Factors influencing implementation of the community health fund in Tanzania

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.

The paper concludes that managerial practices influence policy implementation and scheme performance. The authors recommend that in order to better 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. Identifying more clearly the causes of current implementation problems is vital in considering in how they can be addressed. [adapted from author]