Evaluating health service access and associated factors among improved community health fund insured patients attending same district hospital in Kilimanjaro

Abstract

ABSTRACT Background: Community Health Fund permits family members to access health care services from primary health facilities and secondary health services up to regional referral hospital without out-of-pocket payments. Despite the source of fund and mode of payment for health services, patient access to health service is a major factor for attaining quality health service. Objectives: This study aimed at evaluating health service access and associated factors among improved Community Health Fund members attending Same District Hospital in Kilimanjaro. Methods: The study used a hospital-based, analytical cross-sectional design with a quantitative approach, targeting clients aged 18 and older at Same District Hospital, Kilimanjaro. Data was collected using a pretested questionnaire from randomly selected respondents. Key aspects assessed included affordability (ability to pay for health services), physical accessibility (transportation convenience), facility accessibility (distance from residences), and acceptability (satisfaction with services). SPSS version 23 was used for data analysis, with chi-square tests to evaluate associations and Modified Poisson regression analysis to identify factors associated with healthcare access. Significance was set at 0.05. Results: 479 iCHF members consented to participate. Participants were predominantly aged 30-44 years, male, married and had secondary education and above. Affordability issues were significant, with 45.9% finding iCHF unable to provide necessary services without extra payments, and high dissatisfaction with cost of medicine, medical supplies, investigations, procedures, and referrals. Physical accessibility was viewed positively by 74.5%, though 27.8% still faced barriers. Acceptability was high, with 68.7% participants finding services acceptable overall. Significant associations were found between access to healthcare and non-infectious disease status (adjusted PR: 1.85, p=0.001) and age over 45 years (adjusted PR: 2.41, p<0.001). Conclusion and Recommendations: The study reveals significant gaps in affordability, physical accessibility, and overall access despite high levels of service acceptability. A substantial number of members, particularly from lower and middle-income brackets, encounter financial hurdles due to costs not covered by the insurance. Notably, access varies by illness type and age. It is recommended that enhancing financial protection by expanding iCHF coverage to include essential and specialized services, thereby reducing the financial burden. Improving physical accessibility through investments in transportation infrastructure and the addition of more health facilities, along with mobile clinics and community outreach programs, are suggested to mitigate physical barriers.