equity implications of health sector user fees in tanzania

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� A proposal of three to five pages that outlines the consultant(s) interpretation of the Terms of Reference and proposed approach and methodology for carrying out the analysis to produce insightful and useful results � Timetable for carrying out the assignment, including completion of � detailed outline (“inception report”) � first draft � final draft following comments from reviewers � Budget, including direct costs of the research and fees � CVs of principle consultant(s) Outputs A comprehensive paper of not more than 30 pages with a succinct Executive Summary that highlights key findings and recommendations. An editor will develop a separate synthesis paper of approximately 10 pages. Timeframe In order to contribute to the PRS Review Process, the final draft of the study must be completed no later than 30 April, 2004. The workplan, above, should reflect this end-date and intermediary deadlines. Management RAWG will review the inception report, first draft and final drafts of the paper, and will be responsible for identifying a writer for the synthesis report Budget Proposed by Consultant(s) References Bangser M. “Policy Environments: Macro-Economics, Programming and Participation” in Engendering International Health: The Challenge of Equity, 2002, Cambridge, MA: MIT Press Gilson L. “The Lessons of User Fee Experience in Africa”, Health Policy and Planning 1997; 12(4):273-85 Mbugua J.K., Bloom G.H. and Segall M.M. “The Impact of User Charges on Vulnerable Groups: The Case of Kibwezi in Rural Kenya”, Social Science and Medicine 1995; 41(6):829-835 Nanda P. “Gender Dimensions of User Fees: Implications for Women’s Utilization of Health Care” Reproductive Health Matters 2002; 10(20):127-134 Nyonator F. and Kutzin J. “Health for Some? The Effects of User Fees in the Volta Region of Ghana” Health Policy and Planning 1999; 14(4):329-341 Government of the Republic of Tanzania, National Bureau of Statistics, Tanzania Reproductive and Child Health Survey 1999 Tanzania Participatory Poverty Assessment, forthcoming Waddington, C.J. and Enyimayew K.A., “A Price to Pay: The Impact of User Charges in Ashanti-Akim District, Ghana” International Journal of Health Planning and Management Waddington, C.J. and Enyimayew K.A., “A Price to Pay Part Two: The Impact of User Charges in Volta Region of Ghana, International Journal of Health Planning and Management 1990; 5:287-312 Equity Implications of Health Sector User Fees in Tanzania IV
ANNEX 2 DATA MATRIX FOR CATEGORISATION AND IDENTIFICATION OF KEY ISSUES DATA MATRIX TO ASSIST WITH DATA COLLECTION AND DATA ANALYSIS Guiding questions per section: � In which type of documents/studies do these particular topics receive attention and quantify/score how often these topics are mentioned in the categories of literature? This indicates what areas are prioritized and what areas are neglected/forgotten/ hardly subject of research � What are the views/ideas/suggestions of the key-stakeholders that were interviewed (per stakeholder) such as Ministry of Health, Ministry of Finance, PO RALG, Other relevant ministries, Donor agencies, NGOs, FBOs, Other Civil Society Organisations, Universities, Research Institutes? Issues mentioned in the TOR 1. Equity implications of the user fees in Tanzania 2. Poverty Reduction Strategies 3. Proposed charges at primary health care facilities (health centre/dispensary) 4. Actual charges at primary health care facilities 5. Rationale for introduction and implementing user fees in the health sector Related topics to be looked at and high lighting of the key findings/ideas/thoughts/visions per topic in the literature � In Tanzania, in Uganda and Kenya, in Africa (as a continent)? � In general, in Tanzania? � What are the other guiding PRS questions in relation to health (apart from the one that is mentioned in the TOR)? � What did earlier PRS reviews (in TZ) say on equity of user fees? Is there a trend or a shift in PRSP thought over user fees? � In Tanzania, In Uganda and Kenya, in Africa (as a continent)? � Charges to be converted to US Dollar rates to allow for comparison? Charges in relation to income level and poverty level � What are the fee levels in the hospitals in Tanzania (Government and private)? � What are the proposed and actual charges at PHC level in Tanzania (Government and private)? � In Tanzania, in Uganda and Kenya, in Africa (as a continent)? � Charges to be converted to US Dollar rates to allow for comparison? � Charges in relation to income level and poverty level (In $ rate)? � For raising revenue? � For enhancing efficiency? � For enhancing sustainability? � For improving services? � For reducing frivolous consumption of health care? � For substituting formal fee systems for informal charging? � For extending coverage? � For increasing equity? � For improving access? � For special vulnerable groups? � For reduction poverty? � Others, which ones? Equity Implications of Health Sector User Fees in Tanzania V
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C R Y S T A L EQUITY IMPLICATIONS O
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TABLE OF CONTENT ABBREVIATIONS ....
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ABBREVIATIONS AIDS Acquired Immune
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EXECUTIVE SUMMARY 1. Background Ear
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Tanzania has opted for a system of
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ACKNOWLEDGEMENT Many resource perso
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I INTRODUCTION 1.1 Background to th
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II LITERATURE REVIEW 2.1 Introducti
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have been highlighted in Technical
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met with donor support. After the a
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III POVERTY AND HEALTH IN TANZANIA
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diseases, (3) reducing malnutrition
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VI HEALTH SECTOR STRATEGIES TANZANI
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Pro-poor observations Tanzania has
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V COST SHARING STRATEGIES TANZANIA
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eported income proportion for the h
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VI IMPACT OF USER FEES IN TANZANIA
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An indication of actual charges and
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Table 6.3: Critical observations re
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All in all, there is limited eviden
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User fee policy Stakeholders mostly
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persons suggested to design a polic
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eneficiaries such as identity numbe
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VII CONCLUSIONS Poverty and health
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Importance of the public PHC facili
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� In the absence of effective per
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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 76 and 77: Elements of the Community Health Fu
Page 78 and 79: stems from the rapid increase in de
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 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: � Access to services for the poor
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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