equity implications of health sector user fees in tanzania

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11. Does the PRSP identify the burden of disease among the poor? � It explicitly describes the diseases that are most commonly found among the poor � It describes the burden of disease among the population, but does not explicitly refer to the poor � It does not explicitly describe the population health status, except for an overview of social/health indicators 12. Does the PRSP mention studies that have analyzed why the health system fails to serve the poor? � It explicitly does: � It implicitly does: � It mentions studies that have analyzed the constraints of the health system, but does not explicitly refer to the poor � It does not 13.a Does the PRSP identify why the health system fails to serve the poor? � It explicitly describes why the health system fails to serve the poor: � It describes why the health system fails to serve the population, but does not explicitly refer to the poor: � It does not describe the constraints of the health care system 13.b Does the PRSP identify what groups do not have access to health care (disabled people, HIV/AIDS clients): � It does: � It does not 13.c Does the PRSP describe existing financial barriers to health care, particularly for the poor? � It does: � It does not c.2 Health sector strategy and policies 14. What are the overall objectives of the strategy and how are they subdivided into pillars or themes? 15.a Does the PRSP explicitly mention the central values underlying the strategy? � It does: � It does not explicitly mention these values, but it is possible to identify them (implicit values): 15.b Does the PRSP explicitly mention equity as a central value underlying the strategy? � It does: � It does not, but it does explicitly mention 16. Does the strategy include specified strategies and a detailed time-line? Is the strategy budgeted and what level of detail is presented? 17. Is the strategy based on poverty-related health data (evidence-based)? � The strategy targets the named poorest regions � The strategy targets the named poorest and vulnerable groups � The strategy targets the burden of disease among the poor (HIV/AIDS, communicable diseases) � The strategy targets those services that are known to benefit the poor (primary health care, sexual and reproductive health, child health, etc) � The strategy includes the health needs of (poor) women 18. Does the strategy include (re)allocation proposals, including to the poorest regions and the health services that predominantly benefit the poor? � It does: � It does, but without explicitly mentioning the poor: � It does not Equity Implications of Health Sector User Fees in Tanzania XVI
c.3 User fees 19. Does the strategy include or propose user fees? � It does: � It does not 20.a Does the PRSP mention the rationale and/or objectives of user fees? � It does: � It does not 20.b Are the user fees directly related to health professionals’ salaries or institutional funding? � They are: � They are not 21. Does the PRSP mention studies that have analyzed the affordability of health services: � It does, explicitly paying attention to the poor’s ability to pay: � It does: � It does not 22. Does the PRSP mention the level of health care delivery at which user fees are or will be asked (primary health care facilities (dispensary and health centre level), hospital facilities)? � It does: � It does not 23. Does the PRSP mention user fees in relation to both the public and the private sector? � It does, explicitly paying attention to the equity implications for the poor: � It does: � It does not 24. Does the PRSP include information on the set-up and design of user fee policies and implementation (community participation)? � It does: � It does not 25.a Does the PRSP include explicit statements on how user fees are excluding the poor compared to the non-poor? � It does: � It does not 25.b Does the PRSP propose measures to reduce (existing) financial barriers to health care and/or to help mitigate the potential negative impacts of user fees (exemption systems, waiver systems, CHF approaches)? � It does, explicitly mentioning the poor � It does: � It does not 26. Does the PRSP include information on the user fees in the education sectors? � Equity Implications of Health Sector User Fees in Tanzania XVII
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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
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Gilson, L. 1997. ‘The Lessons of
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Ministry of Health. 2003. Assessmen
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Schwerzel, P. 2001. Evaluation Repo
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World Bank. 2000. Poverty Reduction
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TECHNICAL PAPER
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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 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: ANNEX 4 TOOL FOR ANALYSIS OF POVERT
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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