equity implications of health sector user fees in tanzania

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Equity Implications of Health Sector User Fees in Tanzania viii
ACKNOWLEDGEMENT Many resource persons contributed to this study on Equity Implications of the Health Sector User Fees in Tanzania. People from a wide range of organisations availed documents, website and email numbers and reserved ample time to meet with the members of the study team. We have included the names of all resource persons in Annex 6. We would like to express our deep appreciation for all the support and guidance we received throughout the study period. We first of all would like to thank the resource persons in the Netherlands and England who were instrumental to direct the study team to relevant documents. We especially would like to thank resource persons from Wemos and from Medact. In Tanzania, resource persons based in Kagera Region, Dar es Salaam and Dodoma provided valuable information. We would like to thank the resource persons in Kagera Region for their participation in the study. We are especially thankful to the Kagera Regional Medical Officer (RMO) who availed one of his senior staff members, Dr. Tiimanywa Lutaremwa (MPH), for data collection in Bukoba District. We are also thankful to the offices of the District Rural Development Programme (DRDP) and the Kagera Health Sector Reform Programme for availing various study documents. Lastly we would like to thank the health workers from the Ministry of Health (MOH), Faith Based Organisations (FBOs), Non Governmental Organisations (NGOs) and private clinics for their participation in the study. Especially the participation of guardians, orphans, people living with HIV and AIDS (PLWHA) and persons with a disability was highly valued. We especially would like to express our appreciation for the valuable contribution to this study by senior resource persons in the Ministry of Health. In particular, we would like to thank Dr. Faustine Njau (Health Sector Reform Secretariat and Department of Policy and Planning), Dr. Ahmed Hingora (Health Sector Programme Support and Health Sector Reform Secretariat), Ms. Dorothy Mallya (Acting Chief Nursing Officer) and Ms. Kikuli (Budget Section Department of Policy and Planning). We received valuable assistance from the President’s Office, Regional Administration and Local Government (PORALG). We furthermore have been greatly assisted by resource persons from the Vice President’s Office (VPO), bilateral and multilateral donor agencies (GTZ, DANIDA and WHO), the Tanzania Essential Health Intervention Project (TEHIP), the Christian Social Services Commission (CSSC) and the office of the National Institute for Medical Research (NIMR). We would like to express our special thanks to Ms. Maggie Bangser from the Women’s Dignity Project (WDP) who has been providing instrumental support throughout the study period. We also would like to express our sincere thanks to all the members of the REPOA Research and Analysis Working Group and to the REPOA staff members, Mr. Donald Mmari and Mr. Lucas Katera, who have been providing valuable support and assistance to the study team. Lastly, we would like thank our colleagues of ETC Crystal who have been providing valuable guidance and support to the study team. We sincerely hope that the findings of this study will contribute in a positive way to the Tanzanian Poverty Strategy Review Process 2004. June 2004 Leontien Laterveer Michael Munga Patricia Schwerzel Equity Implications of Health Sector User Fees in Tanzania ix
Page 1 and 2: C R Y S T A L EQUITY IMPLICATIONS O
Page 3 and 4: TABLE OF CONTENT ABBREVIATIONS ....
Page 5 and 6: ABBREVIATIONS AIDS Acquired Immune
Page 7 and 8: EXECUTIVE SUMMARY 1. Background Ear
Page 9: Tanzania has opted for a system of
Page 13 and 14: I INTRODUCTION 1.1 Background to th
Page 15 and 16: II LITERATURE REVIEW 2.1 Introducti
Page 17 and 18: have been highlighted in Technical
Page 19 and 20: met with donor support. After the a
Page 21 and 22: III POVERTY AND HEALTH IN TANZANIA
Page 23 and 24: diseases, (3) reducing malnutrition
Page 25 and 26: VI HEALTH SECTOR STRATEGIES TANZANI
Page 27 and 28: Pro-poor observations Tanzania has
Page 29 and 30: V COST SHARING STRATEGIES TANZANIA
Page 31 and 32: eported income proportion for the h
Page 33 and 34: VI IMPACT OF USER FEES IN TANZANIA
Page 35 and 36: An indication of actual charges and
Page 37 and 38: Table 6.3: Critical observations re
Page 39 and 40: All in all, there is limited eviden
Page 41 and 42: User fee policy Stakeholders mostly
Page 43 and 44: persons suggested to design a polic
Page 45 and 46: eneficiaries such as identity numbe
Page 47 and 48: VII CONCLUSIONS Poverty and health
Page 49 and 50: Importance of the public PHC facili
Page 51 and 52: � In the absence of effective per
Page 53 and 54: LIST OF CONSULTED DOCUMENTS 50 Year
Page 55 and 56: Gilson, L. 1997. ‘The Lessons of
Page 57 and 58: Ministry of Health. 2003. Assessmen
Page 59 and 60: Schwerzel, P. 2001. Evaluation Repo
Page 61 and 62:
World Bank. 2000. Poverty Reduction
Page 63:
TECHNICAL PAPER
Page 66 and 67:
2. Groups with most regressive outc
Page 68 and 69:
Although the primary purpose is to
Page 70 and 71:
Technical Paper 6
Page 72 and 73:
Health Sector Reforms: Strategic Pl
Page 74 and 75:
Technical Paper 10
Page 76 and 77:
Elements of the Community Health Fu
Page 78 and 79:
stems from the rapid increase in de
Page 80 and 81:
Technical Paper 16
Page 82 and 83:
Type of service Clarifications Refe
Page 84 and 85:
Charges in the public and private h
Page 86 and 87:
� Implementation of fees at the l
Page 88 and 89:
- Enhance the accessibility of serv
Page 90 and 91:
Technical Paper 26
Page 92 and 93:
Critical factors that hamper access
Page 94 and 95:
An exploratory study 11 in Kagera R
Page 96 and 97:
Table TP 15 Views of 4 orphans towa
Page 98 and 99:
this way the health centre prevents
Page 100 and 101:
dispensaries. That is where most of
Page 103 and 104:
ANNEX 1 TERMS OF REFERENCE Equity I
Page 105 and 106:
� Access to services for the poor
Page 107 and 108:
ANNEX 2 DATA MATRIX FOR CATEGORISAT
Page 109 and 110:
(These are the key questions in the
Page 111 and 112:
ANNEX 3 GUIDELINES FOR DATA COLLECT
Page 113 and 114:
� Can you mention negative experi
Page 115 and 116:
� Which groups are exempted from
Page 117 and 118:
ANNEX 4 TOOL FOR ANALYSIS OF POVERT
Page 119 and 120:
c.3 User fees 19. Does the strategy
Page 121 and 122:
ANNEX 5 TANZANIA COUNTRY PROFILE 1.
Page 123 and 124:
2. Tanzania Millennium Goals Countr
Page 125 and 126:
ANNEX 6 RESOURCE PERSONS Name of Re
Page 127 and 128:
ANNEX 7 ITINERARIES 1. Itinerary Pa
Page 129 and 130:
03-04-2004 � Continued desk study
Page 131:
ANNEX 8 MAP OF TANZANIA Equity Impl
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