Feasibility of a community health fund scheme in Tanzania: a qualitative analysis of policy prospects and local stakeholders’ experience-based views in Kagera Region

Abstract

Objective: We undertook a study to analyze from perspectives healthcare managers and community stakeholders the feasibility of  launching a community health fund (CHF) scheme in Kagera Region, Tanzania focusing on its acceptability and proposed membership fee payment modalities.
Methods: We collected data using group discussions with household members and hospital management teams (HMTs) and interviews  with government officers at village, neighbourhood, ward, district and regional levels. Data were organized thematically and executed  manually using a qualitative content analysis approach. Results: All stakeholders had at least heard of a CHF scheme. There were mixed  views regarding its benefits, majority expressed preference to join a CHF scheme to current outof-pocket user-fee payment system.  Doubt was expressed about poor household members‟ ability to pay (ATP) promptly if an annual premium rate of 10,000 shillings per  household was officially approved. Payment in installments appeared to be an important option to encourage enrollment of those with  low ATP the approved premium rate at once. However, HMTs viewed that a sizeable number of dishonest households still might not  comply with installment payment system. Debate evolved regarding polygamous families and parents living under the same roof with  their married sons/daughters paying same amount as small-sized families. In-kind payments involving non-cash products if allowed were  perceived to relieve poorest households, but critics doubted about the acceptability of such a payment system among most service  providers owing to inconvenience associated with storage and marketing products for costrecovery. Household members expressed low trust in the quality of healthcare and CHMTs‟ capacity and accountability. Follow up interviews with regional officers performed ten years after the original survey confirmed experience with low enrollment rates to the launched CHF scheme in Kagera and reports reveal low  community sensitiveness on insurance issues and trust in CHF scheme following experience gained from other regions in Tanzania.  Conclusion: CHF schemes are potential safety-net community insurance opportunities for protecting the poor, vulnerable and  marginalized groups, but before launching them, target communities should be adequately informed and sensitized on them so as to  build public trust such schemes including their management. Communities should also be involved in proposing CHF scheme‟s design  and management system.