COMMUNITY HEALTH FUND Best Practices in Tanzania Workshop Singida District Council Juma H.Tantau CHF Coordinator

1.0 Basic information about CHF in Singida District Council CHF started to operate in May,1998 Number of expected current CHF households – 63,940 Number of current members (registered households) up to December, 2006 – 23,103 (36) Contributions – 115,564,500/= Matching fund received – 103,534,500/= Matching fund not received- 12,030,000/= User fees collections – 76,875,000/= NHIF contributions – 30,793,191.35/= Total funds collected – 326,767,191/= Trend of enrolment  May,1998 – Members  Members  Members  Members  Members  Members  ,218 Members

2.0 Use and Management of CHF in Singida District Council Funds collected are used for the purpose of improving the quality of health services Main areas of expenditures are:  Drugs  Medical supplies and equipment  Furniture procurement  Rehabilitation of Health Facilities  Referral system for CHF members to Regional Hospital and Makiungu Hospitall( V.A)

2.1 Procurement of drugs and medical supplies/equipment CHMT prepares the needs as indicated in Comprehensive Council Health Plan Requisition/order sent to MSD Local Purchase Order prepared Payment made to MSD Purchase of drugs and medical supplies/equipment from MSD

2.2 Procurement of furniture Furniture needs assessment is done by CHMT and the procurement procedures are followed:  Requisition  Local Purchase Order  Payment made to selected tenderer  Purchase of furniture

2.3.Procedure of using CHF funds Health Facility Governing Committees identifies their rehabilitation needs Needs are sent to Ward Health Committee for discussion and approval Approved needs with minutes are sent to CHMT CHMT compile all rehabilitation needs and submit them to the Council Health Services Board (CHSB) for approval When approved by CHSB the needs are forwarded through the council’s committees as follows:  Social Services Committee  Finance, planning and administration Committee  Full Council Committee Once approved by the full council committee, procurement process starts according to each health facility need In summary, the District Council managed to use the CHF to improve health services in the following areas:  Purchase of drugs and medical supplies/equipment - Tsh. 165,659,700/=  Procurement of furniture's - Tsh. 20,680,000/=  Electrical installation in Health Facilities - Tsh. 9,635,282/=  Construction of 33 buildings for storage of refrigerator gas tanks - Tsh. 6,600,000/=  Printing of CHF receipts - Tsh. 1,715,760/=  Purchase of a motorcycle for CHF supervision - Tsh. 4,855,795/=  Training of Clinical Officers on Laboratory services - Tsh. 15,960,000/= In total all expenditures costed Tsh. 225,106,846/=

3. 0 Management of Community Health Fund 3.1 CHF collections  The District Council estimates CHF collections from the projected CHF household membership  Each household contributes 5,000/= by which a government provides an equal sum of money as matching fund  CHF money are collected at each Health Facility 3.2 User fees collections  The user fees are being supervised closely in Health Centres and Dispensaries as part of CHF design  All Households which are not members of the CHF programme pay for their members when they fall ill and attend to the government health facility  The District Council estimates user fees collections based on projections of households which are expected to be none members of CHF programme  User fees are charged on the patient who is attending the health facility for the treatment.Therefore the estimate of user fees collections is based on the projected number of cases attended

3.3 Banking The funds collected are banked in a single account called “CHF Account” Funds are utilized according to Local Government Financial Regulations

4.0 Way Forward Increasing the CHF members from the current 36% to 40% by the end of 2007

5.0 Conclusions The introduction of cost-sharing measures such as CHF, user fees and NHIF in Singida District Council contributed positively in addressing the financial problems experienced in the health sector since it started to function CHF helped to ensure:  Adequate availability of drugs, medical supplies and equipment  Health Facility buildings are in good condition  Good working environments “CHF ensures greater security of access to health care, empowering households and communities in health care decisions and promoting cost sharing with strong local participation”