KILOSA DISTRICT COUNCIL Challenges of low CHF Enrolment CHF KILOSA Dr. Mapunjo Ag. DMO Kilosa

INTRODUCTION : CHF implementation in Kilosa District started in 1999 It operates in all government health facilities Annual membership fee per household / family is 5000/= and a 100% matching grant for the pooled community health fund is provided by the government The user fees contribution was decided to be T shs 1000/= in dispensaries, 1500/= in Health centre and 2000/= for the district Hospital

TRENDS OF CHF ENROLMENT SINCE THE YEAR 200O IN KILOSA DISTRICT

ENROLMENT OF MEMBERS IN COMMUNITY HEALTH FUND : Kilosa District struggles with low enrolment levels (on average 2.6% of the population) even though CHF has been in operation for six years. Among the Reasons for Low enrolment: Introduction of National Health Insurance for Civil Servants in 2002.

ENROLMENT OF MEMBERS IN COMMUNITY HEALTH FUND (Cont. 2) Among the Reasons for Low enrolment: Shortage of drugs and other supplies from medical stores department at a particular period. Inadequate cooperation and sensitization from community leaders and community health committees. Shortage of adequate qualified human resource for health. Insufficient laboratory facilities at lower facility level particularly at dispensary level.

REASONS FOR LOW ENROLMENT cont. CHF membership not valid at referral level and does not cover secondary care. Broad National exemption policy. Low user fees Poor perception of the community about the benefits provided by the community health fund and services provided in Health facilities.

AMONG THE ACHIVEMENTS The funds collected have been contributing in various areas in improving health services such as: To renovate several buildings such as 4 wards at the District Hospital, toilets, Outpatient clinics e.t.c in District hospital, 4 Health centers and 32 dispensaries buildings.

AMONG THE ACHIVEMENTS (cont. 2) To build some facilities such as 8 toilets in hospital,dispensaries, and health centre, 1 maternal and child health clinic, mortuary and inpatient ward in two health centre,health staffs houses in 2 dispensaries.

AMONG THE ACHIVEMENTS (cont. 3) Installation of electricity in 4 dispensaries and to connect piped water supply in 3 dispensaries. To support buildings of District hospital fence and corridor. To purchase essential drugs and supplies when need arises

PROBLEMS IN IMPLEMENTING CHF : Politicians discourage community to contribute in CHF in order to gain popularity in communities especially during election campaign.

PROBLEMS IN IMPLEMENTING CHF (Cont. 2) –Guidelines for identifying poor people for exemption in the society are not clear its very difficult to identify who is poor. –Community leaders are not playing there required roles in sensitization, collection and storage of CHF information all tasks are done by Health workers

RECOMMENDATION Politician and community leaders they have to understand importance of cost sharing in health in order to improve Health services.

RECOMMENDATION (Cont. 2) There is a need to revise some of the guidelines and criteria for granting exemption and waivers. The coverage of CHF has to be increased up to secondary care so as to increase risk pooling for poor people in the community.