Factors affecting ability and willingness of community members to enrol Improved Community Health Fund in Dodoma and Iringa regions

Abstract

Financial protection has been recognised as an important element within the  healthcare  financing   system   of   many  low   and   middle-income countries. Pre-payment schemes have been advocated as a means of curbing high out of pocket expenditure and achieving universal health coverage.  A  number  of  financing  reforms  have  been  taking  place, however   there   is   a   limited   rigorous   contextual   evidence   on   the willingness-to-pay (WTP) for the recently Improved Community Health Fund (iCHF) in Tanzania. The study took place in district councils of Dodoma  and  Iringa  regions.  Data  were  collected  from  a  household survey conducted in 2021. Contingent valuation methodology was used to elicit households’ the willing to pay (WTP) for iCHF premium using the bidding game technique. In addition, the relationship between WTP and other socio-economic variables was examined using logistic regression models. Majority 88% respondents said they will repay their package after expiry considering the quality of the services provided by health insurance. The results showed a statistically significant negative relationship 0.526 (p = 0.034) between household aged above 55 years of age and WTP. More specifically, as age increases above 55 years, the likelihood to pay for health insurance premium decreases. We also found a positive statistically significant relationship 1.882 (p = 0.034) between the household with small business and   WTP,   which suggest   the individuals with small business are in a better position to pay for iCHF premium compared to those with formal employment. It is important to educate the households to raise awareness about the benefits of being a member of insurance scheme in both formal and informal sector. The households should be encouraged to formalize their small business, this will improve their income and enrolment into the insurance schemes. The benefit packages should be revised to fit the need of the people as WTP was also influenced by the nature of the packages.