PRIME MINISTER’S OFFICE, REGIONAL ADMINISTRATION AND LOCAL GOVERNMENT TOPIC: LEGAL AND ORGANISATIONS ASPECTS IN IMPLEMENTING COMMUNITY HEALTH FUND IN TANZANIA A PAPER PRESENTED AT THE COMMUNITY HEALTH FUND BEST PRASTISE WORKSHOP HELD AT GOLDEN TULIP HOTEL DAR ES SALAAM By: Kharist Luanda Assistant Director

INTRODUCTION: The economic and social arena in Tanzania has changed fundamentally over the last decade. The changed economy is characterized by the following changes namely, political and economic pluralism, involvement of individual and private sector in service delivery, globalization, regionalization and competitive and dynamic market economy. These changes paved way to the introduction of the Public Sector Reform which is a Government response to the changed Economy. The Public Sector Reform laid the foundation of other sector reforms including the health sector reform. The Health Sector Reform among other things emphasizes the community participation in the delivery of the basic health care services as a complementary Scheme to the Government health care financing efforts.

INTRODUCTION Cont… Dwelling on the philosophy of Community participation and bearing in mind the expanded demands of affordable basic health care services the Government through the Ministry of Health (as it then was) introduced the Community Health Fund as financing Scheme.

LEGAL AND ORGANISATIONAL ASPECTS OF THE FUND. Establishment and Management of the Fund. The Community Health Fund is established by the Community Health Act No 1/2001.However the actual establishment of the Fund in respective Council s is made by By laws made by each Council under the powers vested to them by Local Government Laws. The Fund is a Voluntary Community Based Financing Scheme whereby households pay contributions to finance part of their basic health care Services to complement the Government health financing efforts.

Establishment and Management of the Fund. The Objective of the Fund are as follows:- to mobilize financial resources from the Community for the provisions of health care service to its members. to provide quality and affordable health care services through a sustainable financial mechanism and, to improve health care service management in the community through decentralization by empowering the communities in making decisions and contributing on matters affecting their health.

Establishment and Management of the Fund. The management and administration of the Fund is categorized at four levels. At the National level is managed by the ministry responsible for health matters and the ministry responsible for Local Government which have been mandated to provide advice and technical support to the Fund and monitor and evaluate the activities of the Fund. At district level the Fund is managed and administered by the District/Town/Municipal/City Council through a Council Health Service Board.

Establishment and Management of the Fund. At ward level the Fund is managed and administered by the Ward Development Committee through Ward Health Committee. At Village level the Fund is managed and administered by the Village council through the Village Social Service committee.

Establishment and Administration of the Board. The Council Health Service Board is established by an instrument made under the provisions of Section 86 A of the Local Government (District Authorities) Act Cap 287 (Previously Act No 7/1982) for District Authorities and section 56A of the Local Government (Urban Authorities) Act Cap 288 (Previously Act No 8/1982) for Urban Authorities.

Establishment and Administration of the Board. The Board is composed of the following members. –Four Community Service users at least two shall be female. –One representative each from a non-profit voluntary agency and a private for profit health care facility appointed by the Council from amongst health care facilities. –The head of the Council Social Services Committee. –Council Planning Officer

Establishment and Administration of the Board. –The District Medical Officer who shall be the Secretary. –One representative from the hospital. –One representative from the Regional Health Management Team.

Establishment and Administration of the Board. The functions of the Board shall be. to provide district health services and monitor Community Health Fund operations and activities. to mobilize and administer funds for Community health Fund. to work in consultation with the Council Health Management Team to ensure quality health care and professionalism. to set exemption criteria for users of the health care service provided by the Fund. to set targets for the Fund. to review reports from Ward Health Committee. to monitor and make verification on collection, expenditure and control of the Fund, and To design an annual health plans for approval by the Council.

Establishment and Administration of the Board. The roles, duties and responsibilities of the Board shall be: to ensure that the population receives appropriate and affordable, promotive, preventive, curative and rehabilitative health care services; to discuss, amend health plans, budget and submit to the Council for approval; to receive, analyze and approve implementation reports from the Council Health Management Team; to identify, mobilize and solicit financial resources for running council health service; to mobilize adequate resources that will ensure effective, efficient and equitable access to health services in the district; to support Council health Management Team in managing and administering heath resources; to prepare and recommend on a council wide health plan and budget the committees for health services; to promote sustainable health infrastructure and reliable logistics and supply systems; to develop, supervise and manage health services in the district;

Establishment and Administration of the Board. The Council Health Service Board is accountable to the Council in performing its functions, roles, duties and responsibilities mentioned above. The Council through the committee responsible for social services is charged with the responsibilities of coordinating the day to day activities of the Board.

IMPLEMENTATION OF THE COUNCIL HEALTH FUND. Sources of Fund. In attaining the intended objectives the Fund need financial resources from various sources. The funds and resources of the Fund consists of:- –all moneys received in respect of contributions paid by members –User fee payable for using a government health centre or dispensary. –Government Contribution (Matching grants). –grants from Council, organizations or any other donor –any other money lawfully acquired from other sources.

IMPLEMENTATION OF THE COUNCIL HEALTH FUND. The money accrued to the Fund shall be used for health related purposes specified in the health plans and approved by the Board, and any other essential health purposes or activities as may approved by the Board. The financial Management of the Fund is vested to the Board. The Board is responsible for keeping proper accounts and other records and shall prepare the Council statement of accounts. The Board is also responsible for the preparation of the performance reports of its functions and submit to the Council through the committee responsible for social services.

Achievement Since the operationalisation of the Community Health Fund Act and its related By laws 69 Councils out of 122 have established Health Service Boards and Council Health Fund.

Achievement Owing to this broader achievement the following specific achievements have been underscored:- More people have increased access to appropriate and affordable promotive, curative and rehabilitate health care services. The Community has got a reliable financial Scheme Households need not keep money for medical treatments Increased standard of Health care services.

Achievement Challenges and Problems The most serious challenges includes:- Poor and unreliable contributions from the households. Delay in By-Law making due to extended procedural requirements.

Achievement Reluctance of the Communities to accept the Scheme and make the contributions. Some Communities still believe that the provisions of health care services is the exclusive responsibilities of the government. Inadequate financial resources in the sense that the contributions made by the Council and the Central government. Ineffective participation of communities in decision making processes. The composition of the Board does not allow effective participation of the ordinary inhabitants of respective council.

Corrective Measures The problems of poor and unreliable contribution and inadequate financial contributions can easily be solved by the increasing awareness creation and advocacy. The National Poverty Eradication strategy (MKUKUTA) has offered a new avenue to overcome the problem. Strengthening legal régime so as to bring on board fully communities participation across the board. Installation and operationalisation of a Web- enabled By-Law making Data base and issuance of Legislative Manual stands to cure the delay in By – Law making processes.

CONCLUSION Notwithstanding the challenges and constraints facing the effective implementation of the Scheme, it is undisputed fact that the Community Health Fund is the only available avenue to achieve the intended objective of improving access to appropriate and affordable promotive, preventive, curative and rehabilitative health care services in the country. It is the reliable scheme available to the poor households. In line with the goal and objective of the Community Health Fund, it is my hope that this session will eventually find means and ways to improve the community participation as a complementary scheme to the government efforts in the provisions of high quality health care services.