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

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... ves. 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. Results: The findings of the study indicate that the most important factors which hindered the uptake of the CHF were: low household income, lack of knowledge of the CHF scheme and poor quality of health care services. Conclusion: The study concludes that individual, community, and health systems factors contribute to the low enrolment in the CHF schemes. Therefore, increased enrollment in the CHF schemes requires collaborative efforts of community leaders, health providers and health system managers. This study underlines the need for continuous sensitization of communities. Therefore, local government authorities should make CHF a permanent agenda in community meetings. Likewise, the government needs to invest more in the health sector with a view to improving the quality of health care services, particularly availability of medicines, medical supplies and health care providers.