The University of Dodoma University of Dodoma Institutional Repository http://repository.udom.ac.tz Business Master Dissertations 2012 An assessment of factors that determine sustainability of community health fund (CHF) in Tanzania: A case of Kintinku ward, Manyoni district Chaula, Luckness The University of Dodoma Chaula, L. (2012). An assessment of factors that determine sustainability of community health fund (CHF) in Tanzania: A case of Kintinku ward, Manyoni district. Dodoma: The University of Dodoma. http://hdl.handle.net/20.500.12661/780 Downloaded from UDOM Institutional Repository at The University of Dodoma, an open access institutional repository. AN ASSESSMENT OF FACTORS THAT DETERMINE SUSTAINABILITY OF COMMUNITY HEALTH FUND (CHF) IN TANZANIA: A CASE OF KINTINKU WARD, MANYONI DISTRICT By Luckness Chaula A Dissertation Submitted in Partial Fulfillment of the Requirements for the Award of Masters in Business Administration of the University of Dodoma The University of Dodoma September, 2012 CERTIFICATION The undersigned certifies that he has read and hereby recommends for acceptance by the University of Dodoma a dissertation entitled ―AN Assessment of Factors that Determine Sustainability of Community Health Fund (CHF) in Tanzania. A Case of Kintinku Ward, Manyoni District” in partial fulfillment of the requirements for the Degree of Masters of Business Administration of the University of Dodoma. ...................................................... Dr. Damas K. Mbogoro Supervisor i DECLARATION AND COPYRIGHT I, Luckness Chaula, declare that this thesis is my own original work and that it has not been presented and will not be presented at any other University for a similar or any other degree award. Signature……………………………..………………….. No part of this thesis may be reproduced, stored in any retrieval system, or transmitted in any form or by any means without prior written permission of the author or the University of Dodoma. ii ACKNOWLEDGEMENT In the course of accomplishing this task, many individuals and institutions were involved from whom I benefited a lot. I feel greatly indebted to them all. Although it is difficult to mention each individual by name, the following deserve special thanks. First and foremost, I would like to express my sincere gratitude to my employer National Health Insurance Fund, for allowing me to go for studies when I asked for, so as to undertake my studies. Secondly, I would like to express my heartfelt thanks to my supervisor Dr. D.K.Mbogoro to whom I am indebted so much for his guidance, tireless advice, criticisms and cooperation. His supervision greatly shaped this dissertation. Thirdly, special thanks should go to all members of my family, especially to my mother Debora Malima for praying to God to assist me during my studies. Though the list can be endless it is my responsibility to extend my gratitude to members of staff, School of Business and Economic studies, The University of Dodoma for their part they played during my studies. Lastly I am very thankful to everybody and every institution that enabled me to collect data in an unbiased way and all those who helped in proof reading and editing my initial drafts of this work. I declare that errors and shortcomings are solely my own responsibility and therefore should not be attributed to any of the acknowledged person(s) or institution(s). iii DEDICATION This dissertation is dedicated to my beloved Grandfather Stephano Malima Nyamakababi. iv ABSTRACT This research aimed at assessing factors that determine the sustainability of Community Health Fund (CHF) taking Manyoni District as a case study. Specifically, the study covered the operationalisation of Community Health Funds (CHF), social economic factors for CHF to be used, extent of effects of CHF and effects facing the CHF. The study used a cross sectional design with a case study that aimed at getting in depth data and study the CHF once irrespectively. This study used a random sample of 96 respondents who were the heads of households. Data on the CHF were collected by survey method through the use of a structured questionnaire. In addition, a checklist was used to collect secondary data related to CHF through documentary review and focused group discussion .The analysis of data was done through the use of SPSS-15. It was found out that the operationalization of the CHF follows the D by D policy in which decisions emanate from the grass roots and the Ministry of Health is the policy maker. The sustainability of the CHF is questionable because of how CHF is operationalized, social economic factors that influence joining the CHF and the extent of rural households with community health insurance. The study recommends that the government should promote CHF and ensure that equity is considered in the discharge of the CHF to the poor. In addition, education should be provided to both consumers and providers of CHF to avoid information asymmetry which could lead into market failure and unnecessary government failures. v TABLE OF CONTENTS CERTIFICATION ............................................................................................................... i DECLARATION AND COPYRIGHT .............................................................................. ii ACKNOWLEDGEMENT ................................................................................................ iii DEDICATION................................................................................................................... iv ABSTRACT ........................................................................................................................ v TABLE OF CONTENTS .................................................................................................. vi LIST OF TABLES ............................................................................................................. ix LIST OF FIGURES ............................................................................................................. x LIST OF APPENDICES ................................................................................................... xi LIST OF ABBREVIATIONS ........................................................................................... xii CHAPTER ONE ................................................................................................................. 1 INTRODUCTION............................................................................................................... 1 1.1 Background of the Problem .................................................................................. 1 1.2 Statement to the Problem ........................................................................................ 4 1.3 Objectives of the Study ........................................................................................... 7 1.3.1 General Objective .................................................................................................... 7 1.3.2 Specific Objectives .................................................................................................. 7 1.4 Research Questions ................................................................................................. 7 1.5 Significance of the Study ........................................................................................ 7 1.6. Conclusion............................................................................................................... 8 CHAPTER TWO ................................................................................................................ 9 LITERATURE REVIEW .................................................................................................... 9 2.1 Introduction ............................................................................................................. 9 2.2 Theoretical Review: Theory of Demand for Health Insurance ............................... 9 2.3 Empirical Review .................................................................................................. 11 2.3.1 Health Insurance .................................................................................................... 11 2.3.2 Factors for Existence of Rural Health Insurance .................................................. 12 2.3.3 Extent of Rural Health Insurance at Household Levels ........................................ 13 vi 2.3.4 Impacts of Rural Health Insurance ...................................................................... 15 2.3.5 Way Forward to Improve Health Insurance Schemes .......................................... 16 2.4 Conceptual Framework ........................................................................................ 17 2.5 Conclusion............................................................................................................ 19 CHAPTER THREE ........................................................................................................... 20 RESEARCH METHODOLOGY ...................................................................................... 20 3.1 Study Area ............................................................................................................ 20 3.2 Research Design ................................................................................................... 20 3.3 Sampling Frame, Sampling Methods and Sample Size ....................................... 21 3.4 Data Type, Data Collection Methods and Tools ..................................................