equity implications of health sector user fees in tanzania

More documents

Recommendations

Info

6. Results in achieving goals through the establishment of user fees 7. Impacts of user fees documented 8. Exemption strategies for user fees 9. Suspension of user fees 10. Policy implications for financing health care 11. Impact of the user fees in the overall health sector and the potential impact of further extension of user fees at PHC level in Tanzania � Improved Services? � Greater equity and for who? � Generated income for health facilities? � How much percent (%) is the generated revenue out of the recurrent costs and the non-recurrent costs? � Does user fees contribute to quality improvements and which ones? � Does user fees contribute to availability of drugs and which ones? � Has the cost-sharing (in TZ) contributed to the overall resource envelope and to what extent? � What definitions are used about the poor? � Fees tend to dissuade poor from using health services more then the rich? � Do fees limit poor people to get access to care? � Fees are associated with delays in accessing care? � Fees lead to increased self-medication and informal resources of care? � Do fees lead to quality improvement and does this lead to increase or decreased utilization of health care services? � Do fees generate adequate revenue? � Do fees contribute to re-allocation of resources to enable substantial and sustained improvements in health care for the poor? � Does formal fee exemption lead to effective protection of the poor and prevention of full payment of fees? � Does informal fee exemption lead to effective protection of the poor and prevention of full payment of fees? � What kinds of informal fee exemption systems are applied? � What are regressive outcomes of fees for categories of patients and diseases (e.g. ante-natal care, decline in safe deliveries, decline in OPD visits, reduced utilization of STD services, people with multiple visits, lower income category patients, delay to seek treatment because illness is not serious enough)? � What exemptions strategies (formal and informal) are commonly used? � Which categories of patients are exempted and for what reasons? � Which exemption strategies are successful and not successful and for what reasons? � At which level of health services has this been done? � What are documented practices? � What are experiences in Africa (as a continent)? � What are experiences in Tanzania and Kenya and Uganda? � Is the Government/Ministry of Health willing to suspend user fees? � What are pro and contra arguments? � Concern about impact if user fees on the poor as a health care financing mechanism? � Declining popularity of user fees as a health care financing mechanism? � Evidence of supposed benefits of user fees? � Are fees critical to maintain basic and tertiary health services in the country? � Do the user fees thrust people in greater poverty? � New resources generated and used at the facility level? � Local ownership and accountability, and provider responsiveness resulting from fees? � Whether and how revenue generated by fees is used to improve services? � Transaction costs and administration requirements of implementing the system? � Access to services for the poor due to fees (by which categories of client; age, sex, socio-economic group; at what levels of health facility)? � Effectiveness of the exemption and waiver mechanisms including if the data points to particular categories of clients who are most affected? Equity Implications of Health Sector User Fees in Tanzania VI
(These are the key questions in the TOR) 12. Options for revising the current user fees in order to achieve greater equity and effectiveness 13. Contribution to PRS Review process � Contribution to the overall resource envelope of the health sector in general? � Payment of “unofficial fees” by the poor after the introduction of official fees? � What is optimal scenario for utilization of fees to maximize new resources while minimizing negative impacts? � Fees imposed at all levels of health care delivery? � No fees charges at any level? � Fees charges at only hospital level and not at dispensary/health center level? � A potential waiver and exemption system what would enable persons entitled to these mechanisms to use them? � Key requirements of the system in order to increase access of the poor to a basic level of quality care? � What is considered to be a basic level of quality care for the poor? What should be in the minimum package and what would be the cost of such a minimum package? � What arguments form a strong case for policy makers to reconsider further introduction of the user fees at PHC level? � What is a pro-poor health policy for Tanzania? � What is the right balance between the need to finance health services, the pressure to become less dependent on external donor funding and the need to maintain accessibility of quality health services for the lower income groups? � What are effective safety nets for the poor? � What legislation and systems are required to establish suitable safety nets? � What are useful guidelines for the health workers at PHC level who have to deal with the user fees issues? � What can be an effective exemption strategy at PHC level? At what level should user fees be retained? � Who is best placed to assess the ability to pay and the need for exemption? � How to compensate for the money that is lost as a result of exemption? � At what level should user fees be retained? � What are mechanisms for payment of fees in the context of household expenditure pattern and gender relations? Equity Implications of Health Sector User Fees in Tanzania VII
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 and 10:
Tanzania has opted for a system of
Page 11 and 12:
ACKNOWLEDGEMENT Many resource perso
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 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 and 106: � Access to services for the poor
Page 107: ANNEX 2 DATA MATRIX FOR CATEGORISAT
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
show all

equity implications of health sector user fees in tanzania

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?