Factors Associated with the Implementation of an Improved Community Health Fund in the Ubungo Municipality Area, Dar es Salaam Region, Tanzania

Community-based health insurance schemes help households to afford healthcare services. This paper describes healthcare facilities and community factors that are associated with the Improved Community Health Fund (iCHF) scheme in the Ubungo district of Tanzania. A cross-sectional descriptive study was conducted using online questionnaires that were completed by healthcare providers and community members in public-owned healthcare facilities in the Ubungo Municipal Council district of Dar es Salaam, Tanzania, between October and November 2021. The data were analyzed using descriptive statistics and the chi-squared test of association. We found a statistically significant relationship between income level and satisfaction with the iCHF scheme. For community-related factors, income level was statistically significant in the level of involvement in iCHF implementation among local leaders. Further, income level was statistically significant in relation to community behavior/culture toward the iCHF. Occupation was statistically significant in iCHF implementation, iCHF premiums, and iCHF membership size. A statistically significant relationship was also found between income, iCHF membership size, and iCHF premiums. Moreover, people would be willing to pay the required premiums if the quality of the healthcare services under the iCHF scheme improves. Therefore, the government should allocate resources to reduce the challenges that are facing iCHF implementation, such as the preference for a user fee scheme over the iCHF, the issues that are faced by enrollment officers, and inadequate iCHF premiums and membership size.

[1]  S. Maluka,et al.  The failure of community-based health insurance schemes in Tanzania: opening the black box of the implementation process , 2021, BMC Health Services Research.

[2]  W. Godana,et al.  Factors affecting enrollment status of households for community based health insurance in a resource-limited peripheral area in Southern Ethiopia. Mixed method , 2021, PloS one.

[3]  Edosa Tesfaye Geta,et al.  Magnitude and Determinants of Dropout from Community-Based Health Insurance Among Households in Manna District, Jimma Zone, Southwest Ethiopia , 2020, ClinicoEconomics and outcomes research : CEOR.

[4]  S. Maluka,et al.  An Assessment of the Implementation of the Re-structured Community Health Fund in Gairo District in Tanzania , 2020 .

[5]  A. Bedi,et al.  The Effect of Ethiopia’s Community-Based Health Insurance Scheme on Revenues and Quality of Care , 2020, International journal of environmental research and public health.

[6]  S. Maluka,et al.  Uptake of community health fund: why is Mtwara District lagging behind? , 2019, Journal of Global Health Science.

[7]  G. A. Biks,et al.  Determinants of community-based health insurance implementation in west Gojjam zone, Northwest Ethiopia: a community based cross sectional study design , 2019, BMC Health Services Research.

[8]  P. Develtere,et al.  Understanding the limitations of "quasi-mandatory" approaches to enrolment in community-based health insurance: Empirical evidence from Tanzania. , 2019, The International journal of health planning and management.

[9]  C. Lengeler,et al.  Looking at the bigger picture: how the wider health financing context affects the implementation of the Tanzanian Community Health Funds , 2019, Health policy and planning.

[10]  A. Touré,et al.  Distribution of out of pocket health expenditures in a sub-Saharan Africa country: evidence from the national survey of household standard of living, Côte d’Ivoire , 2019, BMC Research Notes.

[11]  M. Nzayirambaho,et al.  Factors Contributing to Low Adherence to Community-Based Health Insurance in Rural Nyanza District, Southern Rwanda , 2018, Journal of environmental and public health.

[12]  Huihui Wang,et al.  Progressive Pathway to Universal Health Coverage in Tanzania: A Call for Preferential Resource Allocation Targeting the Poor , 2018, Health systems and reform.

[13]  Soonman Kwon,et al.  Adverse selection and supply‐side factors in the enrollment in community‐based health insurance in Northwest Ethiopia: A mixed methodology , 2018, The International journal of health planning and management.

[14]  Ntuli A. Kapologwe,et al.  Barriers and facilitators to enrollment and re-enrollment into the community health funds/Tiba Kwa Kadi (CHF/TIKA) in Tanzania: a cross-sectional inquiry on the effects of socio-demographic factors and social marketing strategies , 2017, BMC Health Services Research.

[15]  C. Mpambije Decentralisation of Health Systems and the Fate of Community Health Fund in Tanzania: Critical Review of High and Low Performing Districts , 2017 .

[16]  S. Maluka,et al.  Do Management and Leadership Practices in the Context of Decentralisation Influence Performance of Community Health Fund? Evidence From Iramba and Iringa Districts in Tanzania , 2016, International journal of health policy and management.

[17]  J. Borghi,et al.  The administrative costs of community-based health insurance: a case study of the community health fund in Tanzania , 2013, Health policy and planning.

[18]  George Kivelege Community health fund and quality health services in Morogoro district, Tanzania , 2015 .

[19]  B. Njau,et al.  Feasibility of introducing compulsory community health fund in low resource countries: views from the communities in Liwale district of Tanzania , 2013, BMC Health Services Research.

[20]  L. Gilson,et al.  Factors influencing implementation of the Community Health Fund in Tanzania. , 2007, Health policy and planning.