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Assessment findings of the functionality of Community Health Funds in Misenyi, Musoma Rural, and Sengerema districts
The goal of the USAID-funded Tibu Homa Project (THP) is to reduce morbidity and mortality of children under five years of age in the Lake Zone of Tanzania (Mwanza, Mara, Kagera, Shinyanga, Simiyu, and Geita regions) by improving proper diagnosis and treatment of severe febrile illness in children under five years of age, focusing on improving case management at the facility level (both public and private). Tibu Homa is implemented by University Research Co., LLC (URC) in collaboration with Management Sciences for Health (MSH) and Amref Health Africa.
To ensure sustained, long-term improvements in case management, Tibu Homa is supporting health managers from 27 districts in the Lake Zone to mobilize resources from sources other than the government. These efforts aim to complement limited funds from the government budgeted for child health services and thereby contribute to financial sustainability in management of childhood illnesses in the Lake Zone.
One of the alternative sources of funding being implemented is community-based health financing (CBHF). According to Carrin (2003), CBHF has emerged as one of the responses to the existing challenges in health financing in developing countries with low economic growth, constraints in the public sector, and low organizational capacity. CBHF schemes can be seen as a step towards universal health coverage following the widely acknowledged difficulties in tax financing and social health insurance, especially in less developed countries. CBHF is an option for extending insurance coverage in low-income countries, particularly among rural and informal sectors. Rwanda has implemented CBHF on a national scale, and health insurance coverage has increased dramatically with CBHF services to about 85% of the population (mostly rural and poor) (Shimeles 2010).
Just like Rwanda and other sub-Saharan countries, Tanzania has a small health budget which makes it hard to improve access to health services. To date, the country has not been able to meet the Abuja Declaration 2001 target of allocating at least 15% of the national budget to health. The allocation to health and a proportion of the national budget has fluctuated between 10% and 13% (United Republic of Tanzania 2012).
To help make health care affordable, the Ministry of Health and Social Welfare (MoHSW) supports the implementation of the Community Health Funds (CHFs). This paper provides a snapshot of the functionality of the CHFs in three selected districts in the Lake Zone (Missenyi, Musoma, and Sengerema) in terms of the status of implementation; the roles and responsibilities of the health governance structures such as the Council Health Services Boards and Health Facility Governing Committees, which are supposed to oversee the implementation of the scheme; and the challenges in implementing community-based health financing. Based on these findings, interventions to strengthen the CHFs in the three districts are proposed.