Partnerships between public health insurance schemes and private-sector actors are increasingly recognized as essential for improving healthcare access in low- and middle-income countries. Persistent weaknesses in public pharmaceutical supply systems frequently result in medicine shortages, which erode public confidence in health insurance programs and discourage enrolment. In Tanzania, these challenges prompted reforms to the Community Health Fund (CHF) alongside the introduction of the Jazia Prime Vendor System to strengthen medicine procurement for public facilities. Despite these efforts, many rural and informally employed populations continue to obtain medicines primarily from Accredited Drug Dispensing Outlets (ADDOs). This study investigates whether and how ADDOs could be incorporated into the improved Community Health Fund (iCHF), focusing on anticipated benefits, potential risks, and feasible implementation options. An exploratory qualitative approach was adopted, combining semi-structured interviews, group discussions, and analysis of policy and program documents to capture perspectives from a range of stakeholders. Findings indicate broad stakeholder support for integrating ADDOs into the iCHF, largely driven by ongoing medicine shortages at public health facilities and the resulting strain on both patients and healthcare workers. While the Jazia Prime Vendor System was perceived to have alleviated some supply constraints, it was not considered a comprehensive solution. Participants emphasized that contracting ADDOs could enhance medicine availability at the community level and potentially strengthen uptake of the iCHF. However, several barriers were identified, including price structures at ADDOs that exceed current iCHF reimbursement levels and limited technical capacity to support digital claims processing and information exchange. To mitigate these challenges, respondents proposed a phased implementation, beginning with a small number of eligible ADDOs and drawing on contracting models already used by the National Health Insurance Fund (NHIF). Ongoing health financing reforms in Tanzania, particularly the transition toward a unified national health insurance system, create a timely opportunity to formally engage ADDOs within the iCHF framework. Building on existing NHIF–ADDO arrangements and lessons from the Jazia Prime Vendor System may support a more inclusive and resilient approach to medicines access. The study contributes to broader discussions on leveraging public–private collaboration to strengthen health insurance schemes in resource-constrained settings.
