在资源匮乏国家引入强制性社区卫生基金的可行性：来自坦桑尼亚利瓦勒区社区的观点
Feasibility of introducing compulsory community health fund in low resource countries: views from the communities in Liwale district of Tanzania.
作者信息
Marwa Boniphace, Njau Bernard, Kessy Joachim, Mushi Declare
出版信息
BMC Health Serv Res. 2013 Aug 8;13:298. doi: 10.1186/1472-6963-13-298.
BACKGROUND
In 1995, Tanzania introduced the voluntary Community Health Fund (CHF) with the aim of ensuring universal health coverage by increasing financial investment in the health sector. The uptake of the CHF is low, with an enrolment of only 6% compared to the national target of 75%. Mandatory models of community health financing have been suggested to increase enrolment and financial capacity. This study explores communities' views on the introduction of a mandatory model, the Compulsory Community Health Fund (CCHF) in the Liwale district of Tanzania.
METHODS
A cross-sectional study which involved 387 participants in a structured face to face survey and 33 in qualitative interviews (26 in focus group discussions (FGD) and 7 in in-depth interviews (IDI). Structured survey data were analyzed using SPSS version 16 to produce descriptive statistics. Qualitative data were analyzed using content analysis.
RESULTS
387 people completed a survey (58% males), mean age 38 years. Most participants (347, 89.7%) were poor subsistence farmers and 229 (59.2%) had never subscribed to any form of health insurance scheme. The idea of a CCHF was accepted by 221 (57%) survey participants. Reasons for accepting the CCHF included: reduced out of pocket expenditure, improved quality of health care and the removal of stigma for those who receive waivers at health care delivery points. The major reason for not accepting the CCHF was the poor quality of health care services currently offered. Participants suggested that enrolment to the CCHF be done after harvesting when the population were more likely to have disposable income, and that the quality care of care and benefits package be improved.
CONCLUSIONS
The CHF is acceptable to the most of study participants and feasible in rural Tanzania as an alternative mechanism to finance health care for the rural poor. Community members are willing to join the scheme provided they are well informed, involved in the design and implementation, and assured quality health care. Strong political will and a supportive environment are key ingredients for the success of the CCHF.
背景
1995年，坦桑尼亚推出了自愿性社区健康基金（CHF），旨在通过增加对卫生部门的财政投入来确保全民健康覆盖。CHF的参保率很低，参保率仅为6%，而国家目标是75%。有人建议采用强制性社区卫生筹资模式来提高参保率和财政能力。本研究探讨了坦桑尼亚利瓦勒区社区对引入强制性模式即强制社区健康基金（CCHF）的看法。
方法
一项横断面研究，包括387名参与者参与结构化面对面调查以及33人参与定性访谈（26人参与焦点小组讨论（FGD）和7人参与深入访谈（IDI））。使用SPSS 16版对结构化调查数据进行分析以生成描述性统计数据。使用内容分析法对定性数据进行分析。
结果
387人完成了调查（男性占58%），平均年龄38岁。大多数参与者（347人，89.7%）是贫困的自给自足农民，229人（59.2%）从未订阅过任何形式的医疗保险计划。221名（57%）调查参与者接受了CCHF的想法。接受CCHF的原因包括：减少自付费用、提高医疗保健质量以及消除在医疗服务点获得豁免者的耻辱感。不接受CCHF的主要原因是目前提供的医疗保健服务质量差。参与者建议在收获后进行CCHF参保登记，因为那时人们更有可能有可支配收入，并且建议改善医疗服务质量和福利套餐。
结论
CHF为大多数研究参与者所接受，并且在坦桑尼亚农村地区作为为农村贫困人口提供医疗保健资金的替代机制是可行的。社区成员愿意加入该计划，前提是他们得到充分的信息、参与设计和实施过程，并能确保获得高质量的医疗保健。强大的政治意愿和支持性环境是CCHF成功的关键要素。
Zotero 插件