Uptake of community health fund: why is Mtwara District lagging behind?

Background: Globally, there is an increased advocacy for community-based health insurance (CBHI) schemes. CBHI refers to voluntary, non-profit health insurance, normally organized at local level where formal health insurance does not provide protection against the cost of illness. The community health fund (CHF) is a type of CBHI scheme which is being implemented in Tanzania since 1996. Despite this seemingly noble initiative, there is a growing concern that this scheme has not achieved its intended objectives. At present, enrolment rate in CHF is still low and there is also high dropout of members from CHF. This study explored the socio-economic, political, and health system factors that contribute to the low uptake of the CHF in Mtwara Region. Methods: This study employed descriptive qualitative case study design. The study primarily relied on 2 data collection techniques, namely individual interviews (n = 49) and focus group discussions (n = 12). A thematic analysis approach was used to analyse the collected data.