Abstract
BACKGROUND: The initiative for improved Community Health Fund (iCHF) in Tanzania as a means of accessing affordable health care and protecting people from catastrophic expenditure, was not achieved due to low enrolment in the scheme. The enrolment rate was only 25% by 2018/ 2019 nationally raising the need to understand why community members are not enrolling in the scheme across all geographical regions. Therefore, this study assessed health services delivery factors associated with enrolment in the improved community health fund among household members in the Manyara region of Tanzania. METHOD: Community-based cross-sectional study design using a quantitative approach conducted from January to February 2021. We recruited 403 household members aged 18 years and above from Babati and Hanan'g councils in the Manyara region. Chi-square was applied for the relationship of variables and logistic regression for predictors of iCHF enrollment. RESULTS: Out of 403 participants in this study, 157 (39%) were enrolled in an improved community health fund. Results of multivariate analysis revealed that good customer care from health care providers (p = 0.009; AOR = 2.80; CI = 1.29-6.09), availability of medicine throughout the year (p < 0. 0.012; AOR = 2.69, CI = 1.25, 5.78), short time waiting for services (p = 0.033; AOR = 1.97, CI = 1.06, 3.68) and availability of referral system when needed (p < 0. 0.036; AOR = 1.62, CI = 1.03, 2. 54) were statistically significant predictors for iCHF enrollment. CONCLUSION: The finding from the current study showed that less than half of the participants were enrolled in the iCHF. The predictors for enrolment in the scheme were availability of medicine throughout the year, good customer care, short time waiting for services, and availability of referral services when needed in the health facilities. There is a need for the health providers to strengthen good customer care to the clients/patients and for the government to improve the health systems service delivery to enhance satisfaction with the services and increase the enrolment rate to the scheme.