1. COMMUNITY HEALTH FUND BEST PRACTICE MUHEZA PRO POOR COUNCIL FUNDING By: Victoria Wasapa CHF Coordinator

2. 1.1 Situation of Poverty in Muheza Poverty in Muheza is high 50% of the population lives on less than 1 US dollar per day. Majority of people depend on small scale agriculture. The crops which are grown are maize, tea, cassava, oranges, coconuts and sisal (diminishing). Also there are business groups such as Milk, timber and small industries

3. Definition of Poverty Lack of money to meet one’s basic needs (necessities of life) Not having enough food to eat. Lack of access to sufficient, clean and safe water, basic medical services, good housing and clothing Poor quality of education, low literacy and numeric skills Not participating in making decisions that affect one’s life Non – ownership of land.

4. Enrolment and funding for the poor Membership: Membership shall be restricted to be paid up by individuals and families except for exemption as may be issued by the council, from time to time under the provision of the CHF Act 2001.Requesting that councils should seek funding for enrolment of the poor.

5. Exemptions Mechanism for the poor CHSB will set exemption mechanism and criteria for the poor; –Village Council to recommend individual exemption –Ward Health Committee and WDC to issue individual exemptions –Council to authorize individually exempted person to receive CHF cards –Council to seek for alternative means financing for exempts

6. Cont… Budget for exempting the poor should be made on annual basis and incorporated in the Comprehensive Council Health Plans. Application procedure for exemption Who to be exempted: those who cannot make enough to eat who extreme low income.

7. Cont… Old people over 60 years who cannot manage to pay for health services, Cannot produce due to disabilities or handicapped persons, Pregnant women, under 5 children, those who have chronic disease like TB, Leprosy etc. Catastrophic reasons/disasters may be considered for exemptions.

8. Exemption procedures Apply for pro poor funding access Should be seconded by hamlet members To be discussed and recommended by the village committee Should be screened by the HFGC and Ward health Committee and WDC. The District Full Council and CHSB will approve and fund membership and annual premiums for those exempted

9. Exemption form Exemption issue form (EIF) No………………..Based on the recommendation of the village Council of _______village (see attached Document) the Ward Health committee of _________ ward issues here by the exemption certificate for the following person to be enrolled in the District CHF

10. Name of dependants also to be exempted: Surname: _____________ First name: ___________ Date of birth: __________ Sex :___________________ Address: ______________

11. Name of dependants also to be exempted: Surname: _____________ First name: ___________ Date of birth: __________ Sex :___________________ Address: ______________

12. 1. Surname: ____________ 5.Surname: ____________________ 2. First name: _________ First name: ____________________ 2. Surname: ____________ 6. Surname: _____________________ First name: ___________________ First name: ___________________ 3. Surname: _____________________ 7.Surname: _____________________ First name: ___________________ First name: ___________________ 4. Surname: _____________________ 8. Surname: ____________________ First name: ___________________ First name: __________________

13. Muheza Case Study Results of enrolling the poor in Muheza District, Tanga Muheza CHF Since July 2005 2005/6 Council funds released for Poor Funding: TSH 3,000,000 (next 5 years, planned amount TSH 5,000,000 p.a.) Additionally: Tsh 665,000 collected by partners Total Pro-Poor Fund Nov’05: Tsh 3,665,000 (excluding potential monies from DBF) 31.Oct’05: 1047 self-paying families enrolled (tot. beneficiaries: 6282/ 279,423 tot pop.) This Pro-Poor Fund is able to cover 733 families/ 4398 individuals – about 8.9% of poor families of the District (41.1% of total CHF Fund) Tot. # of Poor Families in Muheza: 8197 (food poverty line ratio of poor: 17.16%)

14. Access to Health Care Services for the Poor General Weaknesses of Exemption/Waiver systems Poor recording and reporting (incomplete records/ monitoring) Unclear definition of waiver categories (e.g. who is poor?) Unawareness among health staff (categories and handling) Organization and management at facilities weak (not standardized across facilities/ too complex/ eligibility controls etc.) Unstable funding mechanisms

15. National Strategy Towards Tackling the Problem of Access to Health Services by the Poor National Health Financing Workshop 2005 Strengthen alternative health financing mechanisms Improve efficiency of exemptions and waivers Regulate, streamline and strengthen health insurance activities in the country CHF strengthening, as mechanisms reaching out to rural communities, the informal sector and the poor Improve the quality of health care especially at PHC facilities

16. Conclusion Additional efforts are needed to improve Pro-Poor Health Financing in Tanzania CHF is one such attempt to tackle the problem at District level So far the impact of the CHF Pro-Poor strategy is being introduced in Muheza District, with some significant results and the potential to offer a solution to the present weaknesses of the waiver system CHF could develop towards an instrument of reaching the poor and protecting them against financial risk when accessing health care