Determinants of the uptake of improved Community Health Fund (iCHF) among agro-pastoralists’ communities in Malinyi district, Tanzania

Abstract

Agro-pastoralists is a group of people normally living in isolated or peripheral environments due to their economic activities of livestock keeping which require enough space for cattle grazing, though they also practice crops farming. Many studies previously conducted were on the factors or reasons for the low enrolment of Community Health Fund (CHF) but not the improved Community Health Fund (iCHF). Also, previous studies were mostly not concentrated on agro-pastoralists’ group which might differ with other community groups demographically, economically, culturally, socially and even psychologically. There was inadequate information about the determinants of the uptake of iCHF in agro- pastoralists’ communities especially the socio-economic, cultural factors, and the household’s cognitive personal values. This study was about the determinants for the uptake of iCHF among agro-pastoralists’ communities in Malinyi District. The study used a cross-sectional research design. The sample size was 100. Descriptive and Inferential analyses were done using STATA 14. Quantitative data were obtained from Questionnaire, Laddering Interview, Key Informants Interview, and Focus Group Discussions. The study revealed that poor health services (51.5%), lack of awareness/ sensitization meetings (40.8/79.2% respondents), and traditions and customs were the major factors for low enrolment and renewal of agro-pastoralists to the iCHF. When felt sick specifically, 53%, 48%, 62%, and 63% for single, married, separated, and widow respondents respectively went to traditional healers. Moreover, 49%, 42%, 68%, and 55% for single, married, separated, and widow respondents respectively preferred traditional herbs when felt sick then went to the health facilities. The effects of major iCHF attribute to the low enrolment were health services (90%); and benefits package (88%). The study revealed that age of respondents and iCHF availability were the factors significant at a 95% level of significance (Confidence Interval level II). Using binary logistic regression, it was found that the β- coefficient for age variable was negative (-0.107) and the odds ratio was below 1. The influence was significant at (p ≤ 0.05). Also, the study findings showed that the coefficient of iCHF availability in the community variable was positive (4.097) and the odds ratio was above 1. The influence was significant at (p ≤ 0.05). Furthermore, the study findings showed that long-time illness and educational level had positive coefficients which were significant at (p≤0.05). The study concluded that most of the demographic and economic characteristics of agro- pastoralists had direct effects on enrolment of agro-pastoralists in the iCHF. The findings also complied with the Theory of Demand for Health Insurance. The study recommended on improvement of the health services, more sensitization meetings, consideration of agro-pastoralists whenever the Government and development partners plan and implementation of different interventions. It further recommended that the Ministry of Natural Resources and Tourism and Regional Administration and Local Government Authority under the President’s Office should work in coordination.