Towards Universal Health Coverage: The Case of Improved Community Health Fund in Rural Tanzania

Abstract

This thesis aims to identify factors influencing rural households’ decision to enroll in a voluntary insurance scheme in Tanzania and assesses its impact on healthcare accessibility and catastrophic health expenditure (CHE). Cross-sectional study design was used and we applied quantitative approaches to collect and analyse the data collected from 722 respondents in two rural districts in Tanzania. Paper I examine perception factors influencing households’ enrolment decisions to the voluntary insurance scheme. Paper II differentiates factors associated with enrollment or dropout and suggests relevant policy implications. Paper III studies risk preference's role among scheme members and non-members. Whereas, paper IV analyzes voluntary insurance (iCHF's) effects on healthcare utilization and catastrophic health expenditure (CHE) across socioeconomic status (SES). The study found that household perception factors like perceived quality of care, household knowledge and scheme understanding, scheme convenience and household beliefs, affect enrollment decisions. Risk preference mainly determines enrollment status. Furthermore, the enrollment factors vary across the never-insured and dropout status. We found that never-insured and dropout status decisions were associated with high education level, absence of chronic disease, negative perceptions towards the quality of services, trust in scheme leaders and positive perceptions towards the traditional healers. The results from paper IV suggest that insured households utilize healthcare more, with lower CHE incidence. Among the lowest socioeconomic groups, insured members utilize more healthcare and face lower CHE compared to non-members. The study recommends the enhancement of community understanding for informed decisions and identifying barriers to enrollment and healthcare utilization among the poorest households for policymaking towards Universal Health Coverage in Tanzania.