RESEARCH ARTICLE Understanding the limitations of “quasi‐mandatory” approaches to enrolment in community‐based health insurance: Empirical evidence from Tanzania Adeline Ajuaye 1,2 | Boris Verbrugge 1 | Jan Van Ongevalle 1 | Patrick Develtere 1 1 HIVA—Research Institute for Work and Society, KU Leuven, Leuven, Belgium 2 Directorate of Social Sciences, Tanzania Commission for Science and Technology (COSTECH), Dar es Salaam, Tanzania Correspondence Adeline Ajuaye, Tanzania Commission for Science and Technology, PO Box 4302, Dar es Salaam, Tanzania. Email: ajuayes@yahoo.com Funding information Belgian policy research group on Financing for Development (BeFinD) Summary In recent decades, a growing number of low‐income coun- tries (LICs) have experimented with voluntary community‐ based health insurance (CBHI), as an instrument to extend social health protection to the rural poor and the informal sector. While modest successes have been achieved, impor- tant challenges remain with regard to the recruitment and retention of members, and the regular collection of mem- bership fees. In this context, there is a growing consensus among policymakers that there is a need to experiment with mandatory approaches towards CBHI. In some localities in Tanzania, local actors in charge of community health funds (CHFs) are now relying on what is best described as quasi‐ mandatory enrolment strategies, such as increasing user fees for non‐members, automatically enrolling beneficiaries of cash transfer programmes and enrolling the exempted groups (people who are entitled to free healthcare). We find that, while these quasi‐mandatory enrolment strategies may temporarily increase enrolment rates, dropout and the non‐ payment of contributions remain important problems. These problems are at least partly related to supply side issues, notably to inadequate benefit packages. Overall, these findings indicate the limitations of any strategy to increase enrolment into CBHI, which is not coupled to clear improvements in the supply and quality of healthcare. Received: 4 April 2019 Accepted: 5 April 2019 DOI: 10.1002/hpm.2795 Int J Health Plann Mgmt. 2019;1–15. © 2019 John Wiley & Sons, Ltd. wileyonlinelibrary.com/journal/hpm 1