1. COMMUNITY HEALTH FUND AS A COMPLEMENTARY FINANCING OPTION IN TANZANIA Presented at CHF Best Practice Workshop: 31 st Jan – 2 nd Feb. 2007 Golden Tulip Hotel –Dar Es Salaam By J. E. Sendoro CHF Coordinator MOH&SW, Tanzania

2. 2 Existing Health Financing Option In Tanzania Government Funding Donor Contributions Social Health Insurance (NSSF,NHIF) Private Health Insurance Donations From Individuals, Companies, NGOs Out Of Pocket Payments (User Fees) Community Contributions

3. 3 Definition Community Health Fund (CHF) in Tanzania is a voluntary pre-payment scheme, which offers a client (household) the opportunity to acquire a “health card” after paying contribution. A household can be an individual or a family A card is renewed after every 12 months.

4. 4 Background  CHF in Tanzania started as a pilot scheme in 1996 in Igunga district.  The scheme was a result of studies conducted in 1990-92 on willingness and ability to pay.  Implementation experience of Igunga was evaluated in 1998 then used to roll out the scheme to nine more districts.  In2001, the policy decision was reached to cover all districts through an Act of Parliament.

5. 5 CHF Concept & Design in Tanzania  It is a voluntary scheme.  It is district based.  CHF entails pre-payment for health care and risk sharing.  Provision of user fee for non-members  Exemption mechanism for poor and vulnerable groups.

6. 6 Concept & Design Cont….  The scheme operates in partnership between communities and the Government.  The Government provide “Matching Grant” to CHF scheme at district level.  Communities can pay contributions during harvest time and enjoy services throughout the year.  CHSB and Community Health Committees manage the Fund.  CHF scheme is not intended to replace the government funding.

7. 7 Objectives of CHF according to Act No.1 of 2001  Mobilize financial resources from the community for provision of health care services to its members.  Provide quality and affordable health care services through sustainable financial mechanism.  Improve health care management in the communities through decentralization.

8. 8 Expected Results  A sustainable financial mechanism.  Adequate medical supplies and equipment at health facilities.  Improved quality of health care services  Adequate, skilled and motivated health providers  Improved community participation.

9. 9 Implementation Status of CHF Achievements  Operational guideline for introduction and management of the scheme is in place.  92 DC’s have been sensitized and adopted CHF Legal Instrument.  69 DC’s have launched the scheme and are in various stages of implementation.

10. 10 Achievements Cont…..  Between July 2004- June 2006 the total of Tshs 800,000,000/= was requested and paid as matching grant.  Capacity building have been done to districts  Improved infrastructure of health facilities  Supportive supervision have been performed accordingly.

11. 11 Achievements Cont…..  The mobilized financial resources are used for health care improvement e.g. rehabilitation.  The introduction of new CHF management tools and software (CHF TRACK).  Contract between MOH&SW and individual councils on expenditure framework of the matching grant.

12. 12 Concerns and Challenges (a)Low enrollment of members  Membership ranges from 4%-20% (b)Inadequate Management skills  CHF is expanding faster (to more districts) than management skills.  Improper record keeping in some councils.

13. 13 Concerns and Challenges Cont…. ( c) Supervision conducted to councils revealed the following:  Inadequate community awareness on CHF  Inadequate community involvement and ownership  Poor quality of care and lack of accountability to the community  Leakages or loss of fees collected  Misuse of membership cards.

14. 14 The Way Forward  Extend the use of New CHF management tools and software to all councils in phases  Enhance monitoring and evaluation at all levels  Harmonize premium country wide  Continue to improve advocacy program at all levels  Strengthen planning and management skills through on the job training and other training opportunities

15. 15 The Way Forward Cont…  Strengthen coordination by use and maintaining Zonal and Regional Coordination Centres  Provision of required materials and equipment to councils  Ensuring the involvement of all key stakeholders in CHF promotion and implementation process

16. 16 The Way Forward Cont…  Assist councils in reviewing and improving the benefit package overtime  In built incentive package in CHF promotion program.

17. 17 ASANTENI KWA KUNISIKILIZA THANK YOU FOR LISTENING

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