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The community health fund concept was developed to increase access and utilization of health services especially for the rural communities so as to achieve financial protection against catastrophic health expenditure. The government goal for 2016/2017 was a 30% improved community health fund (iCHF) enrolment among Tanzanian households at end of the financial year 2019/2020. However, 16.4% was achieved by 2019. This study assessed the factors influencing enrollment and moral hazard practices to the scheme among household members in Manyara Region of Tanzania. This was community-based analytical cross-sectional study design using quantitative and qualitative approaches conducted from January to February 2021. Data were generated from 403 household members employed in Babati and Hanan,g councils in Manyara region. Logistic regression model was used to establish determinants of enrollment and moral hazard practices on iCHF by SPSS, version 26 while qualitative data were analysed by thematic analysis. Out of 403 participants sampled for this study, 157 (39%) were enrolled in improved community health fund. The analysis revealed that availability of medicine (AOR=3.81; CI= 0.37, 0.95; p=0.003), waiting for services (AOR=1.47, CI=1.09, 7.43; p=0.032), willingness to pay (AOR=2.79; CI=0.64,0.98; P=0.014), good customer care (AOR=3.61;CI=3.07, 9.12=;P=0.004) and availability of enrollment officers (AOR=5.62, CI=3.29, 9.62; p<0.001) were statistically significant associated with iCHF enrollment among study participants. Furthermore, availability of medicine (AOR=4.13; CI=2.87, 5.06; P=0.002), waiting time for services (AOR=1.03; CI=0.81, 0.97; P=0.02), Level of education (AOR=5.06; CI=2.78, 9.22; P<0.0001) and occupational (AOR=3.52; CI=1.45, 8.55; P=0.002) were predictors for moral hazard practices. There are increase (39%) of enrollment on iCHF, the predictors were; Availability of medicine, waiting time for services, willingness to pay, good customer care and availability of enrollment officers. Level of education, waiting time for services, availability of medicine and occupation were predictor for moral hazard practices among study participants. |
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