1. USE AND MANAGEMENT FUND Dr. Winfred Philemon Kyambile District Medical Officer HANANG CHF BEST PRACTICE WORKSHOP DAR ES SALAAM 02/02/2007

2. Management of Funds In managing the funds, we are using the following CHF management tools for Documentation of accurate premiums, user fees transactions and maintaining up to date records.

3. CHF MANAGEMENT TOOLS Patient Register/ Indent system Register. CHF membership Register CHF member card filing system CHF and User fee receipt books CHF Financial ledger CHF daily status report register CHF monthly status report register CHF - TRACT soft ware Cash book Stores ledger CHF cheque books Local authority payment voucher

4. Patient Register –It is consistent with Indent system –Is used to record All patients who has been attended at the HF. –It contains Date of visit, patient particulars, Diagnosis prescription and a method of payment column eg NHIF, Papo kwa papo (P), No Payment, Exemption (E) and Receipt No. Column. –It is very Important in Daily Reconciliation of fees collected. The cash received is reconciled to the number of patients seen at the facility on that day and that a receipt was issued for all cash received.

5. Form 1: Patient Register DISTRICT: Hanang Health Facility: Dawar Dispensary S/NDateNameVillage/ Hamlet AgeSexDiagnosis Prescription Method of payment ( Papo kwa papo = P E = Exempt CHF, P= No P ayment: NHIF REC. NO 11/12/2006HildaDawar20FMalariaNHIF0063201 22/12/2006SalomeDawar35FSkin rashCHF003059 33/12/2006AnnaDawar45FMachete wound CHF003085 44/12/2006BassoDawar25MCoughP0015633 55/12/2006YudaDawar2MMalariaNo payment- pay later No payment 88/12/2006JumaDawar34MEye Infection CHF003100

6. CHF membership Register –This register contains information of the CHF membership. It shows the following information. CHF card No, Date of purchase, Household information and expiry date. Membership type eg. New member purchasing membership for the first time (N) or is renewing a membership (R). The amount paid and the Receipt number.

7. FORM 2: CHF MEMBERSHIP REGISTER Hanang District Health Facility: ---------- CHF CARD NO Date of purchase Receipt Number NameWardNo. of members Membership TypeExpiry DateAmount NewRenewal 30851/7/200616001SamtiDawar8N30/06/200710,000 30861/7/200616002AbduDawar10R30/06/200710,000 30872/7/200616003BuraBasotu7N30/06/200710,000 30882/7/00616004QamaraDirma14R01/07/200710,000

8. CHF Daily status report Register Used In Daily recording and daily reconciliation of fees using the patient register and the CHF membership Register

9. CHF Daily Status Report Register Hanang District Health Facility: --------------------- Month & Year --------------------- Date Number of PatientsREVENUE User FeesCHF MembersNHIF MembersExemptionNo PaymentTotal Number of Visits Users fees collec ted CHF fees collecte d Other collecti ons (Includi ng Late User Fees) Total Fees TodayMonth to date TodayMonth to date TodayMonth to date TodayMonth to date TodayMonth to date TodayMonth to date 12 2 55000011882,00015,0000 17,000 224380000126142,00020,0000 22,000 337190000024183,0005,0000 8,000 4 5 6

10. STEPS FOR DAILY RECORDING AND RECONCILIATION OF FEES At the end of the Day, the HF in charge counts the total number of the patients in the patient Register, noting the totals separately for those paying user fees, CHF members, NHIF members, Exempted patients and those who make no payment (eg some re-visits; poor, accident victims and those treated on credit to pay later). The In charge then records them in the CHF Daily status Report Register.

11. STEPS CONT. The In charge makes sure that for each patient paying user fee, a receipt number is noted in the patient Register, and makes sure that the Total amount of user fees collected matches the Total of the user fee receipts value.

12. STEPS CONT. The in charge also, retrieves the CHF member ship Register and counts the number of new CHF memberships sold during the day. Then records the number of CHF membership fees that should have been collected on that day. The in charge should make sure that the amount that have been collected in CHF membership fees matches the total of the CHF Receipts issued that day.

13. DEPOSITING FUNDS AT THE CHMT Funds collected at the HF are deposited on a regular basis at the DMO’s office, who in turn bank them in a CHF Account. The In charge depositing funds at Dmo’s Office, should present to the CHMT member the following. User fee receipt book, CHF receipts book and a daily CHF status report register book.

14. DEPOSITING FUNDS CONT. The Council has established and maintains a separate bank account for CHF money. All the CHF premiums, user fees and other contributions such as NHIF and Matching grants from the government are deposited.

15. CHF financial Ledger This tracks the collection, use and balance of CHF money. All user and CHF membership fees collected should be recorded on a daily basis. In addition, deposits, expenditures and matching grants received should be recorded in the CHF financial ledger.

16. Form 4:CHF Financial Ledger Hanang District Health Facility:Gidahababieg Dispensary, Year 2006 Cash BookDMO/CHMT Transactions DateDetailsDaily Fees collected Cash on hand DepositsExpenditureCHF Account Balance 5/12/2006Opening Balance2,048,464.00 6/12/2006Fees Collected15,000.00 7/12/2006Fees Collected10,000.0025,000.00 8/12/2006Deposit Fees25,000.002,073,464.00 8/12/2006Petty Cash20,000.002,053,464.00 8/12/2006Fees Collected20,000.00 9/12/2006Building Materials253,000.001,800,464.00

17. CHF monthly status report register This records utilization, CHF membership and fee collection information on a monthly basis. The information entered into the CHF monthly status report is based on the patient register, CHF daily status report, CHF membership register and the CHF financial Ledger. The worksheet is to be filled in on last day of the month.

18. Form 5:CHF Monthly status report Register Hanang District Health Facility:Bassodesh Dispensary ; YEAR…2006…………… Month Number of PatientsCHF MembershipFees Collected Total Collecti on Expendi ture Balance User Fees CHF Members NHIF Members ExemptNo Payment Total no of Patients New Renewal ExpiredTotal Active User Fees CHF Fees Other Collecti on Continuing members from Last month 30 Jan.15020052023772413520,000 50,000 070,00010,000 Feb. March Dec. TOTAL

19. THE COMMUNITY HEALTH FUND SOFTWARE (CHF – TRACK) –Is a user friendly tool developed by East, central and southern African Health Community (ECSA) In collaboration with the ministry of Health to assist CHF managers to track and maintain CHF data at district, regional and national level. The tool can in future be used at lower Health facility levels.

20. Chf Track Cont. The Tool has In built formulae to assist in data analysis and generating of various reports regarding Management and performance of CHF.The soft-ware is intended to compliment existing tools of the Health Management Information system.

21. Chf Track cont. (a)Data in puts In order for the soft ware to achieve the above purpose, it needs inputs of data from the following sources; Patient register CHF membership register CHF Daily station report register Financial Ledger Other population and Community data.

22. Chf Track cont. (b) Out-puts generated by the software The software has been designed to generate the following reports as output:- Monthly status reports by health facility showing Total member of patient attendance The status of the CHF membership Total revenue collected, expenditures and balances Quarterly and annual CHF summary reports District performance and service utilization status.

23. Chf Track Cont. NOTE: It is important to note that the quality of output generated by the soft- ware depends very much on the accuracy and Completeness of data collected from the Health facilities ie Daily filling of patient register, daily status report and financial register.

24. USE OF FUNDS. –The CHF money is used according to the approved budgets that originate from Comprehensive Council health plan developed In a participatory manner. –The ward or facility health committees will periodically requests purchases of items or any other expenditure according to the approved budget.

25. Use of funds cont. Expenditure is authorized by the Council Health service Board following the laid down Govt financial regulations. The Fund is usually used to supplement the Government/Council’s budget In Procuring drugs, equipment and medical supplies Minor works in Improving infrastructure Paying salaries to Health sector employees on temporary contracts. Other activities aiming at improving the quality of Health service delivery.