COMMUNITY HEALTH FUND BEST PRACTICE

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• COMMUNITY HEALTH FUND BEST PRACTICE
• MUHEZA PRO POOR COUNCIL FUNDING
• By Victoria Wasapa
• CHF Coordinator

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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

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Definition of Poverty

• Lack of money to meet ones 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
  ones life
• Non ownership of land.

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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.

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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

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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.

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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.

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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

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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
•  

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Name of dependants also to be exempted

• Surname _____________
• First name ___________
• Date of birth __________
• Sex ___________________
• Address ______________

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Name of dependants also to be exempted

• Surname _____________
• First name ___________
• Date of birth __________
• Sex ___________________
• Address ______________

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• 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 __________________

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Muheza Case Study
Results of enrolling the poor in Muheza District,
Tanga
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
Nov05 Tsh 3,665,000 (excluding potential monies
from DBF)
31.Oct05 1047 self-paying families
enrolled (tot. beneficiaries 6282/ 279,423 tot
pop.)
Muheza CHF Since July 2005
Tot. of Poor Families in Muheza 8197 (food
poverty line ratio of poor 17.16)
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)
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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

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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

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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