Developing the improved Community Health Fund in Tanzania: was it a fair process?

Area of Science:

• Health policy and systems research
• Health economics
• Public health administration

Background:

• Tanzania's 2016-26 health financing strategy aimed to reduce inequities and inefficiencies.
• The strategy proposed mandatory national health insurance, a long-term legislative process.
• The improved Community Health Fund (iCHF) was introduced in 2017/18 as a short-term measure for the informal sector.

Purpose of the Study:

• To examine the decision-making process for Tanzania's improved Community Health Fund (iCHF).
• To assess the extent to which the iCHF decision-making process met criteria for procedural fairness.
• To analyze the role of context, content, actors, and process in the iCHF reform.

Main Methods:

• Qualitative research methods were employed.
• Document review and key informant interviews (n=12) were conducted.
• The policy analysis triangle framework and procedural fairness criteria guided the analysis.

Main Results:

• The iCHF reform bypassed standard legislative procedures, excluding public consultation.
• A technical taskforce led the process, but beneficiaries and providers were not involved.
• The iCHF process lacked transparency and did not consider evidence on reducing administrative costs.

Conclusions:

• The iCHF reform partially addressed health financing fragmentation by expanding risk pooling.
• The decision-making process highlighted the need for greater procedural fairness in technical reforms.
• Enhancing procedural fairness can improve the responsiveness, legitimacy, and implementation of health financing reforms.