Abstract:

Background: The Community Health Fund (CHF) was established in Tanzania in 1996 to provide affordable healthcare and promote universal health coverage for all. Despite its intentions, the CHF faced significant challenges, particularly low enrolment rates. To address these issues, the government introduced the Improved Community Health Fund (iCHF) in 2016, offering expanded benefits packages and better operational structures. Nevertheless, enrolment remains low at only 6%, and the quality of health services under the iCHF, as perceived by clients (satisfaction with services), has not been comprehensively assessed.

Objectives: The general aim of this study was to determine clients’ satisfaction and its influencing factors and to explore the potential conflicting policies among members using the improved community health fund scheme in Ikungi District, central Tanzania.

Methods: The study employs a mixed methods approach to assess client’s satisfaction with iCHF services. A structured questionnaire was used to collect quantitative data (N=400), while an interview guide was used to collect qualitative information (N=16). Logistic regression was used to identify factors associated with client satisfaction, while qualitative data was thematically analyzed using NVivo® software to identify potential conflicting policies affecting the management of iCHF. The quantitative data was analyzed using STATA® software version 17.0, and all test statistics used the 5% significant level as the level of significance.

Results: Overall satisfaction of the improved CHF with the offered health services was 39.5% (n = 158; 95% CI: 34.8%–44.4%). Multivariate analysis revealed that clients who had easy access to the health facility were significantly more likely to be satisfied (aOR= 1.99; 95% CI: 1.07–3.71; p = 0.030). Conversely, clients with moderate expectations of reliability were less likely to be satisfied compared to those with low expectations (aOR = 0.55; 95% CI: 0.30–0.99; p = 0.049). Qualitative findings indicated that community participations, government match funding and engaging private sectors played a significant role in influencing the success and satisfaction levels

Conclusion: Based on the findings, this study concludes that accessibility and reliability emerged as key factors influencing client satisfaction with iCHF services. In additions, community engagement optimal match funding from government and engaging private/FBO facilities in services delivery among iCHF clients are unequivocally important. Addressing these challenges, will lead to client’s satisfaction and sustainability of the scheme.

Keywords: Community Health Fund, Improved Community Health Fund, universal health coverage, client satisfaction, primary health facilities, Tanzania.