International Journal of Research and Scientific Innovation (IJRSI) | Volume VII, Issue IV, April 2020 | ISSN 2321–2705 www.rsisinternational.org Page 44 Factors Associated With Low Enrollment to Community Health Fund (CHF) in Mkuranga District- Pwani, Tanzania Bertha Mwinuka 1* , Mary J Chacha 2 1 Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, United Republic of Tanzania 2 Department of Health Services, Mkuranga District Council, Pwani, United Republic of Tanzania *Corresponding author Abstract:- Background: Despite the 15 years of promotion of Community Health Fund (CHF) in Tanzania, overall membership has remained low and this has led to an increase in mortality and morbidity due to unaffordability of health services. Materials and methods: The study was descriptive cross- sectional study. One hundred and thirty consenting were selected purposively and randomly and interview and questionnaires were used to collect the data to identify the major factors associated with CHF enrollment. Quantitative data were analyzed by using STATA and qualitative data were analyzed based on the major themes by a process of content analysis. A p- value of less than 0.05 was considered statistically significant, at 95% confidence interval. Results: Demographic factors, lack of CHF awareness, failure to understand the CHF benefits and poor attendance to CHF sensitization meetings were the factors associated with low CHF enrollment (p-value >0.05).Socio economic factors showed strong association with CHF enrollment. Unavailability of drugs (75%) and lack of training about CHF (100%) were the major challenges faced by health workers. Conclusion: The strategies to improve CHF enrollment were political leaders’ involvement in community sensitization, district support to most vulnerable groups, health service quality improvement and conducting regular community sensitization. Key words: Community Health Fund, enrollment, Mkuranga district council. I. INTRODUCTION bout 1.3 billion people around the world are poor and lack access to effective and affordable health as a result of weaknesses in the financing and delivery of health care (World Bank, 2007;WHO, 2000; Dror & Firth, 2014). World Health Organization (WHO) health financing policy emphasizes that the health insurance as a financing strategy is a key determinant to population health and well-being (WHO, 2007). This is particularly true in the poorest countries where the level of health spending is still insufficient to ensure equitable and universal access to needed health services and interventions. Tanzania like many countries in Sub-Sahara Africa, face problems like tight public health care budget and inaccessibility to basic health care to population in rural areas and informal sectors. As a result, the country introduced different health financing mechanisms namely; user fees, health insurance, and community health funds (CHF) so as to facilitate individual contributions in accessing health services. Tanzania uses a mixture of health financing mechanisms: taxation, donor funding, health insurance (both private and national), user fees and CHF (URT, 2011). Act No. 1 of 2001 introduced the CHF which is the prepayment scheme. The scheme was first introduced in the country as a pilot in 1996 in Igunga District (Government of Tanzania, 1999). CHF is a pre-payment council’s-based scheme aimed at facilitating the community to access health care at an affordable premium that is determined by the community itself. It is expected that household will be well informed about their benefits and choose themselves to join into the CHF. CHF management and principal stakeholders include; community, ward leadership, local authorities and health providers. From the CHF management, funds are being pooled from many households so as to incorporate the fundamental insurance principles of risk pooling. This enables the CHF to cover expenses of health care services required by its members. Households which have not joined CHF pay out of pocket in order to access health services. For the low-income families sometimes it had been difficult to access the services (MOH, 1999). Despite the fact that it’s through the community’s and council’s meeting is where premium for this scheme is determined but still the enrollment rate to this scheme is low. CHF has been on implementation for more than 15 years, in 119 councils reports show that there are several challenges which retard CHF success (NHIF, 2011; Kamuzora & Gilson, 2007). The main challenges are low CHF enrollment (only 24%) which is lower than the national target of 70% set in 2010 (NHIF, 2019; NHIF, 2010). Lack of transparency on the management of the funds has contributed to members drop out tremendously like how it happened in councils like Nzega and Hanang (Mhina, 2005; Chee and Smith, 2001). Other A