Contribution of self-help groups to enrollment in improved community health fund in Tanzania: a case of Dodoma city council

Abstract

ABSTRACT Background: To encourage members to join in Tanzania's improved Community Health Fund (iCHF), the government and stakeholders have launched several programs. Among these measures are paying direct annual fees to destitute households and enrolling members in the iCHF. Individuals are encouraged to join Self-Help Groups (SHGs) to guarantee they can repay at the end of the year after being supported by yearly fee payments and registration in the program. Objectives: This study aimed to explore the contribution of Self-help groups on household enrolment in the iCHF in Dodoma City Council, Dodoma Tanzania. Materials and Methods: A qualitative case study design was employed during the study in Dodoma City Council. The population included supported individuals with annual iCHF subscriptions in the SHGs with multistage and purposive sampling techniques. Data were collected from November 2023 to January 2024 engaging 25 participants selected purposively from a list of the supported individuals shared by enrollment officer. During this study, 14 SHG members benefited from iCHF annual fee payment support were recruited for the two FGDs and 11 SHG members benefited from iCHF annual fee payment support enrolled for IDI during the data collection process. Colletcted data were subjected to thematic analysis using a deductive approach to analyze the collected information involving identifying, analyzing, and reporting patterns (themes) across the collected data through Nvivo 12 software. Results: The study findings show that linking individuals in the SHGs has a high influence on individual enrollment in the iCHF scheme because it provides the opportunity to raise household income and motivate members to prioritize payment for the iCHF. Moreover, participants revealed that the SHG provides opportunities to take loans and pay for health services at the time of financial crisis paying the iCHF scheme. Most of the participants mentioned the SHG sharing out process period as most sustainable way of ensuring individuals are enrolled in the iCHF because they have assurance to have enough money to plan and pay for the iCHF. Further, the participants perceived the iCHF as the most supportive and affordable way of assuring access to health services to its members compared to the use of out-of-pocket payment. Conclusion: Based on the study findings above, ensuring individuals are enrolled in the iCHF, the use of the SHG is the right platform which enable individual enrollment in the iCHF scheme. The emphasis should be made during sharing out process where members whocul be encouraged to pay iCHF fee during this time. This is due to the revealed findings that taking loan from the SHG for the annial iCHF fee payment is a short term sustaining compared to the sharing out process. Moreover, there is positive perception from the members on the use of the iCHF since it provides assurance on access to health services with affordable cost. Recommendation: Sharing out process is a sustainable way of enhancing capacity to pay for iCHF hence iCHF Enrollment Officers and stakeholders supporting those in need should use the SHGs as an entry point to sensitize individual enrollment in the iCHF. Moreover, iCHF requires further improvement hence the iCHF coordinators should engage the community in the improvement of the Community-Based Fund package to increase the ownership and commitment of the community in the utilization of the services. Also, during seeking health services most of the members fail to access services due to limitation of services in the scheme. The Enrollment officers should create awareness to the newly registered members on the services covered by the scheme and services not covered. The policy makers should introduce tiered premium systems based on income levels, where wealthier members contribute more while ensuring subsidies for the most vulnerable.