equity implications of health sector user fees in tanzania

� Which groups are exempted from user fees?
� Which groups receive a waiver from user fees?
� The system that you follow (user fee collection, exemptions and waivers) is that the National
system or is decided upon in your organization or facility?
� Do you feel you have enough information, guidance, tools at hand to implement the user fee
system, exemption and waiver system adequately? If not, what is the reason? What guidelines
would you need?
� Do you know the actual income you receive through the user fees per month and per year?
� Is the actual income stable or does it fluctuate very much?
� Do you know your overall health budget for the organisation/facility?
� Would you know the actual contribution of the user fee to your annual budget in terms of
percentage?
� Do you work with a Community Health Fund?
� Since which year did you start with the introduction of user fees/exemption systems/waiver
systems/CHF?
� If yes, what was the reason /rationale for the introduction of user fees user fees/exemption
systems/waiver systems/CHF?
� 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?
� If no, why did you not introduce user fees/exemption systems/waiver systems/CHF?
o At which level of health services has this been done?
o Is the Government/Ministry of Health willing to suspend user fees?
o What are pro and contra arguments?
� Can you explain the design of the user fees/exemption systems/waiver systems/CHF that you
have adopted?
o What exemptions and waiver strategies (formal and informal) are commonly used?
o Which categories of patients are exempted and for what reasons?
o Which exemption strategies are successful and not successful and for what reasons?
o What are the transaction and administrative costs and requirements of the system?
� Can you mention positive experiences and results with the user fees/exemption systems/waiver
systems/CHF? (e.g. improved access to care, improved revenues, improved quality of care)
� Can you mention negative experiences and results with the user fees/exemption systems/waiver
systems/CHF? What are the main constraints? Do people have to pay unofficial fees? Can you
say more about this?
� Do you see differences in experiences between the public and the private sector? Do poor people
have better access to the private or the public services? Is that the private for profit services or the
non-for profit services?
Equity Implications of Health Sector User Fees in Tanzania XIII