Linking the Community Health Fund with Accredited Drug Dispensing Outlets in Tanzania: exploring potentials, pitfalls, and modalities

Background: In low- and middle-income countries, too, public-private partnerships in health insurance schemes are crucial for improving access to health services. Problems in the public supply chain of medicines often lead to medicine stock-outs which then negatively influence enrolment in and satisfaction with health insurance schemes. To address this challenge, the government of Tanzania embarked on a redesign of the Community Health Fund (CHF) and established a Prime Vendor System (Jazia PVS). Informal and rural population groups, however, rely heavily on another public-private partnership, the Accredited Drug Dispensing Outlets (ADDOs). This study takes up this public demand and explores the potentials, pitfalls, and modalities for linking the improved CHF (iCHF) with ADDOs. Methods: This was a qualitative exploratory study employing different methods of data collection: in-depth interviews, focus group discussions, and document reviews. Results: Study participants saw a great potential for linking ADDOs with iCHF, following continuous community complaints about medicine stock-out challenges at public health facilities, a situation that also affects the healthcare staff's working environment. The Jazia PVS was said to have improved the situation of medicine availability at public health facilities, although not fully measuring up to the challenge. Study participants thought linking ADDOs with the iCHF would not only improve access to medicine but also increase member enrolment in the scheme. The main pitfalls that may threaten this linkage include the high price of medicines at ADDOs that cannot be accommodated within the iCHF payment model and inadequate digital skills relevant for communication between iCHF and ADDOs. Participants recommended linking ADDOs with the iCHF by piloting the connection with a few ADDOs meeting the selected criteria, while applying similar modalities for linking private retail outlets with the National Health Insurance Fund (NHIF). Conclusions: As the government of Tanzania is moving toward the Single National Health Insurance Fund, there is a great opportunity to link the iCHF with ADDOs, building on established connections between the NHIF and ADDOs and the lessons learnt from the Jazia PVS. This study provides insights into the relevance of expanding public-private partnership in health insurance schemes in low- and middle-income countries

Savings Groups for Social Health Protection: A Social Resilience Study in Rural Tanzania

Global health experts use a health system perspective for research on social health protection. This article argues for a complementary actor perspective, informed by the social resilience framework. It presents a Saving4Health initiative with women groups in rural Tanzania. The participatory qualitative research design yielded new insights into the lived experience of social health protection. The study shows how participation in saving groups increased women's collective and individual capacities to access, combine and transform four capitals. The groups offered a mechanism to save for the annual insurance premium and to obtain health loans for costs not covered by insurance (economic capital). The groups organized around aspirations of mutual support and protection, fostered social responsibility and widened women's interaction arena to peers, government and NGO representatives (social capital). The groups expanded women's horizon by exposing them to new ways of managing financial health risk (cultural capital). The groups strengthened women's social recognition in their family, community and beyond and enabled them to initiate transformative change through advocacy for health insurance (symbolic capital). Savings groups shape the evolving field of social health protection in interaction with governmental and other powerful actors and have further potential for mobilization and transformative change

Linking the Community Health Fund with Accredited Drug Dispensing Outlets in Tanzania: exploring potentials, pitfalls, and modalities

Abstract Background In low- and middle-income countries, too, public–private partnerships in health insurance schemes are crucial for improving access to health services. Problems in the public supply chain of medicines often lead to medicine stock-outs which then negatively influence enrolment in and satisfaction with health insurance schemes. To address this challenge, the government of Tanzania embarked on a redesign of the Community Health Fund (CHF) and established a Prime Vendor System (Jazia PVS). Informal and rural population groups, however, rely heavily on another public–private partnership, the Accredited Drug Dispensing Outlets (ADDOs). This study takes up this public demand and explores the potentials, pitfalls, and modalities for linking the improved CHF (iCHF) with ADDOs. Methods This was a qualitative exploratory study employing different methods of data collection: in-depth interviews, focus group discussions, and document reviews. Results Study participants saw a great potential for linking ADDOs with iCHF, following continuous community complaints about medicine stock-out challenges at public health facilities, a situation that also affects the healthcare staff’s working environment. The Jazia PVS was said to have improved the situation of medicine availability at public health facilities, although not fully measuring up to the challenge. Study participants thought linking ADDOs with the iCHF would not only improve access to medicine but also increase member enrolment in the scheme. The main pitfalls that may threaten this linkage include the high price of medicines at ADDOs that cannot be accommodated within the iCHF payment model and inadequate digital skills relevant for communication between iCHF and ADDOs. Participants recommended linking ADDOs with the iCHF by piloting the connection with a few ADDOs meeting the selected criteria, while applying similar modalities for linking private retail outlets with the National Health Insurance Fund (NHIF). Conclusions As the government of Tanzania is moving toward the Single National Health Insurance Fund, there is a great opportunity to link the iCHF with ADDOs, building on established connections between the NHIF and ADDOs and the lessons learnt from the Jazia PVS. This study provides insights into the relevance of expanding public–private partnership in health insurance schemes in low- and middle-income countries