Transcript Improving Quality of Care through Strengthened Community

Improving Quality of Care through Strengthened
Community Health Funds in Ulanga District
Christopher E. Mshana
Ifakara Health Institute
2nd National Quality Improvement Forum;
Mlimani City, Dar – es Salaam, Tanzania.
November 2012
INTRODUCTION (1/3)
 Health sector in Tanzania is faced with inadequate
financial resources from central government to
improve the delivery of quality of health care.
 Community Health Fund (CHF) established as an
alternative to health care financing in the country.
 CHF is a decentralized voluntary prepayment scheme
targeting rural populations and the informal sector.
 Households pay contributions on a regular basis to
finance basic health services to complement the
Government health care financing efforts.
 However, CHF is still a largely untapped source of
health financing at local level.
INTRODUCTION (2/3)
 CHF established to address the following quality
of health services objectives:
 To mobilize financial resources from the
community for provision of health care services to
its members.
 To provide quality and affordable health care
services through a sustainable financial
mechanism.
 To improve health care services management in
the communities by empowering the communities
to make decisions and to contribute on matters
affecting their health.
INTRODUCTION (3/3)
 The Health Sector Strategic Plan III spells out the
target of reaching 30% of the national population
through CHF by 2015.
 Coverage estimated at 8% currently.
 Various analyses of the challenges facing CHF have
been conducted, and they consistently point at
weaknesses in design, management and support
through the health system (Mtei and Mulligan, 2007;
Schulze, 2008; Kessy, 2008 Stoermer et al., 2010).
 Achieving the objectives for establishment of CHF and
the target of 30% coverage by 2015 requires focused
interventions to strengthen management of the
scheme.
WHY CHF SUPPORT BY ACCESS PROJECT?
 The ACCESS project aimed to raise enrolment rates of
CHF in order to improve financial access to quality
healthcare for communities in Ulanga district.
 Prior ACCESS project involvement, the functioning of
CHF scheme in the district was faced by the following
problems:
 Most of community members were not aware of CHF
scheme and its implementation process.
 Members purchased medicines from ADDOs due to
frequent medicines shortages at their facilities.
 Facilities could not spend their contributions even for
minor repairs of their health facilities.
 Members of health governance structures didn’t
have knowledge on their roles in CHF management.
INTERVENTIONS TO STRENGTHEN CHF(1/3)
 Develop operational manual for CHF management
to guide the establishment of CHF schemes in
districts as well as training and resource/tool.
 The manual;
• Provides guidance for establishment of CHF
scheme in the district.
• Increases and broaden knowledge and
understanding on the concept of CHF.
• Enable organs to develop appropriate and
effective communication strategies for CHF
promotion.
• Provide the guidance for CHF data collection and
management.
INTERVENTIONS TO STRENGTHEN CHF (2/3)
 Conducting capacity building training to members of
the health governance structures on their roles and
responsibilities in managing the CHF. These include;
 Council Health Management Team (CHMT)
 Council Health Services Board (CHSB), and
 Health Facility Governing Committees (HFGCs).
 Facilitating development of CHSB ACTION PLANS and
incorporate the plan into Comprehensive Council
Health Plans (CCHPs).
 Introducing data collection and management tool to;
 Enable the CHF managers to maintain appropriate CHF
records at health facility and district level.
 Provide feedback by producing monthly, quarterly,
biannual and annual CHF reports and track CHF
performance at different levels.
INTERVENTIONS TO STRENGTHEN CHF (3/3)
 Develop CHF communication strategies at all
levels;
 CHF behavioral change communication strategies
(setting objectives, message development and
means of communication) developed and training
conducted to Community Resource Persons.
 Community leaders advocacy and sensitization
meetings conducted at village level.
 General population CHF sensitization meetings.
 CHF radio spots aired through local FM radio stations
 Produced CHF IEC materials such as posters,
brochures and branded T/shirts.
ACHIEVEMENTS (1/2)
 CHF performance in Ulanga District has improved
significantly from 2008 to 2012.
Ulanga District
2008
2009
2010
2011
2012
1,900
2,858
3,332
4,158
5,377
CHF beneficiaries
11,400
17,148
19,992
24,948
32,262
District population
79,635
81,176 229,857 234,150 283,415
132,723
135,294 137,914 140,490 143,049
8.59%
12.67% 14.50% 17.76% 22.55%
Household CHF members
Target population (60% of
the total population)
Enrolment Rate (%)
ACHIEVEMENTS (2/2)
 CHF collections increased from 34 million (2008) to
over 105 million (2012) Tanzanian Shillings.
 The cumulative matching fund received from NHIF
from 2003 to 2010 sum up to TZS 63,025,000
 A total of TZS 90 million used to procure essential
medicines and over TZS 57 million used for medical
equipment.
 Funds have also been used for minor infrastructure
repairs, construction of toilets and to procure
cleaning and waste management materials.
CONCLUSION
 Strengthening CHF management with selected
interventions at health system and community level is
crucial for stimulating demand for CHF membership.
 This in turn attracts a larger amount of matching funds
from the central government and hence creates the
base for improving quality of healthcare, including
better availability of medicines and medical equipment.
 Thus, it can be argued that, CHF scheme is a potential
community based healthcare financing mechanism that
can improve supply of perceived quality of healthcare
at local level.
Ifakara Health Institute
Flora Kessy
Dominick Mboya
Christopher Mshana
Novartis Foundation for
Sustainable Development
Alexander Schulze
www.ihi.or.tz
www.swisstph.ch
www.novartisfoundation.org
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