Accessibility and sustainabillty of health services in Iramba district three years after community health fund implementation

Community Health Fund (CHF) was introduced in Iramba district in June 1998. CHF is one of the alternative financing mechanisms that has been introduced following the government failure to meet the cost of the public health services in the rural communities. Low CHF enrollment has negative implications on both revenue generation and exemption for the poor. The trend of low CHF enrollment may lead to unsustainable health care services. Several factors might have influenced the enrollment. Therefore, the study focused on '" the important factors which may influence the improvement of access and sustainability of health care system. The broad objectives were: To assess the accessibility to health care services among CHF and non-CHF members at the household level and to assess sustainability of health services under CHF scheme in Iramba district. A household survey, Focus Group Discussion, (FGD) and key informant interviews were used to collect information. The study population constituted heads of households or their representatives in Iramba district. In this respect, a household was defined as a monogamous marriage or single parent or a guardian and children who are under eighteen years of age. In case of polygamous relationship, the different wives were --- IX regarded as belonging to different households. This definition was adopted from the CHF scheme in Tanzania. Multistage random sampling was used to select households for the structured questionnaire interviews. A simple random sampling was used to select health facilities and correspondingly, households were selected by the same method from the facilities catchment areas. A total of four health facilities were selected and for each health facility, two villages were selected. In total of212 households were interviewed. For the focus group discussion, a total of eight health workers, two from each health facility were selected. The in-depth interview was conducted with CHF managers. Selection was done according to their position in the managements of the CHF. The data was analyzed using an EPI Info program. Where appropriate, statistical tests were carried out. The 0.05 cut off point was used to interpret the p value. Most of households were found to be located not more than five kilometers from health facility. It was found that most (95.8%) of the households were aware of CHF. Village meetings and health facilities were identified as the main source of awareness about CHF. The study findings revealed that the current household membership rate was 50%, where, 43.5% were members who enrolled since 1998, and among household interviewed, about 9% had dropped from CHF. The rate of recruitment of new members was 4.1 % in the year 2001. The level of education and the nature of occupation were found to have a substantial influence on CHF enrolment. As the level of education increases awareness and CHF enrolment also increases. -----~----- x Association between self reported income of the household and CHF membership was found not to be a determinant of CHF enrolment. The willingness of people to enroll in CHF was conditioned by the availability of drugs, easy accessibility of services and improvement of the general quality of care of the services. It was seen that, the promises from CHF management to health workers likebenefit packages were not fulfilled up to rhe time this research was conducted .. Hence, that may have affected the health care provision. The CHF scheme in Iramba district was not yet fully functioning despite the fact that, revenue collection continued. The funds were still kept unused in the bank. Delivery of health care services was not yet improved, so consumers' expectationsof good quality health care were not yet met. Recommendations: Guidelines for utilization of funds should be transparent, and the bureaucracy for approval of funds use should be shortened for the purpose of improving quality of service and that would attract more individuals to enroll in the CHF. To ensure sustained CHF promotion campaigns should be continuous, and more focuse