Background
Methods
Study setting
Data collection and analysis methods
Quantitative data
Qualitative data
Stakeholder type | District | Total | |
---|---|---|---|
Mbulu | Kigoma | ||
Health facility committee members | 2 | 2 | 4 |
CHF members | 2 | 2 | 4 |
Non-insured individuals | 2 | 2 | 4 |
Total | 6 | 6 | 12 |
Ethics and quality control
Results
Quantitative analysis results
Descriptive statistics
Variable | Variable description | Total N = 1,225 | CHF member | Un-insured | |||
---|---|---|---|---|---|---|---|
n = 524 | n = 701 | ||||||
N | % | n | % | n | % | ||
Gender of the household head,** | 1 = male, | 1,025 | 83 | 468 | 89 | 557 | 79 |
0 = female | |||||||
Marital status of the household head,** | 1 = married | 796 | 65 | 383 | 73 | 413 | 59 |
0 = otherwise | |||||||
Wealth groups
| |||||||
Poorest, (reference group) | 1 = Poorest Household | 304 | 25 | 107 | 21 | 197 | 29 |
0 = Otherwise | |||||||
Second poorest, | 294 | 25 | 129 | 25 | 165 | 24 | |
Middle, | 275 | 23 | 122 | 24 | 153 | 22 | |
Second richest, | 222 | 19 | 102 | 20 | 120 | 17 | |
Least Poor, | 1 = Least Poor Household | 102 | 9 | 49 | 10 | 53 | 8 |
0 = Otherwise | |||||||
Educational level of household head
| |||||||
Completed primary level education, | 1 = Has completed primary school | 921 | 75 | 397 | 78 | 542 | 77 |
0 = Otherwise | |||||||
Secondary level education and above,* | 1 = Has completed secondary education and above | 49 | 5 | 27 | 5 | 22 | 3 |
0 = Otherwise | |||||||
No formal education, (reference group) | 1 = Has no formal education | 189 | 15 | 75 | 14 | 114 | 16 |
0 = Otherwise | |||||||
Districts
| |||||||
Kigoma Rural,*** | 1 = Household comes from Kigoma rural district | 325 | 27 | 149 | 28 | 176 | 25 |
0 = Otherwise | |||||||
Kilosa | 1 = Household comes from Kilosa district | 246 | 20 | 71 | 13 | 175 | 24 |
0 = Otherwise | |||||||
Mbulu,** | 1 = Household comes from Mbulu district | 323 | 26 | 149 | 28 | 1744 | 24 |
0 = Otherwise | |||||||
Singida Rural | 1 = Household comes from Singida Rural district | 331 | 27 | 155 | 30 | 176 | 25 |
0 = Otherwise | |||||||
Employment status of household head
| |||||||
Employed in the formal sector,** | 1 = Household head is employed in formal sector | 47 | 4 | 28 | 5 | 19 | 3 |
0 = otherwise | |||||||
Employed in the informal sector | 1 = Household head is employed in the informal sector | 1118 | 91 | 478 | 91 | 640 | 91 |
0 = otherwise | |||||||
Not employed, (reference group) | 1 = Household head is not employed | 20 | 2 | 6 | 1 | 14 | 2 |
0 = otherwise | |||||||
Health status of the household head
| |||||||
Health poor | 1 = Household head has poor self assessed health | 114 | 9 | 53 | 10 | 61 | 9 |
0 = otherwise | |||||||
Health average | 1 = Household head has average self assessed health | 361 | 30 | 175 | 34 | 186 | 27 |
0 = otherwise | |||||||
Health Good, (reference group) | 1 = Household head has good self assessed health | 732 | 60 | 291 | 56 | 441 | 64 |
0 = otherwise | |||||||
Religion of household head*** | 1 = Christian | 718 | 58 | 330 | 63 | 388 | 55 |
0 = Muslim, or Hindu/Buddhist or no religion | |||||||
Exemption eligibility of household head*** | 1 = eligible for exemptions | 190 | 16 | 87 | 17 | 103 | 14 |
0 = not eligible for exemptions | |||||||
Continuous variables
| |||||||
Mean age of the household head in years, Mean [sd]* | 1225 | 44.4 [13.3] | 524 | 46.4 [12.7] | 701 | 42.9 [13.5] | |
Mean number of children under 18, Mean [sd] | 1225 | 3.6 [1.9] | 524 | 4.0 [2.1] | 701 | 3.4 [1.2] | |
Household size, Mean [sd]*** | 1225 | 6.2 [2.6 ] | 524 | 7.0 [2.5] | 701 | 5.5 [2.6] |
Determinants of CHF membership
Variable | Marginal effects coeff | p-values |
---|---|---|
Gender* | 0.109 | 0.059 |
Second poorest** | 0.110 | 0.015 |
Middle* | 0.096 | 0.091 |
Second richest | 0.112 | 0.115 |
Least Poor | 0.057 | 0.604 |
Age | 0.010 | 0.273 |
Age squared | −0.000 | 0.565 |
Completed primary education | −0.002 | 0.950 |
Completed secondary education and above | −0.016 | 0.871 |
Household size*** | 0.043 | 0.000 |
Marital status | 0.044 | 0.253 |
Religion* | 0.067 | 0.096 |
Household head eligible for exemptions | −0.025 | 0.675 |
Number of observations | 1,112 | |
Wald | 155.46 | |
Prob | 0.000 | |
Pseudo | 0.078 | |
Log pseudolikelihood | −698.46 |
Qualitative analysis results
Demand side factors explaining membership
“You can sell one or two hens and manage to pay 5000 Tanzanian shilling (Tsh), it’s cheap but not everybody has a business or cattle, thus [joining] becomes difficult” (FGD, Mbulu DC, HFGC members).
“We have teachers who are civil servants covered by the National Health Insurance Fund (NHIF) and they are also members of the CHF to extend coverage to other dependants” (FGD, Mbulu DC, HFGC members).
“Some people are poor, so [they] can’t afford the premium and nowadays earnings from farming are very low” (FGD, Mbulu DC, HFGC members).“We have many people who can’t even afford to buy food; it is not possible for them to pay Tsh 5000” (FGD, Kigoma DC, CHF members).
“Everybody in this area is capable of paying this amount, Tsh 5000/=. We join the scheme because the premium is very low” (FGD, Kigoma DC, CHF member).“User fees are expensive when you go to the dispensary several times in a year, compared to the CHF premium” (FGD, Mbulu DC, Uninsured).
“The main reason for joining is having an extended family. If you join you start to experience a relief from those expenses, especially when you have to take care of more than one person, or repeated illness cases” (FGD, Kigoma DC, CHF members).“One day I brought my son to the clinic, and a few days later my wife was also sick, though she was only given aspirin at the facility as there were no other drugs. She was supposed to go and buy outside the facility [other drugs prescribed by the doctor] but we didn’t pay at the facility because of the CHF card” (FGD, Mbulu DC, HFGC members).
“Due to the instability of my income, which depends on farming which is seasonal and unpredictable, I have no other choice; my whole family is looking at me, depending on me,” (FGD, Kigoma DC, HFGC members).
“My parents depend on me to take care of them when they fall sick, and I have my nephew with skin problems and my own children. Having a CHF card has been helpful especially to my nephew who visits the hospital most often” (FGD, Mbulu DC, HFGC members).“If your dependants also experience severe illness often you will suffer even more. You will be paying money every day to buy drugs. That’s why people decide to join insurance though it doesn’t cover all you need [the benefit package is limited]” (FGD, Kigoma DC, CHF members).
“Why should I pay again to join for the next year, while I know my dependants didn’t fall sick this year? I didn’t use my money!” (FGD, Kigoma DC, Uninsured).
Supply side factors affecting membership
“Now, what made me drop out of this scheme it’s the shortage of drugs at the facility. And at the drug shop you can pay more than half of the fees that you paid to become a member of the scheme. This is double payment, it is better that I don’t join any more” (FGD, Mbulu DC, uninsured).“When you go to the facility to be told to go and buy drugs at the private pharmacy, there is no difference between those who are insured and those un-insured” (FGD, Kigoma DC, CHF members).
“Sometimes they don’t treat what was supposed to be treated at the dispensary, because there is no diagnostic equipment” (FGD, Mbulu DC, Uninsured).
“....But there is no guarantee of the service provided. Today you get a complete service tomorrow half of the service, this is what discourages us” (FGD, Mbulu DC, CHF members).
“Often one can spend almost the whole day waiting at the facility, with only two staff to take care of everyone, it is not easy. CHF member can’t opt to go elsewhere, as they are restricted to one facility [where they first sign up to the scheme]” (FGD, Kigoma DC, Uninsured).
“There is no improvement in the service, even if the government also contributes to the fund” (FGD, Kigoma DC, HFGC members).“We were told if we contribute, the government would match our contribution by the same amount” (FGD, Mbulu DC, HFGC members).
“The scheme only covers services at one facility, when you travel to other villages you will have to pay, and wait a long time to get attended to and that is discouraging” (FGD, Kigoma DC, uninsured).
“Hospital care is included in the CHF and the CHMT is working hard to ensure there are enough drugs for members, however you won’t always get the drugs, to be honest there are still some challenges” (FGD, Mbulu DC, HFGC members).“Yes we have been told, we can go to the district hospital but the transport cost discourages members to go there” (FGD, Mbulu DC, CHF members).
“There are a lot of free services […] sometimes people see no need [to join] because there are groups accessing free services” (FGD, Kigoma DC, CHF members).“Sometimes it is better to join, as for instance old people are supposed to get free services, but when they visit the health facility they often pay. They provide only free childhood vaccinations and clinic services” (FGD, Mbulu DC, Uninsured).