1. Dr. Dhally M. Menda
MD, MPH, MBA
Director of Health Programmes
Churches Health Association of Zambia -
CHAZ
Community Healthcare Financing
The Zambia Experience
ACHAP 7th Biennial Conference
Meeting
24 February 2015
Nairobi, Kenya

2. What is Community-Based
Health Financing?
Any scheme that has the following features:
Common objective, e.g. to meet unmet
health needs, increase financial access to
health services.
• Voluntary in nature
• Predominant role of community in
mobilizing, pooling, allocating, and
managing and/or supervising health care
resources.

3. 7. Has Control
6. Has
Delegated
Authority
5. Plans Jointly
4. Advises
3. Is Consulted
2. Receives
Information
1. None
High
Low
Arnstein’s Ladder of Community Participation

4. Universal Health Coverage
Tanahashi. (2007)
Lost Poor

5. Commodities
Human
Resources
Geographic
Access
Utilization
Initial Continuous
Quality
(meeting
minimum
standards)
= Effective Coverage
(Result of interface between Health System and Communities)
Supply side
(Health System
controlled)
Demand side
(Community
controlled)
Quality
(Health System
controlled)
Healthcare Accessibility Barriers
+ +

6. Zambia
Experience
Cenfri. (2009). Zambia Private Health Insurance: Optimal Regulation and Market Development

7. Community Managed User Fees

8. Community Managed User Fees
Relies mainly on out-of-pocket payments at
the point of contact with providers.
The community is involved in:
• Setting user fee levels,
• Allocating funds,
• Carrying out general management and
oversight

9. Performance
Based
Financing
PBF

10. Quantitative & Qualitative Indicators
Qualitative Indicators Available Marks
(1) Curative Care 35
(2)ANC 50
(3)FP 0/57
(4)EPI 28
(5)Delivery Room 65
(6)HIV 16
(7)Supply Management 21
(8)General Management 20
(9)HMIS 18
(10) Community Participation 9
(11) TB Screening 25
(12) Admission ward 15

11. PBF

12. Effect of PBF: Bonus Utilization
Bonus Distribution: 50%:
• Staff - 40%: HF Investment
• 10%: Community Activities

13. Effect of PBF: Bonus Utilization
Staff Bonus:
• Bonus per staff: 55-68$ /Month
Investment Bonus:
• Hire Health Workers
• Procure Medical Equipment/Instruments
• Procure Medical Supplies
• Stationery & Lap Tops
• Renovation/Construction
• Mama Baby Kits Procurement
• Provision of meals to patients

14. Effect of PBF: Bonus Utilization
Community Bonus:
• Drill Holes
• Purchase Torches, Scales, Registers for
U5
• Motivation Rewards to CBHWs
• Sensitizations of health issues

15. Provider- Based Health Insurance

16. Provider- Based Health Insurance
Hospital voluntary membership, prepayment
of usually a one-time annual fee
Involvement of community in supervision,

17. Care and Prevention
Model
CPT

18. HF + Community Leaders
• Plan Community &
HF Activities
• Payment in kind
• Upfront materials for
projects

19. Successes
Increased:
• Community
ownership (health
resources and results).
• Resources for health.
• Demand for Health
Services.
Improved:
• Quality of services
• Health Governance.
• Relationship Health
Facility - Community
(reduced conflict)

20. Challenges
• Health Facilities feel not accountable
to communities
• Community over stepping boundaries
(Micromanagement)

21. Thank You
God Bless