Quality of health care services in influencing Community health fund membership in Kilosa district.

Abstract

In Tanzania soon after independence, health care services were provided for free. The government financed health care services through general government taxes. However by the mid 1980s, the country faced economic problems which led to new policy formulation to match the economic crisis. Health Sector Reform (HSR) was implemented and the government was no longer the only health care financier. Other financing mechanisms to complement health care financing in the country, such as, Cost sharing, health insurance fund, private insurance and Community health fund were introduced (1) (2)(3) CHF is a voluntary pre payment health financing scheme whose premium is determined by the community itself, and mostly offered to the informal sector population who are mainly from the rural areas. It aims to increase accessibility, provide good quality of essential health care services and provide financial protection to the vulnerable groups in the country.(4)(5)(6)(7) The current enrolment proportion of CHF in Kilosa district is about only 2% of eligible households. This is very small compared to the required proportion of 85%, if the recommended proportion would be achieved, it would lead to health financing universal coverage. (8), (9), (10) OBJECTIVES: The purpose of the study was to explore the quality of health care services in influencing the Community Health Funds (CHF) memberships in Kilosa. METHODOLOGY: The study employed quantitative cross sectional study design. A two cluster sampling used, 12 government health facilities were systematic random selected, from a total of 47 health facilities using a sampling interval of (k=N/n=4). Then followed by systematic random sampling to obtain 27 clients from each of the 12 health facilities make a total of 328 aged from 18 up to 59 years clients and then exit interview was conducted. Questionnaires, structured and semi structured questions, used for data collection. Data were entered and analyzed using (SPSS 15.0 version) software, frequencies and cross tabulation were performed to obtain Chi- Square and then logistic regression was run in order to control confounders, so that the influences of qualities of health care in CHF memberships be well established. viii RESULTS: The results show proportion of CHF memberships among respondents was 33.8%. Medicines availability at the health facilities, waiting time before attended and presence of skilled health staffs found to be significantly (P<0.05) influencing CHF memberships in the District. Therefore, all these three components of quality health care services were factors encourage more people to join the scheme. However for the case of health customer care services, there was no statistical significant (P>0.05) in influencing CHF memberships. CONCLUSIONS: in order to increase CHF memberships in the community, these health quality components; Medicines availability, short waiting time and presence of skilled health staffs should be improved for more CHF enrolment and increased memberships. RECOMMENDATION: Policy-makers for Community Health Funds should include people’s perceptions and preferences on health services provisions, so that to during policy formulation are to be considered so that to improve the quality of health care services and increase CHF memberships to the community.