BackgroundIn 1995, Tanzania introduced the voluntary Community Health Fund (CHF) with the aim of ensuring universal health coverage by increasing financial investment in the health sector. The uptake of the CHF is low, with an enrolment of only 6% compared to the national target of 75%. Mandatory models of community health financing have been suggested to increase enrolment and financial capacity. This study explores communities’ views on the introduction of a mandatory model, the Compulsory Community Health Fund (CCHF) in the Liwale district of Tanzania.MethodsA cross-sectional study which involved 387 participants in a structured face to face survey and 33 in qualitative interviews (26 in focus group discussions (FGD) and 7 in in-depth interviews (IDI). Structured survey data were analyzed using SPSS version 16 to produce descriptive statistics. Qualitative data were analyzed using content analysis.Results387 people completed a survey (58% males), mean age 38 years. Most participants (347, 89.7%) were poor subsistence farmers and 229 (59.2%) had never subscribed to any form of health insurance scheme. The idea of a CCHF was accepted by 221 (57%) survey participants. Reasons for accepting the CCHF included: reduced out of pocket expenditure, improved quality of health care and the removal of stigma for those who receive waivers at health care delivery points. The major reason for not accepting the CCHF was the poor quality of health care services currently offered. Participants suggested that enrolment to the CCHF be done after harvesting when the population were more likely to have disposable income, and that the quality care of care and benefits package be improved.ConclusionsThe CHF is acceptable to the most of study participants and feasible in rural Tanzania as an alternative mechanism to finance health care for the rural poor. Community members are willing to join the scheme provided they are well informed, involved in the design and implementation, and assured quality health care. Strong political will and a supportive environment are key ingredients for the success of the CCHF.
BackgroundIn recent years, Performance Based Financing (PBF); a form of result based financing, has attracted a global attention in health systems in developing countries. PBF promotes autonomous health facilities, motivates and introduces financial incentives to motivate health facilities and health workers to attain pre-determined targets. To achieve this, the Tanzanian government through the Christian Social Services Commission initiated a PBF pilot project in Rungwe district, Mbeya region. Kilimanjaro Christian Medical Center was given the role of training health workers on PBF principles in Rungwe. The aim of this study was to explore health care providers’ perception on a three years training on PBF principles in a PBF pilot project at Rungwe District in Mbeya, Tanzania.MethodsThis was an explorative qualitative study, which took place at Rungwe PBF pilot area in October 2012. Twenty six (26) participants were purposively selected. Six took part in- depth interviews (IDIs) and twenty (20) in the group discussions. Both the IDIs and the GDs explored the perceived benefit and challenges of implementing PBF in their workplace. Data were manually analyzed using content analysis approach.ResultsOverall informants had positive perspectives on PBF training. Most of the health facilities were able to implement some of the PBF concepts in their work places after the training, such as developing job descriptions for their staff, creating quarterly business plans for their facilities, costing for their services and entering service agreement with the government, improved record keeping, customer care and involving community as partners in running their facilities. The most common principle of paying individual performance bonuses was mentioned as a major challenge due to inadequate funding and poor design of Rungwe PBF pilot project.ConclusionDespite poor design and inadequate funding, our findings have shown some promising results after PBF training in the study area. The findings have highlighted the potential of PBF to act as leverage for initiating innovative and proactive actions, which may motivate health personnel performance and quality of care in the study setting with minimal support. However, key policy issues at the national level should be addressed in order to exploit this opportunity.
Background: Microfinance Institutions (MFI) award small loans and women are the primary target. Whilst much literature has explored and acknowledged its impact on poverty alleviation and gender equality few studies have examined whether the added income also improves health outcomes to program clients. This study examined the association between participation in MFI programmes and wellbeing of clients and their family members via social determinants of health in Moshi, Tanzania.Methods: Cross-sectional data among non-elderly women were collected between October and December 2011. Multistage random sampling technique was employed to obtain study participants. The primary predictor variable was participation in MFI programs while the outcome measures were: odds of facing exclusion to health care, knowledge to health indicators related to health promotion, and self-assessed health status. A questionnaire was used to collect extensive data on demographic and socioeconomic information of the study participants.Results: A total of 900 women participated in the study. Program participation was found to be associated with increasing age (p<0.001), increasing number of living children (p<0.002) and level of income (p<0.001). We found no association between program participation and access to health care, knowledge to health indicators related to health promotion and self-assessed health status. Only one out of seven indicators (14.2%) was significantly associated with MFI participation and access to health care. Two out of six (33.3%) health indicators showed association to MFI programme participation, while only 3 out of 15 (20%) dimensions measured in self-assessed health status showed significant association to MFI programme participation.Conclusion: These findings indicate that MFI programme participation is not associated with improved health outcomes of clients and their family members in Moshi. Strategies are needed to enhance the health-promoting capacity of MFI programmes in Moshi as shown elsewhere.
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