Abstract:
Background: Tanzania like many other developing countries is facing challenges in
finding proper mechanism of health care financing that would ensure equitable
access to health care for all her citizens especially those employed in non-formal
sector. The government of Tanzania has initiated a number of prepayment schemes
as an effort to provide health care financial protection for its citizen. Community
Health Fund (CHF) is one of the schemes aimed for rural population. CHF have
proved to provide well functioning health care financial protection to its members.
However, its enrolment level in all districts has remained unexpectedly very low.
Objectives: The main objective of this study was to identify household and health
facility related factors that contribute to low enrolment to CHF scheme in Rombo
District.
Methods: It was a cross-sectional study which employed mixed methods of data
collection. Both qualitative and quantitative data were concurrently collected. The
study involved four samples: 144 household heads; 150 exit patients; 36 health staff
and 3 CHF district officials. The four samples were included in order to obtain
enough triangulation of information. Data from each method were analysed
separately; Quantitative data ware entered and analysed in the SPSS computer
program where descriptive statistics were derived; Qualitative data were analysed by
generating themes according to the study objectives with the aid of ATLAS.ti 6
computer program. The generated themes were embedded in to the quantitative
results to enrich where it fits.
Results: Health staffs' practices were highly accepted by exit patients; also health
staff had positive opinions on CHF usefulness. These were potential optimistic
findings that were expected to attract more community members to join the scheme.
However, lack of knowledge about CHF operations and use of private health
facilities among household heads had significant negative effect in CHF enrolment.
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In addition, lack of fixed time for registration of CHF members was identified to
create a loophole for drop out and non-enrolment.
Conclusion and Recommendation
Based on the results of this study it is therefore recommended that District CHF
Management should strengthen community sensitization and education about CHF
scheme. Additionally, revisiting the rules that guide implementation of CHF in
Rombo district is necessary in order to remove the loopholes that contribute to non-
enrolment and drop out of the scheme.
