF) are pre-payment schemes in Tanzania designed to achieve universal health coverage (UHC). Despite these efforts, public health facilities have historically struggled with poor-quality care. In response, the Direct Health Facility Financing (DHFF) mechanism was introduced in 2017, enabling health facilities to procure medicines and equipment directly from approved vendors when out-of-stock notifications are received from the Medical Store Department (MSD). This study evaluates the impact of DHFF on health insurance enrollment and service quality in the Dodoma Region. Utilizing a mixed-methods approach with an explanatory sequential design, a total of 35 respondents were involved in the proposed study, of which 30 were obtained from health insurance beneficiaries and 5 were from key informants. Results revealed increased health insurance enrollment for both NHIF and iCHF from 2018–2019 to 2019–2020, attributed to enhanced medicine availability, community education, and sensitization efforts. Beneficiaries reported significant improvements in health facilities, including better medicine availability, upgraded infrastructure, and improved attitudes from healthcare providers. Healthcare providers and authorities also noted improved service quality since DHFF's introduction. However, challenges remain, particularly with MSD's rigidity in notifying health facilities about out-of-stock items. Recommendations include enhancing the MSD's supply chain management to ensure timely notifications and deliveries. Future research should expand to multiple regions to account for cultural variations and additional factors influencing health insurance participation, enrollment, and service quality.

Engaging Community Health Workers in the Centers for Disease Control and Prevention's COVID-19 Public Health Response to Address Health Disparities and Build Community Resilience.

In 2021, the Centers for Disease Control and Prevention's (CDC) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) funded community health workers (CHWs) for COVID Response and Resilient Communities (CCR). CCR is a 3-year, $350 million initiative to implement CHW strategies aimed at reducing COVID-19 impacts, building resilience, and improving health equity by addressing health-related social needs. This paper describes the CCR initiative and experiences to date, underscoring CHWs' critical role in CDC's pandemic response. CCR funds 67 recipients to reach communities who are disproportionately affected by long-standing health disparities (hereafter, priority populations). CCR aims to decrease the impact of COVID-19 and increase community resilience to respond to COVID-19 and future public health emergencies. Recipients implement three strategies: train CHWs to support the COVID-19 response, increase the workforce of CHWs to manage the spread of the disease, and improve utilization of community and clinical resources to engage CHWs to help strengthen communities' resilience to mitigate the impact of COVID-19. We funded three additional organizations to provide technical assistance to CCR recipients and collaborate with us on a national evaluation of the program. CCR recipients hired about 950 CHWs and integrated these CHWs into over 1,000 organizations and care teams. At the end of the second program year, CHWs made over 250,000 referrals to social services and over 150,000 referrals to address specific health conditions. CCR demonstrates that CHWs can be quickly mobilized to participate in a public health emergency and reach those most affected by COVID-19.

Let the records speak: an exploration of rehabilitation services offered in primary healthcare, Johannesburg metropolitan district

BackgroundPrimary healthcare in South Africa aims to transform the national health system by emphasising community-based care and preventive strategies. However, rehabilitation services, particularly for individuals with disabilities and chronic non-communicable diseases, are often overlooked in primary healthcare. This study aimed to investigate the provision of primary healthcare rehabilitation services in the Johannesburg Metropolitan District by exploring client sociodemographics and variations in services provided by rehabilitation professionals.MethodsA retrospective review of clinic rehabilitation records from 2011 to 2020 was conducted at nine provincially funded community health centres (CHCs) offering rehabilitation services. Stratified sampling facilitated record selection based on rehabilitation service type and year. A specifically designed data extraction tool captured demographics, disabilities, rehabilitation received, and referral sources. Descriptive analysis used means, standard deviations, and frequencies.ResultsThe findings show a diverse client population with a wide age range, with a significant proportion falling into the < 5 years and 30–49 years age groups. Neuromusculoskeletal and movement-related disabilities were most prevalent, affecting approximately two-thirds of clients. Referral sources were often undocumented, and inconsistent discharge information with no record of patient follow up, highlighted the need for improved documentation practices. Clinic visits were the primary service delivery mode, followed by limited home visits and outreach services. Occupational therapy and physiotherapy were the most used services. Speech and language therapy services were underused, and some CHCs lacked audiology services. There were variations in the number of individual and group sessions provided by the different rehabilitation services, and there were age- and disability-specific differences in service use.ConclusionThis study offers insights into rehabilitation service provision in the Johannesburg Metropolitan District and enhances our understanding of rehabilitation services in primary healthcare settings. It underscores the importance of a multidisciplinary rehabilitation team to address diverse rehabilitation needs, improving documentation and discharge practices, expanding service delivery models, and reducing disparities in service use. The findings inform strategies for optimising service delivery, workforce, resource allocation, and intersectoral collaboration to ultimately enhance the quality and accessibility of integrated rehabilitation services.

Barriers and facilitators to health insurance enrolment among people working in the informal sector in Morogoro, Tanzania

Background Health insurance is a crucial pathway towards the achievement of universal health coverage. In Tanzania, health-financing reforms are underway to speed up universal health coverage in the informal sector. Despite improved Community Health Fund (iCHF) rollout, iCHF enrolment remains a challenge in the informal sector. This study aimed to explore the perspectives of local women food vendors (LWFV) and Bodaboda (motorcycle taxi) drivers on factors that challenge and facilitate their enrolment in iCHF. Methods A qualitative study was conducted in Morogoro Municipality through in-depth interviews with LWFV (n=24) and Bodaboda drivers (n=26), and two focus group discussions with LWFV (n=8) and Bodaboda drivers (n=8). Theory of planned behaviour (TPB) constructs (attitude, subjective norms, and perceived control) provided a framework for the study and informed a thematic analysis focusing on the barriers and facilitators of iCHF enrolment. Results The views of LWFV and Bodaboda drivers on factors that influence iCHF enrolment converged. Three main barriers emerged: lack of knowledge about the iCHF (attitude); negative views from friends and families (subjective norms); and inability to overcome challenges, such as the quality and range of health services available to iCHF members and iCHF not being accepted at non-government facilities (perceived control). A number of facilitators were identified, including opinions that enrolling to iCHF made good financial sense (attitude), encouragement from already-enrolled friends and relatives (subjective norms) and the belief that enrolment payment is affordable (perceived control). Conclusions Results suggest that positive attitudes supported by perceived control and encouragement from significant others could potentially motivate LWFV and Bodaboda drivers to enroll in iCHF. However, more targeted information about the scheme is needed for individuals in the informal sector. There is also a need to ensure that quality health services are available, including coverage for non-communicable diseases (NCDs), and that non-government facilities accept iCHF.

Developing the improved Community Health Fund inTanzania: was it a fair process?

Tanzania developed its 2016-26 health financing strategy to address existing inequities and inefficiencies in its health financing architecture. The strategy suggested the introduction of mandatory national health insurance, which requires long-term legal, interministerial and parliamentary procedures. In 2017/18, improved Community Health Fund (iCHF) was introduced to make short-term improvements in coverage and financial risk protection for the informal sector. Improvements involved purchaser-provider split, portability of services, uniformity in premium and risk pooling at the regional level. Using qualitative methods and drawing on the policy analysis triangle framework (context, content, actors and process) and criteria for procedural fairness, we examined the decision-making process around iCHF and the extent to which it met the criteria for a fair process. Data collection involved a document review and key informant interviews (n = 12). The iCHF reform was exempt from following the mandatory legislative procedures, including processes for involving the public, for policy reforms in Tanzania. The Ministry of Health, leading the process, formed a technical taskforce to review evidence, draw lessons from pilots and develop plans for implementing iCHF. The taskforce included representatives from ministries, civil society organizations and CHF implementing partners with experience in running iCHF pilots. However, beneficiaries and providers were not included in these processes. iCHF was largely informed by the evidence from pilots and literature, but the evidence to reduce administrative cost by changing the oversight role to the National Health Insurance Fund was not taken into account. Moreover, the iCHF process lacked transparency beyond its key stakeholders. The iCHF reform provided a partial solution to fragmentation in the health financing system in Tanzania by expanding the pool from the district to regional level. However, its decision-making process underscores the significance of giving greater consideration to procedural fairness in reforms guided by technical institutions, which can enhance responsiveness, legitimacy and implementation.

Optimizing Telehealth Services: A Mixed-Methods Needs Assessment Conducted Among Community Health Center Patients.

The COVID-19 pandemic increased telehealth services in federally funded community health centers (CHCs). Yet little is known about common determinants of use among CHC patients. We examined the use of telehealth among patient participants at 1 large CHC network providing care to underserved populations at urban and suburban sites in the Midwest. We conducted a mixed-methods study utilizing a sequential explanatory design. Participants were English and/or Spanish-speaking adults who attended ≥1 visits for themselves or their child over a 12-month period at any practice location. Research staff conducted a structured phone survey of eligible adults. The results subsequently facilitated purposive sampling of telehealth "users" and "nonusers" for qualitative phone interviews. The survey participants included 500 adults. Most had access to the resources needed to utilize telehealth, including a smartphone (90.4%) and home internet (83.0%). About half (50.8%) "rarely or never" had problems with internet speed, reliability, or quality. Most (81.1%) were aware of the patient portal and 59.8% had utilized video visits. Participants who were Spanish-speaking and with limited English proficiency faced some of the greatest barriers. Qualitative interview participants included 12 users and 12 nonusers of telehealth. Users found telehealth convenient and efficient, while nonusers lacked awareness about how telehealth services could be beneficial or needed assistance to sign up, join, or use telehealth. Most participants had the resources and awareness necessary to use telehealth services. Those who use them appreciate the convenience and efficiency. Nevertheless, additional support may be needed to prevent telehealth from exacerbating health inequities.

Level of community contribution toward the financing of health care services in Jigawa state

Community involvement in health related activities is generally acknowledged by international and national health planners to be the key to the successful organization of primary health care, comparatively little is known about its potential and limitations. Drawing on the experiences of Jigawa State, this paper reports on research undertaken to compare and contrast the scope and Extent of community participation in the delivery of primary health care in a community run and financed health post and a state run and financed health post. Unlike many other health posts in Jigawa these facilities do provide effective curative services, and neither of them suffers from chronic shortage of drugs. However, community-financing did not appear to widen the scope and the extent of participation. Villagers in both communities relied on the health post for the treatment of less than one-third of symptoms, and despite the planners' intentions, community involvement outside participation in benefits was found to be very limited. Aim: This study assess the level of community contribution toward the financing of health care services in Jigawa state, Nigeria Methodology: A cross-sectional descriptive research was conducted on the respondents. The study population comprised the entire eligible respondent in a case study of government hospitals in Jigawa state Nigeria within the study area, who were selected and agreed to participate in the study. Sample sizes of One Hundred (100), respondents were recruited using a multistage sampling technique. Data was collected using Questionnaire Data collected was coded, entered, and analyzed using the Statistical Package for the Social Sciences (SPSS) version 24. Result: The cooperation within department and with other departments in cooperation with equals was very good were 65(68.4%), good were 17(17.9%), Ok were 10(10.5%), not so good were 3(3.2%) and bad were 0(0.0%) respectively. The cooperation within department and with other departments in cooperation with PWD was Very good were 50(52.6%), good were 25(26.3%), Ok were 12(12.6%), not so good were 5(5.3%) and bad were 3(3.2%) respectively. In this studied many of the respondents has Diploma with 38.9% as their highest education qualification working with the Jigawa State Healthcare. Therefore, there is need for the continuous education programme of the health workers in the facility for proper and effective conduct of operations. Conclusions: The findings from this study will help to develop programs that can improve knowledge of community Health Financing and services provided by the health-care system and can reduce burden on government by providing other alternative.

Healthcare utilization and catastrophic health expenditure in rural Tanzania: does voluntary health insurance matter?

BackgroundOver 150 million people, mostly from low and middle-income countries (LMICs) suffer from catastrophic health expenditure (CHE) every year because of high out-of-pocket (OOP) payments. In Tanzania, OOP payments account for about a quarter of the total health expenditure. This paper compares healthcare utilization and the incidence of CHE among improved Community Health Fund (iCHF) members and non-members in central Tanzania.MethodsA survey was conducted in 722 households in Bahi and Chamwino districts in Dodoma region. CHE was defined as a household health expenditure exceeding 40% of total non-food expenditure (capacity to pay). Concentration index (CI) and logistic regression were used to assess the socioeconomic inequalities in the distribution of healthcare utilization and the association between CHE and iCHF enrollment status, respectively.Results50% of the members and 29% of the non-members utilized outpatient care in the previous month, while 19% (members) and 15% (non-members) utilized inpatient care in the previous twelve months. The degree of inequality for utilization of inpatient care was higher (insured, CI = 0.38; noninsured CI = 0.29) than for outpatient care (insured, CI = 0.09; noninsured CI = 0.16). Overall, 15% of the households experienced CHE, however, when disaggregated by enrollment status, the incidence of CHE was 13% and 15% among members and non-members, respectively. The odds of iCHF-members incurring CHE were 0.4 times less compared to non-members (OR = 0.41, 95%CI: 0.27–0.63). The key determinants of CHE were iCHF enrollment status, health status, socioeconomic status, chronic illness, and the utilization of inpatient and outpatient care.ConclusionThe utilization of healthcare services was higher while the incidence of CHE was lower among households enrolled in the iCHF insurance scheme relative to those not enrolled. More studies are needed to establish the reasons for the relatively high incidence of CHE among iCHF members and the low degree of healthcare utilization among households with low socioeconomic status.

Estimating causal effects of community health financing via principal stratification

When a treatment cannot be enforced, but only encouraged, noncompliance naturally arises. In applied economics, the common empirical strategy for dealing with noncompliance is to rely on Instrumental Variables methods. When the effects are heterogeneous, these methods allow, under a set of assumptions, to identify the causal effect for Compliers, i.e., the subset of units whose treatment is affected by the encouragement. One of the identification assumptions is the Exclusion Restriction (ER), which essentially rules out the possibility of a causal effect for Never Takers, i.e., those whose treatment is not affected by the encouragement. In this paper, we show the consequences of violations of this assumption in the impact evaluation of an intervention implemented in Uganda, where targeted households were encouraged to join a community health financing (CHF) scheme through activities of sensitization. We conduct the analyses using Bayesian model-based principal stratification, first assuming and then relaxing the ER for Never Takers. This allows showing the positive impact of the intervention on the health costs of both Compliers and Never Takers. While the causal effects for the former could be due to the encouragement but also to the actual participation in the scheme, those for the latter are unequivocally attributable to the encouragement. This indicates that sensitization alone is extremely effective in reducing vulnerability against health costs. This finding is of paramount importance for policy-making, as it is much easier and more cost-effective to implement awareness-raising campaigns than CHF schemes.

Understanding the implication of direct health facility financing on health commodities availability in Tanzania.

The Government of Tanzania (GoT) has in the last decade made progress in strengthening the health system financing with progress towards Universal Health Coverage (UHC). The major reforms includes development of the health financing strategy, reforming the Community Health Fund (CHF) and introduction of the Direct Health Facility Financing (DHFF). DHFF was introduced in all district councils in the 2017/18 financial year. One of the anticipated goals of DHFF is to improve availability of health commodities. The objective of this study is to assess the effect of DHFF in improving the availability of health commodities in primary health care facilities. This study employed cross sectional study design, using quantitative techniques to analyze data related to expenditures and availability of health commodities at the primary health care facilities in Tanzania mainland. Secondary data was extracted from Electronic Logistics Management Information System (eLMIS) and Facility Financial Accounting and Reporting System (FFARS). Descriptive analysis was used to summarize the data using Microsoft Excel (2021) and inferential analysis was done using Stata SE 16.1. There has been an increase in allocation of funds for health commodities over the past three years. The Health Basket Funds (HBFs) accounted for an average of 50% of all health commodities expenditures. The complimentary funds (user fees and insurance) contributed about 20%, which is less than the 50% required by the cost sharing guideline. There is potentiality in DHFF improving visibility and tracking of health commodities funding. Implementation of DHFF has increased the amount of funding for health commodities at health facilities. The visibility and tracking of health commodity funding has improved. There is a scope of increasing health commodity funds at health facilities since the expenditures on health commodities is lower than what is indicated in the cost sharing collection and use guideline.

Factors associated with the implementation of an improved community health fund in the Ubungo Municipality Area, Dar es Salaam Region, Tanzania

Factors associated with the implementation of an improved community health fund in the Ubungo Municipality Area, Dar es Salaam Region, Tanzania

Healthcare workers´ experiences and perceptions of the provision of health insurance benefits to the elderly in rural Tanzania: an explorative qualitative study

BackgroundHealthcare workers play an important part in the delivery of health insurance benefits, and their role in ensuring service quality and availability, access, and good management practice for insured clients is crucial. Tanzania started a government-based health insurance scheme in the 1990s. However, no studies have specifically looked at the experience of healthcare professionals in the delivery of health insurance services in the country. This study aimed to explore healthcare workers’ experiences and perceptions of the provision of health insurance benefits for the elderly in rural Tanzania.MethodsAn exploratory qualitative study was conducted in the rural districts of Igunga and Nzega, western-central Tanzania. Eight interviews were carried out with healthcare workers who had at least three years of working experience and were involved in the provision of healthcare services to the elderly or had a certain responsibility with the administration of health insurance. The interviews were guided by a set of questions related to their experiences and perceptions of health insurance and its usefulness, benefit packages, payment mechanisms, utilisation, and availability of services. Qualitative content analysis was used to analyse the data.ResultsThree categories were developed that describe healthcare workers´ experiences and perceptions of delivering the benefits of health insurance for the elderly living in rural Tanzania. Healthcare workers perceived health insurance as an important mechanism to increase healthcare access for elderly people. However, alongside the provision of insurance benefits, several challenges coexisted, such as a shortage of human resources and medical supplies as well as operational issues related to delays in funding reimbursement.ConclusionWhile health insurance was considered an important mechanism to facilitate access to care among rural elderly, several challenges that impede its purpose were mentioned by the participants. Based on these, an increase in the healthcare workforce and availability of medical supplies at the health-centre level together with expansion of services coverage of the Community Health Fund and improvement of reimbursement procedures are recommended to achieve a well-functioning health insurance scheme.

Factors affecting ability and willingness of community members to enrol Improved Community Health Fund in Dodoma and Iringa regions

Financial protection has been recognised as an important element within the healthcare financing system of many low and middle-income countries. Pre-payment schemes have been advocated as a means of curbing high out of pocket expenditure and achieving universal health coverage. A number of financing reforms have been taking place, however there is a limited rigorous contextual evidence on the willingness-to-pay (WTP) for the recently Improved Community Health Fund (iCHF) in Tanzania. The study took place in district councils of Dodoma and Iringa regions. Data were collected from a household survey conducted in 2021. Contingent valuation methodology was used to elicit households’ the willing to pay (WTP) for iCHF premium using the bidding game technique. In addition, the relationship between WTP and other socio-economic variables was examined using logistic regression models. Majority 88% respondents said they will repay their package after expiry considering the quality of the services provided by health insurance. The results showed a statistically significant negative relationship 0.526 (p = 0.034) between household aged above 55 years of age and WTP. More specifically, as age increases above 55 years, the likelihood to pay for health insurance premium decreases. We also found a positive statistically significant relationship 1.882 (p = 0.034) between the household with small business and WTP, which suggest the individuals with small business are in a better position to pay for iCHF premium compared to those with formal employment. It is important to educate the households to raise awareness about the benefits of being a member of insurance scheme in both formal and informal sector. The households should be encouraged to formalize their small business, this will improve their income and enrolment into the insurance schemes. The benefit packages should be revised to fit the need of the people as WTP was also influenced by the nature of the packages.

Linking the Community Health Fund with Accredited Drug Dispensing Outlets in Tanzania: exploring potentials, pitfalls, and modalities

BackgroundIn low- and middle-income countries, too, public–private partnerships in health insurance schemes are crucial for improving access to health services. Problems in the public supply chain of medicines often lead to medicine stock-outs which then negatively influence enrolment in and satisfaction with health insurance schemes. To address this challenge, the government of Tanzania embarked on a redesign of the Community Health Fund (CHF) and established a Prime Vendor System (Jazia PVS). Informal and rural population groups, however, rely heavily on another public–private partnership, the Accredited Drug Dispensing Outlets (ADDOs). This study takes up this public demand and explores the potentials, pitfalls, and modalities for linking the improved CHF (iCHF) with ADDOs.MethodsThis was a qualitative exploratory study employing different methods of data collection: in-depth interviews, focus group discussions, and document reviews.ResultsStudy participants saw a great potential for linking ADDOs with iCHF, following continuous community complaints about medicine stock-out challenges at public health facilities, a situation that also affects the healthcare staff’s working environment. The Jazia PVS was said to have improved the situation of medicine availability at public health facilities, although not fully measuring up to the challenge. Study participants thought linking ADDOs with the iCHF would not only improve access to medicine but also increase member enrolment in the scheme. The main pitfalls that may threaten this linkage include the high price of medicines at ADDOs that cannot be accommodated within the iCHF payment model and inadequate digital skills relevant for communication between iCHF and ADDOs. Participants recommended linking ADDOs with the iCHF by piloting the connection with a few ADDOs meeting the selected criteria, while applying similar modalities for linking private retail outlets with the National Health Insurance Fund (NHIF).ConclusionsAs the government of Tanzania is moving toward the Single National Health Insurance Fund, there is a great opportunity to link the iCHF with ADDOs, building on established connections between the NHIF and ADDOs and the lessons learnt from the Jazia PVS. This study provides insights into the relevance of expanding public–private partnership in health insurance schemes in low- and middle-income countries.

Does Awareness Matter for the Improved Community Health Fund? Evidence from Street Vendors in Dodoma City, Tanzania

Globally, countries are implementing pro-poor reforms to advance healthcare’s accessibility to all people. The community health fund is part of the global strategies to attain universal health coverage and accessibility of healthcare services. Thus, the community health fund is cited as a possible strategy for granting access to basic healthcare services to the poor and workers in the informal sectors such as street vending without facing financial difficulties. The study was set to assess the awareness of the street vendors on the improved Community Health Fund in Dodoma City Tanzania. Data were collected using a questionnaire from a sample of 100 street vendors and focus group discussions (FGDs) from 24 participants from Dodoma City. Quantitative data were analysed descriptively while qualitative data involved thematic analysis of the recorded interactive discussions with the participants. The findings revealed that most street vendors were aware of the Improved Community Health Fund (iCHF). Similarly, the results showed that the level of awareness of the street vendors about the procedures for the registration and the benefits package was low. In the same breadth, the findings indicated that most street vendors had never attended sensitization seminars and training from CHF officials. The study concludes that the high level of awareness has not translated into high enrollment and registration of the street vendors to the improved CHF. Thus, the CHF management is called upon to provide education through radio and social media to raise the awareness of the street vendors about the benefits and registration procedures of the improved CHF.

The Effect of Adequate Funding and Health Service Provision on Micro Health Insurance Growth: The Case of BEPHA in the NWR of Cameroon

Purpose: Inadequate financial support and provision of poor-quality health services among the health facilities are major causes behind poor performance of Community Health Financing (CHF). The objective of this study was to investigate the effect of adequate funding and health service provision on micro health insurance growth, taking BEPHA as a case study.&#x0D; Methodology: The descriptive and explanatory research designs were used in this study. Data was collected by administering questionnaires to 400 respondents. Interviews were also carried out on 10 staff of BEPHA. Data were analyzed using descriptive statistics, correlation, and multiple regression analysis.&#x0D; Findings: In results regarding BEPHA financing, 70% of those interviewed believed it is high while 30% indicated that it is low. Out of 400 participants 191 (47.8%) of them perceived services offered by BEPHA partner hospitals as fair while 182 (45.5%) perceived their services as good. The correlation results showed a strong positive and significant relationship between sufficiency of BEPHA financing (r= 0.802, p &lt; 0.05) and quality of BEPHA health services (r = 0.667, p &lt; 0.05) with the growth of BEPHA as a health insurance scheme. The multiple regression analysis results showed that sufficiency of BEPHA financing (β=0.166; p &lt; 0.1), has a positive and significant effect on growth of BEPHA. The quality of BEPHA health services (β=0.200; p &lt; 0.1) also has a significant positive effect on growth of BEPHA. Concisely, the study revealed that the funding and quality of BEPHA health services can determine the variations in the growth of BEPHA health insurance scheme.&#x0D; Recommendations: This study thus recommended that, the scheme should reduce the waiting period for minor health risk to at most 2 weeks while the 6 months waiting period for major health risk including delivery should be reduced to one (01) month to increase finances from large enrolment. It also recommended the sensitization of health personnel on good customer service principles to increase service quality at these partner health facilities.

Development strategy for the local health security fund in national health security office region 10, Ubon Ratchathani, Thailand

Local health security funds or Community Health Fund are an innovation introduced to achieve greater local government involvement in Thailand’s Universal Health Coverage and is an outcome of decentralizing power to local administrations and serves as a health fund for people in local communities. The fund’s budget is subsidized by the National Health Security Office which the contributes to a fund with a condition that the local government provides matching funding, but it also found that most funds run by fund administrative committee of Local Administrative Organizations had significant weakness such as their lacked strategies for deploying funds, had taken few steps to promote cooperation among local health care providers and lacked systematic mechanisms for assessing available resources and health informatic system. This study aimed to develop a strategy for agreeing and implementing the Local Health Security Fund in a northeastern Thai provinces. It applied mixed research methodology to investigate fund strategies and development models. The quantitative study component involved a questionnaire completed by 720 members serving on funds administrative committees from 270 fund. The results of study identified six strategies employed by existing funds : 1) Strengthening and developing the capacity of fund committee.

Assessment of Strategic Healthcare Purchasing Arrangements and Functions Towards Universal Coverage in Tanzania.

Strategic health purchasing in low- and middle-income countries has received substantial attention as countries aim to achieve universal health coverage (UHC), by ensuring equitable access to quality health services without the risk of financial hardship. There is little evidence published from Tanzania on purchasing arrangements and what is required for strategic purchasing. This study analyses three purchasing arrangements in Tanzania and gives recommendations to strengthen strategic purchasing in Tanzania. We used the multi-case qualitative study drawing on the National Health Insurance Fund (NHIF), Social Health Insurance Benefit (SHIB), and improved Community Health Fund (iCHF) to explore the three purchasing arrangements with a purchaser-provider split. Data were drawn from document reviews and results were validated with nine key informant (KI) interviews with a range of actors involved in strategic purchasing. A deductive and inductive approach was used to develop the themes and framework analysis to summarize the data. The findings show that benefit selection for all three schemes was based on the standard treatment guidelines issued by the Ministry of Health. Selection-contracting of the private healthcare providers are based on the location of the provider, the range of services available as stipulated in the scheme guideline, and the willingness of the provider to be contracted. NHF uses fee-for-service to reimburse providers. While SHIB and iCHF use capitation. NHIF has an electronic system to monitor registration, verification, claims processing, and referrals. While SHIB monitoring is done through routine supportive supervision and for the iCHF provider performance is monitored through utilization rates. Enforcing compliance with the contractual agreement between providers-purchasers is crucial for the provision of quality services in an efficient manner. Investment in a routine monitoring system, such as the use of the district health information system which allows effective tracking of healthcare service delivery, and broader population healthcare outcomes.

Factors Associated with the Implementation of an Improved Community Health Fund in the Ubungo Municipality Area, Dar es Salaam Region, Tanzania.

Community-based health insurance schemes help households to afford healthcare services. This paper describes healthcare facilities and community factors that are associated with the Improved Community Health Fund (iCHF) scheme in the Ubungo district of Tanzania. A cross-sectional descriptive study was conducted using online questionnaires that were completed by healthcare providers and community members in public-owned healthcare facilities in the Ubungo Municipal Council district of Dar es Salaam, Tanzania, between October and November 2021. The data were analyzed using descriptive statistics and the chi-squared test of association. We found a statistically significant relationship between income level and satisfaction with the iCHF scheme. For community-related factors, income level was statistically significant in the level of involvement in iCHF implementation among local leaders. Further, income level was statistically significant in relation to community behavior/culture toward the iCHF. Occupation was statistically significant in iCHF implementation, iCHF premiums, and iCHF membership size. A statistically significant relationship was also found between income, iCHF membership size, and iCHF premiums. Moreover, people would be willing to pay the required premiums if the quality of the healthcare services under the iCHF scheme improves. Therefore, the government should allocate resources to reduce the challenges that are facing iCHF implementation, such as the preference for a user fee scheme over the iCHF, the issues that are faced by enrollment officers, and inadequate iCHF premiums and membership size.