Factors influencing implementation of the Community Health Fund in Tanzania

• Published in: Health policy and planning Vol. 22; no. 2; pp. 95 - 102
• Main Authors: Kamuzora, Peter, Gilson, Lucy
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.03.2007; Oxford Publishing Limited (England)
• Subjects: Bureaucracy; Case studies; Community Health Planning - economics; Community health services; Councils; Developing countries; Fees & charges; Finance; Financing, Personal - organization & administration; Financing, Personal - utilization; Health administration; Health care expenditures; Health Care Surveys; Health facilities; Health policy; Humans; Impact analysis; implementation; Informal economy; LDCs; Low income groups; Managerial skills; Organizational Policy; Original articles; Policy analysis; Policy implementation; prepayment schemes; Prepayments; Program Evaluation; Public health; Public policy; street-level bureaucrats; Studies; Tanzania; User fees; Tanzania; street-level bureaucrats; prepayment schemes; Policy analysis; implementation; Tanzania
• ISSN: 0268-1080; 1460-2237
• DOI: 10.1093/heapol/czm001

Although prepayment schemes are being hailed internationally as part of a solution to health care financing problems in low-income countries, literature has raised problems with such schemes. This paper reports the findings of a study that examined the factors influencing low enrolment in Tanzania's health prepayment schemes (Community Health Fund). The paper argues that district managers had a direct influence over the factors explaining low enrolment and identified in other studies (inability to pay membership contributions, low quality of care, lack of trust in scheme managers and failure to see the rationale to insure). District managers' actions appeared, in turn, to be at least partly a response to the manner of this policy's implementation. In order better to achieve the objectives of prepayment schemes, it is important to focus attention on policy implementers, who are capable of re-shaping policy during its implementation, with consequences for policy outcomes.