edoc

Looking at the bigger picture: how the wider health financing context affects the implementation of the Tanzanian Community Health Funds

Renggli, Sabine and Mayumana, Iddy and Mshana, Christopher and Mboya, Dominick and Kessy, Flora and Tediosi, Fabrizio and Pfeiffer, Constanze and Aerts, Ann and Lengeler, Christian. (2019) Looking at the bigger picture: how the wider health financing context affects the implementation of the Tanzanian Community Health Funds. Health policy and planning, 34 (1). pp. 12-23.

[img] PDF - Published Version
Available under License CC BY (Attribution).

428Kb

Official URL: https://edoc.unibas.ch/70980/

Downloads: Statistics Overview

Abstract

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.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Health Interventions > Malaria Interventions (Lengeler)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Household Economics and Health Systems Research > Health Systems and Policies (Tediosi)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Society, Gender and Health > Gender and Health (Zemp Stutz)
UniBasel Contributors:Renggli, Sabine and Tediosi, Fabrizio and Pfeiffer, Constanze Dorothee D. and Lengeler, Christian
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Oxford University Press
ISSN:0268-1080
e-ISSN:1460-2237
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
Identification Number:
Last Modified:01 Jul 2019 14:27
Deposited On:01 Jul 2019 14:25

Repository Staff Only: item control page