Household and health facility related factors contributing to low enrolment to community fund in Romeo district

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.

vu 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.