ACORD hosts stakeholders' dialogue on Community Health Fund implementation in Tanzania
ACORD Tanzania, with support from UKaid and the Big Lottery Fund, facilitated a multi-stakeholder forum on the implementation of the Community Health Fund (CHF). The forum, which was organised in collaboration with the National Policy Forum and held in Dar-es-Salaam, was strategically intended to bring the views of the marginalised pastoralist communities to the national level. Participants at the forum included representatives of civil society organisations; national and local government; media; health practitioners and representatives of the pastoralist communities. The forum focused on building a harmonised understanding of the implementation of the CHF and dialogue on the current national health fund policy in order to maximise the benefits accrued for these hard-to-reach communities.
Reaching the Poorly Served
ACORD Tanzania Country Coordinator presenting ACORD
The forum also provided a good opportunity for participants to understand the levels of achievements so far realised by the different areas within Tanzania with regard to realising access to health through the CHF. It was noted that while achievements are currently being reported at national level, the realities in the different districts like Ngorongoro have continued to fall far below the national averages.
To date, ACORD’s contribution to sexual and reproductive health (SRH) in Ngorongoro District through the SRH programme has realised several achievements including:
- Raising the attention of various sectors on the need to address health, CHF and reproductive health as critical issues for development;
- Bringing together multi stakeholders to plan for SRH services in the district;
- Improving the operations of the district health department, specifically supporting supervision of health facility services and increasing skills among health facility and front line staff through trainings;
- Strengthening knowledge and appreciation of SRH services by the pastoralist communities by ensuring that information, education and communication materials are in the local languages as well as audio visual materials to reach out to the illiterate population; and
- Increasing access of the basic SRH services including maternal health through referrals and trainings.
Radio calls to curb maternal mortality in Ngorongoro
The Head of the National CHF coordination office provided a national dimension of the CHF as a financing option in the country that earned Tanzania an award based on the level of implementation realised so far. To date, major improvements have been realised in the implementation of CHF, demonstrated through increased membership from 1,200,000 members in 2008 to 5,558,274 as of March 31, 2015. With regard to specific regional performance, there are variations where Ngorongoro district still falls far lower than the regional status (3.5 per cent) compared to Arusha region (7.2 per cent).
Major outstanding challenges discussed include shortage of medicines and medical consumables, especially in government facilities and rural areas; uncontrolled increase of prices of medicines, equipment and other services in the health sector due to lack of a regulatory body on pricing; negative attitude by some health providers towards CHF members (use of card vs. cash) at the point of service; lack or poor education on health insurance and social security issues; low awareness of the roles of CHF by members and general population by subscribers; lack of a regulatory authority for ensuring provision of quality health services; low awareness of CHF by members; poor record keeping and data management and ineffective management and accountability of the funds.
Moving forward, the CHF coordination office plans to address some of the outstanding challenges by introducing web-based data mechanisms for ease of access by beneficiaries, documentation of pilot projects to inform national guidelines and procedures for implementation of the fund; fiscal decentralisation facilitating/assisting LGA’s on implementation of the CHF; strengthening conducting monitoring and evaluation as well as supportive supervision; and finalisation of rolling over CHF and submission of a proposal to MoHSW on pro-poor interventions.
Mananasi, mpango mzima: It’s all about pineapples!
The forum provided a very good opportunity for dialogue among the different stakeholders, more particularly for the national level stakeholders to appreciate and understand the realities of the hard-to-reach populations with regard to the pastoralist communities. Potential areas for addressing some of the gaps highlighted include strengthening the role of the community or beneficiaries in governance of the CHF; strengthen the gender power analysis within the implementation of the CHF; strengthening the CHF coordinators in the districts; raising awareness through community radios among the population in order to change negative attitudes towards CHF and networking among implementers of CHF in the district.