Exploring the effects of user fees, quality of care and utilization of health services on enrolment in community health fund, Bagamoyo district, Tanzania.

Abstract

Background: The co-existence of Community Health Fund (CHF) and user fees in Tanzania as health financial mechanisms have affected to CHF enrolment. However, little is known about the effect of user fees on CHF enrolment, non-enrollment and drop-out. Objectives: The study aimed at exploring the effects of coexistence of user fees and Community Health Fund scheme, quality of care and utilization of health services on CHF enrolment, non-enrollment and drop out in Bagamoyo District, Coast Region, Tanzania. Methods: An exploratory cross sectional community and health facility study was conducted in Bagamoyo District between April and May 2012. The study involved heads of households who were categorized in four groups; CHF members from community (63), non CHF members from the community (60), CHF members from health facilities (145) and non CHF members from health facilities (144). The study participants were interviewed using a semistructured questionnaire. Univariate and multivariate analyses were done to find factors associated CHF enrollment, non-enrollment and drop-out. Results: Although user fee was not pointed as the reason for not joining CHF, CHF members were significantly more likely to pay higher amount of user fee than non CHF members (p < 0.01). Being a CHF member was associated with non- payment of user fees and higher expenditure on health services. Furthermore, health services utilization, although slightly lower among non CHF members, was not statistically different between CHF and non CHF members (p = 0.09). Poor quality of health services at health services and poor referral mechanisms were the main reasons for dropping out from CHF. Recommendations: The co-existence of user fees and CHF should be re-visited. Efforts should be taken to improve quality of health services and referral mechanisms in the public health facilities in Bagamoyo in order to reduce unnecessary distress to the CHF members, decrease drop out and improve the performance of CHF in Bagamoyo.