Looking at the bigger picture

How the wider health financing context affects the implementation of the Tanzanian Community Health Funds

Datos Bibliográficos

ID11491009
AutoresSabine Renggli (0000-0001-8233-6154, Swiss Tropical and Public Health Institute, autor de correspondencia), Iddy Mayumana (Ifakara Health Institute), Christopher Mshana (Ifakara Health Institute), Dominick Mboya (Ifakara Health Institute), Flora Kessy (Ifakara Health Institute), Fabrizio Tediosi (0000-0001-8671-9400, Swiss Tropical and Public Health Institute), Constanze Pfeiffer (0000-0002-9487-2867, Swiss Tropical and Public Health Institute), Ann Aerts (0000-0003-1241-8730, Novartis Foundation, Basel, Switzerland), Christian Lengeler (0000-0002-8883-7950, Swiss Tropical and Public Health Institute)
Año2019
Volumen34
Número1
Páginas12-23
Fecha de publicación2019-02-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaHealth Policy and Planning (JOURNAL)
Identificadores de la revistaISSN: 0268-1080 • E-ISSN: 1460-2237
EditorialOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czy091
PMID30689879
OpenAlexW2913331068
IdiomaEN
Citas recibidas9
Referencias citadas23

In Tanzania, the health financing system is extremely fragmented with strategies in place to supplement funds provided from the central level. One of these strategies is the Community Health Fund (CHF), a voluntary health insurance scheme for the informal rural sector. As its implementation has been challenging, we investigated different CHF implementation practices and how these practices and the wider health financing context affect CHF implementation and potentially enrolment. Two councils were purposively selected for this study. Routine data relevant for understanding CHF implementation in the wider health financing context were collected at council and public health facility level. Additionally, an economic costing approach was used to estimate CHF administration cost and analyse its financing sources. Our results showed the importance of considering different CHF implementation practices and the wider health financing context when looking at CHF performance. Exemption policies and healthcare-seeking behaviour influenced negatively the maximum potential enrolment rate of the voluntary CHF scheme. Higher revenues from user fees, user fee policies and fund pooling mechanisms might have furthermore set incentives for care providers to prioritize user fees over CHF revenues. Costing results clearly pointed out the lack of financial sustainability of the CHF. The financial analysis however also showed that thanks to significant contributions from other health financing mechanisms to CHF administration, the CHF could be left with more than 70% of its revenues for financing services. To make the CHF work, major improvements in CHF implementation practices would be needed, but given the wider health financing context and healthcare-seeking behaviours, it is questionable whether such improvements are feasible, scalable and value for money. Thus, our results call for a reconsideration of approaches taken to address the challenges in health financing and demonstrate that the CHF cannot be looked at as a stand-alone system.

Business · Context (archaeology) · Economic growth · Economics · Health care · Public economics · Revenue · Finance · Global Maternal and Child Health · Healthcare Systems and Reforms · Poverty, Education, and Child Welfare