The Contribution of the Improved Community Health Fund on the Utilization of Outpatient Healthcare Services in Singida Municipal Council

Abstract

Introduction: The government of Tanzania established the Community Health Fund (CHF) in 1996 and the improved Community Health Fund (iCHF) in 2018 to provide financial protection for outpatient healthcare services for rural and informal-sector populations. However, utilization of outpatient healthcare services remains a challenge in Tanzania. This study aimed to assess the contribution of the iCHF on the utilization of outpatient healthcare services and associated factors in the Singida Municipal Council.

Methods: A sequential mixed-methods design was employed to conduct a before-and-after outcome evaluation of the iCHF. The questionnaire was used to collect quantitative data, while key informant interviews were used to collect qualitative data. A Chi-square test was used to assess the association between iCHF and outpatient healthcare service utilization. Thematic analysis approach was used to analyse health facility factors contributing to outpatient healthcare service utilization among iCHF members.

Results: The utilization of outpatient healthcare services has increased by 7% compared to the period of CHF. Age (p=0.047), sex (p=0.000) and level of education (p=0.015) were significantly associated with increased utilization of outpatient healthcare services. Availability of a clear framework for the enrollment procedure, an advanced information system, a broadened benefit package, availability of essential medicines, medical equipment and implementation of clients’ retention mechanisms were the contributing factors to the utilization of outpatient healthcare services.

Conclusions: The findings highlight an increase in healthcare services utilization following the introduction of iCHF and the factors associated with this change. However, healthcare services utilization among iCHF members remains relatively low due to low enrollment. Therefore, efforts are needed to increase iCHF enrollment to improve outpatient healthcare.