The Centre for International Development and Research (CIDR) is a French international NGO that has successfully established its insurance program in Mbozi District, Tanzania, where the attendance rate at medical facilities by members of the Community Health Insurance Fund (CHIF0 is five times higher than the uninsured. The annual re-enrolment rate is nearly 90%, indicating satisfaction with the quality of health care provided by Moravian Church Mbozi Hospital, which is the facility of choice. This activity supports the replication of the CHIF program in Kyela District. The objectives of this activity are (a) to raise awareness and change behaviours among community members in relation to HIV/AIDS, sexual and reproductive health, and malaria, (b) to establish a health insurance fund that is governed by members and that gives them a choice of medical providers and optional pre-paid health packages, and (c) to contribute to the policy dialogue at the national level on health financing and HIV/AIDS risk management strategies.

This activity contributes to Partnership Framework Goal 1: Service Maintenance by aiming "to reduce morbidity and mortality due to HIV and AIDS and improve the quality of life for PLHIV and those affected by HIV and AIDS. Care, treatment, and support services include services for OVC, community and home-based care, and facility-based care (ART, PMTCT, and TB/HIV). Supporting quality improvements is an integral part of this goal." This endeavor also will contribute to the Partnership Framework Goal 3: Leadership, Management, Accountability, and Governance. More specifically, it will to build the capacity of non-state actors at national and local levels in the response to HIV/AIDS.

After more than 25 years of socialism during which medical care was provided free of charge, the government introduced a nominal fee structure and a Community Health Fund intended to create a pre-pay health finance pool. However, it is generally recognized that the government's Community Health Fund (CHF) does not adequately develop the understanding and ownership of the CHF by its members or the community at large, which is reflected in the low enrolment rates in the country. First, membership on the Council Health Service Boards and Health Facility Governing Boards do not automatically include enrolled CHF members. In fact, most of the board members have not even joined the scheme. Second, most districts are not actively providing opportunities for current or potential CHF members to learn about their rights and the benefits of the program. Finally, there is a general lack of transparency on how the CHF operates. In contrast, CIDR establishes representative structures and convenes regular assemblies that allow members to take ownership of their self-managed health insurance schemes. At the same time, CIDR takes great care to involve government officials and influential community leaders in the development of the CHIF so that they understand how the CHIF works. In the long-term it is hoped that the CHF will be transformed into the CHIF, which operates as a broker between insurance members and health providers without undue influence on the part of district authorities. It is anticipated that the Lutheran Church's Matema Hospital will be the facility of choice.

PPPs inherently are targeted leveraging mechanisms. The CHIF is a community-owned program that will relieve the state of having to fully finance the health care system. PEPFAR funding for this activity is being used to leverage funds from Biolands Ltd, one of the major coco traders that supplies Kyela production to markets in Europe, which has pledged Redacted in contributions per year for five years to the CHIF. GTZ, which has provided technical assistance to government's CHF in Kyela, is also contributing funds to actively recruit low-income families into the CHIF. The Elton John AIDS Foundation is funding the HIV re-insurance component. CIDR is required to submit quarterly progress reports that document the results being achieved.

It is estimated that Tanzanians pay over 60% of their total healthcare costs out-of-pocket. For a variety of reasons, the government-led Community Health Fund (CHF) has realized very low enrolment rates, leaving the bulk of the population vulnerable to unexpected health expenses that may empty financial reserves or, worse, prevent families from accessing quality health care. In contrast the Community Health Insurance Fund (CHIF) will demonstrate the viability and benefits of member-owned and managed health insurance schemes. More importantly it will model how insurance programs should function as an intermediary between healthcare providers and consumers. By choosing health plans and providers that offer quality healthcare, CHIF members channel their pooled pre-pay funds to facilities that provide the best service, thereby raising the general level of healthcare. Intermittent formal evaluations will be conducted and the resultant studies will be shared with national policy makers and legislators. The CHIF includes an HIV reinsurance component to the general insurance scheme to provide additional fundsso that PLWHA receive adequate care and treatment.

PPPs inherently are targeted leveraging mechanisms. PEPFAR funding for this activity is being used to leverage funds from Biolands Ltd, one of the major coco traders that supplies Kyela production to markets in Europe. The company has pledged $60,000 per year for five years to help capitalize the CHIF. GTZ, which has provided technical assistance to the district government to establish the CHF in Kyela, is contributing funds to be used for actively recruiting low-income families into the CHIF. The Elton John AIDS Foundation is funding the HIV re-insurance component.

It is estimated that Tanzanians pay over 60% of their total healthcare costs out-of-pocket. For a variety of reasons, the government-led Community Health Fund (CHF) has realized very low enrolment rates, leaving the bulk of the population vulnerable to unexpected health expenses that may empty financial reserves or, worse, prevent families from accessing quality health care. In contrast the Community Health Insurance Fund (CHIF) will demonstrate the viability and benefits of member-owned and managed health insurance schemes. More importantly it will model how insurance programs should function as an intermediary between healthcare providers and consumers. By choosing health plans and providers that offer quality healthcare, CHIF members channel their pooled pre-pay funds to facilities that provide the best service, thereby raising the general level of healthcare. Intermittent formal evaluations will be conducted and the resultant studies will be shared with national policy makers and legislators. The CHIF includes an HIV reinsurance component to the general insurance scheme to provide additional fundsso that PLWHA receive adequate care and treatment.

PPPs inherently are targeted leveraging mechanisms. PEPFAR funding for this activity is being used to leverage funds from Biolands Ltd, one of the major coco traders that supplies Kyela production to markets in Europe. The company has pledged $60,000 per year for five years to help capitalize the CHIF. GTZ, which has provided technical assistance to the district government to establish the CHF in Kyela, is contributing funds to be used for actively recruiting low-income families into the CHIF. The Elton John AIDS Foundation is funding the HIV re-insurance component.