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

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 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 Background  CHF in Tanzania started as a pilot scheme in 1996 in Igunga district.  The scheme was a result of studies conducted in 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 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 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 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 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 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 Achievements Cont…..  Between July 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 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 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 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 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 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 The Way Forward Cont…  Assist councils in reviewing and improving the benefit package overtime  In built incentive package in CHF promotion program.

17 ASANTENI KWA KUNISIKILIZA THANK YOU FOR LISTENING

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