Reaching the Informal Sector with SHI: A CHF for Small-Scale Tea Farmers in Rungwe District, Tanzania A Public-Private Partnership Dr Shaaban Sheuya Tanzania Network of Community Health Funds (TNCHF)

Background Wakulima Tea Company (WTCO) and the Rungwe Small Tea Growers Association (RSTGA) are partners under the roof of Tanzania Tea Packers (TATEPA). RSTGA and WAKULIMA want to provide adequate health services to their members and workers. So far there is no organized health care provision system for the farmers. The GTZ/TGPSH advised the association and the company to set up an innovative Community Health Fund (CHFplus) within the framework of a PPP where RSTGA/WATCO partner with GTZ/TGPSH. Local technical assistance is contracted-out to the TNCHF, an NGO,during the implementation and strengthening phase of the CHF

Potential of CHF The innovative CHFplus system, introduced in the GTZ/TGPSH assisted regions charges usually an annual premium of 5,000 TShs for a unit of 6 persons. In addition, the Government of Tanzania (GoT) subsidizes the system with an annual matching grant of the same amount. Potential members of CHF in Rungwe is as follows: RSTGA: 60,000 persons WATCO: 750 persons Surroundings: 5,000 persons Total: 65,750 persons Making up about 21% of the Districts overall population (307,270)

Fair Trade for Health RSTGA/ WATCO have fair trade arrangement with the FLO in London: – distinct advantage as funds are available for the farmer’s social protection purposes - the CHF premiums for the farmers are funded by this fair trade money - the administration of finances and enrolment into the CHF is simplified, as there is only one partner paying for all members.

Benefits of CHF to the Whole District For the remaining population of the district the CHF is equally beneficial. The only difference is that the people have to contribute the premium out of their own pocket unless they are identified as poor. In the latter case, the District Council will be paying the premium on their behalf. Rungwe CHF has now been functioning and enrolling people since December 2005

A Recent Evaluation of the Rungwe CHF Main Questions assessed: - Is access to health services among the farmers and workers improving through CHF membership? - Which effects does the CHF PPP with the economic group have on the District at large? What is the comparative advantage of the PPP approach? - What impact does implementing CHF via an economic group have ? Is the Rungwe approach replicable country- wide?

Findings of the Recent Evaluation of the Rungwe CHF Access to Health Services - easier access to HS by CHF members reported including availability of adequate stocks of drugs - feeling that relatively better health care services are provided as enrolled as one big group - feeling that the two organizations,RSTGA and WATCO, care for their farmers/workers - Farmers are assured of availability of health care services for the whole year even when they do not have cash in hand

Findings of the Recent Evaluation of the Rungwe CHF Effects of the CHF PPP with RSTGA/WATCO on the District: - District can better plan its activities as large amounts of CHF funds come in at once - District has been able to procure adequate stock of medicines - Extend coverage to include broader service package

Findings of the Recent Evaluation of the Rungwe CHF Impact of CHF via the economic group: - About 70% of current CHF members in the District are RSTGA/Wakulima farmers/workers = this mass enrolment puts pressure on providers to deliver appropriate services - Through the yearly payment of Tsh 60 mio. (through RSTGA/WATCO) which the MoH tops up by 100% the District managed to mobilise significant funds through alternative financing sources - Other economic groups (e.g. diary milk producers with 2400 members) want to emulate the example set by RSTGA/Wakulima.

Recommendations (access to health care services) -Increase CHF membership in the whole District by targeting other economic groups; - Involve FBOs in the provision of health care services; - Encourage replication of this PPP approach where there are organized groups that have a stable source of income coupled with able leadership that can forge public private partnerships

Recommendations continues (quality of services) -Create an independent CHF support structure to provide technical assistance to help accelerate and strengthen the Fund - Use this support to: ( 1) develop negotiation skills to e.g. establish discounted premium rates for enrolling large groups (2) establish service agreements with the District Council (to ensure quality health care from public providers) (3) provide appropriate, output based incentive packages for health care staff and take disciplinary action against those who frustrate the efforts to promote CHF

Concluding remarks The results of the evaluation generally show that the PPP approach could achieve desired impacts. High efficiency is shown through this instrument as opposed to approaching individual households The improved access to health care services recorded in a short period of time, the effects and impacts on the District could not have been attained without the PPP

Thanks for your attention!