Transcript CHALLENGES OF SCALING UP COMMUNITY HEALTH FUND …

COMMUNITY HEALTH FUND AS A
COMPLEMENTARY FINANCING
OPTION IN TANZANIA
Presented at CHF Best Practice Workshop:
31st Jan – 2nd Feb. 2007
Golden Tulip Hotel –Dar Es Salaam
By J. E. Sendoro
CHF Coordinator
MOH&SW, Tanzania
Existing Health Financing Option In
Tanzania
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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
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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.
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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.
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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.
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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.
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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.
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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.
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Implementation Status of CHF
Achievements
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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.
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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.
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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.
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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.
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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.
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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
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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
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The Way Forward Cont…
 Assist councils in reviewing and improving
the benefit package overtime
 In built incentive package in CHF
promotion program.
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ASANTENI KWA KUNISIKILIZA
THANK YOU FOR LISTENING
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