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Health Policy and Planning Advance Access published online on February 13, 2007
Health Policy and Planning, doi:10.1093/heapol/czm001
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2007; all rights reserved.

Factors influencing implementation of the Community Health Fund in Tanzania

Peter Kamuzora1,* and Lucy Gilson2,3

1Institute of Development Studies, University of Dar es Salaam, Tanzania.
2Centre for Health Policy, University of Witwatersrand, Johannesburg, South Africa.
3Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, UK.

* Corresponding author. Institute of Development Studies, University of Dar es Salaam, P.O. Box 35169, Dar es Salaam, Tanzania. Tel: +255 22 241 0075. Cell phone: +255 754 801 222. Fax: +255 22 241 0237. E-mail: petkamu{at}udsm.ac.tzand pckamuzora{at}yahoo.com

Although prepayment schemes are being hailed internationally as part of a solution to health care financing problems in low-income countries, literature has raised problems with such schemes. This paper reports the findings of a study that examined the factors influencing low enrolment in Tanzania's health prepayment schemes (Community Health Fund). The paper argues that district managers had a direct influence over the factors explaining low enrolment and identified in other studies (inability to pay membership contributions, low quality of care, lack of trust in scheme managers and failure to see the rationale to insure). District managers’ actions appeared, in turn, to be at least partly a response to the manner of this policy's implementation. In order better to achieve the objectives of prepayment schemes, it is important to focus attention on policy implementers, who are capable of re-shaping policy during its implementation, with consequences for policy outcomes.

Key Words: Policy analysis, prepayment schemes, implementation, street-level bureaucrats, Tanzania

Accepted for publication 13 November 2006.


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