Understanding the limitations of “quasi‐mandatory” approaches to enrolment in community‐based health insurance: Empirical evidence from Tanzania

Abstract

Summary In recent decades, a growing number of low‐income countries (LICs) have experimented with voluntary community‐based health insurance (CBHI), as an instrument to extend social health protection to the rural poor and the informal sector. While modest successes have been achieved, important challenges remain with regard to the recruitment and retention of members, and the regular collection of membership fees. In this context, there is a growing consensus among policymakers that there is a need to experiment with mandatory approaches towards CBHI. In some localities in Tanzania, local actors in charge of community health funds (CHFs) are now relying on what is best described as quasi‐mandatory enrolment strategies, such as increasing user fees for non‐members, automatically enrolling beneficiaries of cash transfer programmes and enrolling the exempted groups (people who are entitled to free healthcare). We find that, while these quasi‐mandatory enrolment strategies may temporarily increase enrolment rates, dropout and the non‐payment of contributions remain important problems. These problems are at least partly related to supply side issues, notably to inadequate benefit packages. Overall, these findings indicate the limitations of any strategy to increase enrolment into CBHI, which is not coupled to clear improvements in the supply and quality of healthcare.

Factors Associated with the Implementation of an Improved Community Health Fund in the Ubungo Municipality Area, Dar es Salaam Region, Tanzania

“…Another study in Dodoma, Tanzania, indicated that the implementation of the iCHF scheme improved after the involvement of community leaders. District authorities ensured that all local leaders were registered with the iCHF scheme and were informed as to its importance for the local community [23]. Therefore, in addition to an increased awareness of the health insurance scheme, other factors and barriers that influence enrollment need to be further investigated in future studies.…”

Invasive breast Cancer treatment in Tanzania: landscape assessment to prepare for implementation of standardized treatment guidelines

“…Another study from Tanzania found late stage of presentation, high proportions of aggressive histologic types of breast cancer, and a general lack of hormone and targeted receptor testing as contributory causes of high mortality in this region [ 8 – 10 ]. Additionally, therapies can be costly and 90% of women in Tanzania remain uninsured due to poor uptake of community-based health initiative schemes to increase insurance coverage for the low socioeconomic rural sector in Tanzania, which may contribute to inequality in access to healthcare [ 11 , 12 ]. Notably, data on precise medical regimens and the extent of treatment completion, as well as factors that influence treatment adherence, are lacking in this region, as in many LMICs.…”