equity implications of health sector user fees in tanzania

dispensaries. That is where most of the people go to.
� The Government should subsidize the PHC services. The
Government should be committed to help all its people. NGOs
have to come in to assist as well.
� Fees should only be charged in hospitals and not in health
centres and dispensaries. If the services are charged at PHC
level, people will not use them. More corruption might take
place if charges are introduced at this level.
� If fees are abolished at PHC level, the Government should
compensate for the money lost through (1) Government
revenues (2) insurance systems, (3) cooperative unions (4)
revolving drug funds. Not much money will be lost since the
generated income is a small portion of the total budget.
services are also given a higher
value.
� Fees should be introduced at all
PHC levels. However fees
should be reasonable. It will
improve quality of the services
and it will reduce disturbance to
the people. They will get what
they need and do not have to be
transferred to the private
pharmacies. The current drug kit
system does not cover all
requirements. Additional funds
will overcome this problem.
� Fees at PHC level should be
introduced gradually.
Table 29: Views of 59 Resource Persons towards the Community Health Fund, March 2004
Positive Views about
More Critical and Concerned Views about Community Health
Community Health Fund
Fund
� A CHF is a pro-poor solution � More information and sensitization is required on the CHF.
for Tanzanians since it will � It is not 100% effective since it is limited to certain health facilities.
help people to get access to If one travels outside Kagera, he/she can not use the CHF card in
health services. People can other areas. The CHF only operates in 2-3 districts.
receive treatment when they � The annual lowest fee of Tshs. 5,000/=, per person, per year, is
have no money. Eventually it still too high to pay for by poor people.
will cover all communities. It is � The co-payment of Tshs 300/= is a barrier as well.
part of the solution.
� The problem is to pay for the whole family. We have then to select
� The CHF is beneficial since it one family member who can participate in the CHF.
reduces tension in families. � For the poor people a waiver system is more pro-poor then a
One is sure to receive
CHF. If people receive a waiver they have better access to health
treatment. It is helpful to those services. It will prevent misuse of CHF by the local leaders.
without a reliable income. � If many people are poor the fund will not have enough money.
� People appreciate the CHF. � The CHF is not the solution. It will exclude the poorest people
unless other money is generated for the poor so that they can
participate or contribute to the fund. Poor people can not afford to
pay Tshs. 10,000/= if they can not pay in installments.
Technical Paper 36