Community awareness and preferences on health financing mechanisms for priamary health care services in Songea rural district

A descriptive cross-sectional study was undertaken in Songea Rural District, Southern part of Tanzania during the period of May to June 2002. The main objective was to determine the community awareness and preferences on health financing mechanisms for primary health care services in Songea Rural District. A total of 622 respondents aged 18-86 years of age were interviewed using structured interviewer-administered questionnaires. The results showed that majority of respondents were aware of Community Health Fund (CHF) and User Fees i.e. 94.9% and 93.2% respectively, while a much lower proportion of them were aware of National Health Insurance Scheme (NHIS) (34.6%) or that one could get exempted from payment and thus get ‘free care’ (39.5%). Health service providers and village meetings were established to be the main sources of information on CHF and User Fees. User Fees was the main health financing mechanism used by the majority of respondents (81.2%) to obtain primary health care services with all occupational categories using this health financing mechanism except for those employed who were found to be using NHIS. The highest level of satisfaction with the currently used health financing mechanism was expressed by members using NHIS (77.9%), while the least satisfaction was expressed by CHF members (44.7%). Study findings have established that User Fees followed by CHF were the most preferred health financing options among study respondents i.e. 38.5% and 30.6% respectively. A high preference was NHIS expressed by employed respondents (73.7%). While 118 respondents (19%) preferred to be exempted from payment none of the 2 individuals who reported that they had been exempted during their last illness episode preferred it. Study recommendations include the need for raising community awareness on NHIS and exemption using established channels i.e. health service providers and village meetings and a call for further studies to establish factors for the low satisfaction with User Fees and Community Health Fund among residents of Songea Rural district established in this study.