Factors influencing implementation of the community health fund in Tanzania

Abstract

This paper, published in Health Policy and Planning, reports on the findings of a study that examines the factors influencing low enrolment in Tanzania’s health prepayment schemes (community health fund). Prepayment schemes are hailed internationally as part of a broader solution to health care financing problems in low income countries. However, evidence suggests that schemes often exclude the poor and those most in need of health care. The paper finds that district managers have a direct influence over the factors explaining low enrolment (inability to pay membership contributions; low quality of care; lack of trust in scheme managers). District managers’ actions appeared, in turn, to be at least partly a response to ways in which the community health fund was implemented.