equity implications of health sector user fees in tanzania

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Internet users 3,000.0 60,000.0 80,000.0 Paved roads (% of total) 4.2 .. .. Aircraft departures 6,100.0 4,400.0 4,500.0 Trade and finance Trade in goods as a share of GDP (%) 24.4 26.6 27.3 Trade in goods as a share of goods GDP (%) 38.4 41.9 43.0 High-technology exports (% of manufactured exports) 3.2 1.6 .. Net barter terms of trade (1995=100) 101.0 95.0 .. Foreign direct investment, net inflows in reporting country (current US$) 172.3 million 327.2 million 240.4 million Present value of debt (current US$) .. .. 1.8 billion Total debt service (% of exports of goods and services) 21.0 10.2 8.9 Short-term debt outstanding (current US$) 917.2 million 558.2 million 642.9 million Aid per capita (current US$) 31.1 36.9 35.0 Source: World Development Indicators database, August 2003 Equity Implications of Health Sector User Fees in Tanzania XX
2. Tanzania Millennium Goals Country Profile Tanzania Country Profile Click on the indicator to view a definition 1990 1995 2000 2001 1 Eradicate extreme poverty and hunger 2015 target = halve 1990 $1 a day poverty and malnutrition rates Population below $1 a day (%) .. 19.9 .. .. Poverty gap at $1 a day (%) .. 4.8 .. .. Percentage share of income or consumption held by poorest 20% .. 6.8 .. .. Prevalence of child malnutrition (% of children under 5) 28.9 30.6 29.4 .. Population below minimum level of dietary energy consumption (%) 36.0 .. 47.0 .. 2 Achieve universal primary education 2015 target = net enrollment to 100 Net primary enrollment ratio (% of relevant age group) 51.4 47.7 46.7 .. Percentage of cohort reaching grade 5 (%) 78.9 81.3 81.8 .. Youth literacy rate (% ages 15-24) 83.1 87.1 90.5 91.1 3 Promote gender equality 2005 target = education ratio to 100 Ratio of girls to boys in primary and secondary education (%) 96.8 96.8 98.9 .. Ratio of young literate females to males (% ages 15-24) 86.5 90.7 94.3 94.8 Share of women employed in the nonagricultural sector (%) .. .. .. .. Proportion of seats held by women in national parliament (%) .. 18.0 16.0 .. 4 Reduce child mortality 2015 target = reduce 1990 under 5 mortality by two-thirds Under 5 mortality rate (per 1,000) 163.0 164.0 165.0 165.0 Infant mortality rate (per 1,000 live births) 102.0 103.0 104.0 104.0 Immunization, measles (% of children under 12 months) 80.0 78.0 78.0 83.0 5 Improve maternal health 2015 target = reduce 1990 maternal mortality by three-fourths Maternal mortality ratio (modeled estimate, per 100,000 live births) .. 1,100.0 .. .. Births attended by skilled health staff (% of total) 44.0 38.0 35.0 .. 6 Combat HIV/AIDS, malaria and other diseases 2015 target = halt, and begin to reverse, AIDS, etc. Prevalence of HIV, female (% ages 15-24) .. .. 8.1 8.1 Contraceptive prevalence rate (% of women ages 15-49) 9.5 18.0 25.4 .. Number of children orphaned by HIV/AIDS .. .. 1.1 million 810.0 thousand Incidence of tuberculosis (per 100,000 people) .. .. 359.1 .. Tuberculosis cases detected under DOTS (%) .. 61.0 45.0 .. 7 Ensure environmental sustainability 2015 target = various (see notes) Forest area (% of total land area) 45.0 .. 43.9 .. Nationally protected areas (% of total land area) .. 15.6 15.6 .. GDP per unit of energy use (PPP $ per kg oil equivalent) 0.9 1.0 1.1 .. CO2 emissions (metric tons per capita) 0.1 0.1 0.1 .. Access to an improved water source (% of population) 38.0 .. 68.0 .. Access to improved sanitation (% of population) 84.0 .. 90.0 .. Access to secure tenure (% of population) .. .. .. .. 8 Develop a Global Partnership for Development 2015 target = various (see notes) Youth unemployment rate (% of total labor force ages 15-24) .. .. .. .. Fixed line and mobile telephones (per 1,000 people) .. 3.1 10.1 16.0 Personal computers (per 1,000 people) .. 1.6 2.8 3.3 General indicators Population 25.5 million 29.6 million 33.7 million 34.4 million Gross national income ($) 4.8 billion 4.9 billion 9.0 billion 9.4 billion GNI per capita ($) 190.0 160.0 270.0 270.0 Adult literacy rate (% of people ages 15 and over) 62.9 69.2 75.0 76.0 Total fertility rate (births per woman) 6.3 5.8 5.3 5.2 Life expectancy at birth (years) 50.1 48.5 44.4 43.7 Aid (% of GNI) 28.8 17.1 11.4 13.3 Equity Implications of Health Sector User Fees in Tanzania XXI
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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
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Although the primary purpose is to
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Technical Paper 6
Page 72 and 73: Health Sector Reforms: Strategic Pl
Page 74 and 75: Technical Paper 10
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 and 118: ANNEX 4 TOOL FOR ANALYSIS OF POVERT
Page 119 and 120: c.3 User fees 19. Does the strategy
Page 121: ANNEX 5 TANZANIA COUNTRY PROFILE 1.
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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