Desirability, challenges and options for launching a community health fund scheme in Tanzania: interview-based views from community members and health managers in Kagera Region and review of lessons from other CHF implementing districts

Abstract

Objective: To analyze community and health managers‟ views about desirability of, and challenges to launching a community health  fund (CHF) scheme in Kagera Region, Tanzania.

Methods: 301 household members in three districts were interviewed, preceded by interview of 191 same members as a baseline survey  in another district, supplemented by health communications with health managers at regional and district levels. Additional data were obtained through review of reports from other districts regarding their experience with CHF implementation. Data were analysed using  STATA software programme.

Results: About 73% of all respondents were involved in petty farming as their main occupation. All  respondents acknowledged to have heard about the CHF scheme mainly through local health committee members and mass media.  Nearly 54% of the respondents expressed a positive willingness to pay (WTP) Tanzanian Shillings (TZS) 10,000 premium rate per annum  for their households to enrol into the CHF scheme. Only 28.1% perceived that their households would be able to pay immediately, the  remainder include those who were uncertain or/indifferent about their ability to pay (ATP) and those unwilling. The mean and median  WTP amounts were TZS 7,098 and TZS 6,500, respectively. Seasonal unreliability of cash intensified doubts about ATP of some households.  Perceived households WTP was significantly higher among the respondents with formal education and those married than  their counterpart groups. Some respondents urged the authorities to allow in-kind payments, however, critics were concerned about the  acceptability of such payments to service providers and quality of care at healthcare facilities if a CHF scheme were launched. CHF  scheme was viewed as a potential option alternative to out-of-pocket userfees paid at healthcare service counters. The scheme has so far  been operating in more than half of the districts throughout Tanzania, but rates of enrolment have remained lower than anticipated.  

Conclusion: With proper public sensitization on health insurance issues and setting affordable premium rates and acceptable payment  modalities, households‟ WTP to join CHF scheme would increase to minimize chances of healthcare payment difficulties at the onset of  illness or injury.