EVENGALICAL LUTHERAN CHURCH IN TANZANIA (ELCT) COMMUNITY BASED HEALTH FUND SCHEME

1. INTRODUCTION: The ELCT (national health office in Arusha) established Health Funds as Provider based (Partnership) model between Soon later, the schemes faced serious challenges: - management capacity - sustained social marketing - establishment of CHF schemes in some districts where the ELCT schemes existed Consequently, membership dropped and, to date many of the schemes have ceased. However, in 2001, ELCT North Western Diocese ventured into a diversified model, the Community Based Health Funds (CBHF).

INTRODUCTION, cont. The NWD is one of the 20 dioceses of the ELCT in Tanzania. Located in Kagera Region, the North Western corner of Tanzania. The diocese’s service areas are the 5 administartive districts of Kagera Region, which are Bukoba (urban and rural), Muleba, Chato, Biharamulo and Missenye, covering a total area of 28,694 sq.km (73% of the total area of the region), with a total population of 2,038,888 people (census-2002).

2. MEMBERSHIP AND PREMIUMS) The CBHF of the NWD, established in 2001, is a diversified scheme from the original Provider based model. The target population is that of the 5 administrative districts of Kagera region mentioned above. Since 2001, there has been an increase in number of members as shown in the following schedule. YEAR Members Premiums Collection s 14,300,00015,400, ,405, ,350,00039,100, ,200,000

3.IMPLEMENTATION The scheme designed by ELCT/NWD is well adapted to cover the vast distances of the diocese and to reach to the most scattered population Mobilization and marketing are continuous activities implemented as planned since 2001.

4. BENEFIT PACKAGES Medical care refers to routinely available medication and services available at accredited health facilities across the 5 districts Health facilities include ELCT / NWD and Roman Catholic health facilities ( i.e. 5 hosp, 3 HCs, 15 church disps and one private disp), and the Regional govt hosp.

5. SUCCESSES Success is attributed to the following: Well structured marketing and mobilization strategy Support from the Church leadership, both at national ELCT office as well as Diocesan level and good collaboration with other churches Support from the government leadership, mainly at grass root level Incentives to members (consistent availability of quality services at accredited facilities, 24 in number) CBHF has helped to sustain the health facilities as membership has reduced debts and absconding. Revenues are generated for the payment of running costs.

6. CHALLENGES in respect to emerging CHF Competition between CHF and ELCT-CBHF - challenge for CHF in gaining membership in an area where ELCT schemes well established - confinement to 1 Health Facility with CHF as opposed to ELCT-CBHF which allows members to seek health care at all ELCT accredited facilities It will take time for the community to differentiate between different types of CHFs. If the government will initiate CHF where there is already an existing scheme, this can be a cause of confusion for the people especially in rural areas. Lack of financial support (e. matching funds) to sustain the ELCT CBHF schemes like other CHF schemes supported by the government. Adverse selection, Moral hazards, Fluctuation of Treatment costs. High staff turn over in the accredited health facilities leading to disruption and lowering of motivation.

7. WAY FORWARD Dialoguing with government for linkages with CHF (e.g. financial support/matching funds). It is better to strengthen the existing ELCT-CBHF schemes where people are already enrolled and introduce CHF to the areas where ELCT is not yet operating. Strategies to link CHF with poverty alleviation initiatives/activities for community members (discussion with government). To encourage enrolment of new members in groups to avoid adverse selection. Continued marketing and educating the communities on benefits.

Thank you Presented by Lulinga.J CHF-BEST PRACTICE WORKSHOP DAR-ES-SALAAM-31st,Jan-2ndFeb,2007