equity implications of health sector user fees in tanzania

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External debt (% of GNI) 158.5 144.5 82.2 71.9 Investment (% of GDP) 26.1 19.8 17.6 17.0 Trade (% of GDP) 50.1 59.3 37.7 39.9 Source: World Development Indicators database, April 2002 Note: In some cases the data are for earlier or later years than those stated. Goal 1 targets: Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day. Halve, between 1990 and 2015, the proportion of people who suffer from hunger. Goal 2 target: Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling. Goal 3 target: Eliminate gender disparity in primary and secondary education preferably by 2005 and to all levels of education no later than 2015. Goal 4 target: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate. Goal 5 target: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio. Goal 6 targets: Have halted by 2015, and begun to reverse, the spread of HIV/AIDS. Have halted by 2015, and begun to reverse, the incidence of malaria and other major diseases. Goal 7 targets: Integrate the principles of sustainable development into country policies and programs and reverse the loss of environmental resources. Halve, by 2015, the proportion of people without sustainable access to safe drinking water. By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers. Goal 8 targets: Develop further an open, rule-based, predictable, non-discriminatory trading and financial system. Address the Special Needs of the Least Developed Countries. Address the Special Needs of landlocked countries and small island developing states. Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term. In cooperation with developing countries, develop and implement strategies for decent and productive work for youth. In cooperation with pharmaceutical companies, provide access to affordable, essential drugs in developing countries. In cooperation with the private sector, make available the benefits of new technologies, especially information and communications. Equity Implications of Health Sector User Fees in Tanzania XXII
ANNEX 6 RESOURCE PERSONS Name of Resource Person Position of Resource Person 1. Pastor Balami, Jonas � Coordinator of HUYAWA Programme 2. Mr. Balengaagabo, Yusufu � Person with a disability 3. Ms. Bangser, Maggie � Member of R&AWG in REPOA and Coordinator Women Dignity Programme 4. Mr. Barongo, James Bushweka � Project Coordinator TADEPA 5. Ms. Bernard, Marcelina � Guardian in PARTAGE VP 14 Ruhano Ishozi Bukoba Rural District 6. Dr. Borg, Jan � DANIDA Advisor Ministry of Health Kagera Region 7. Dr. Briggs � Health Financing Specialist GTZ 8. Ms. Buberwa, Christina � Nurse Midwive and HIV Counsellor in TADEPA Clinic Bukoba Regional Hospital 9. Dr. Bugimbi, M. � Medical Doctor in charge of Bukoba Medical Center 10. Mr. Byeshurilo, Thomas � Person with a disability 11. Ms. Davies, Sian � Project Advisor Medecins du Monde 12. Sr. Donati, Winifrida � Clinical Officer St. Theresia Kajunguti Dispensary 13. Ms. Erasto, Fortunara � Client in TADEPA Clinic Bukoba Regional Hospital 14. Ms. Emmanuel, Christina � Guardian in PARTAGE VP 15 Bukoba Rural District 15. Mr. Ernest, Dina � Kindergarten Teacher in PARTAGE VP 14 Ruhano Ishozi Bukoba Rural District 16. Sr. Felix, Mecktilda � Sr. In Charge of Kashozi Rural Health Centre 17. Mr. Felix, Patrick � Laboratory Assistant in PARTAGE VP 14 Ruhano Ishozi Bukoba Rural District 18. Ms. Francis Adventina � Client in TADEPA Clinic Bukoba Regional Hospital 19. Ms. Gaspar, Anastella � Client in TADEPA Clinic Bukoba Regional Hospital 20. Dr. Gomile, Michael � Health policy analyst Christian Social Services Commission 21. Ms. Halfan, Aura � Clinical Officer in charge of Rwamishenye Health Center 22. Mr. Hashim, Jamila � Client in TADEPA Clinic Bukoba Regional Hospital 23. Ms. Herman, Agnes � Coordinator Pharmacy, PARTAGE 24. Dr. Hingora, Ahmed � Programme coordinator, Health Sector Programme Support (HSPS), Health Sector Reform Secretariat, Department of Policy and Planning, Ministry of Health 25. Mr. Ishabaki, Valence � Clinical Officer in TADEPA Clinic Bukoba Regional Hospital 26. Ms. Kahatano � Senior Nurse Midwive Kahororo Dispensary 27. Mr. Kalokola � Field Assistant in PARTAGE VP 15 Bukoba Rural District 28. Mr. Kamara, Fidelis � Field Assistant in PARTAGE VP 15 Bukoba Rural District 29. Ms. Kanywa, Joyce � Nurse Midwive in PARTAGE VP 14 Ruhano Ishozi Bukoba Rural District 30. Ms. Kitunzi � Nurse Midwive and HIV Counsellor in TADEPA Clinic Bukoba Regional Hospital 31. Mr. Kuper, Meinolf � Resource Person Health Financing with GTZ 32. Mr. Lindeboom, Wietze � Consultant with REPOA 33. Ms. Lukamisa, Fraiska � Nurse Midwive in PARTAGE VP 14 Ruhano Ishozi Bukoba Rural District 34. Mr. Kadebe, Michael � Principal Account President’s Office, Regional Administration and Local Government 35. Ms. Kahangwa, Agnes � Coordinator preventive services PARTAGE 36. Ms. Kalugila, Jenetina � Guardian in PARTAGE VP 14 Ruhano Ishozi Bukoba Rural District 37. Mr. Katera, Lucas � Researcher with REPOA 38. Mr. Kemibala, David � Medical Doctor Hindu Union Charitable Dispensary 39. Ms. Kikuli � Budget Officer, Budget Section Department of Policy and Planning 40. Mr. Magambo, Peter � Person with a disability 41. Mr. Makundi, Emanuel � Sociologist and Health Systems Analyst National Institute for Medical Research 42. Dr. Mallya, Dorothy � Acting Chief Nursing Officer, Ministry of Health 43. Mr. Mapunda, Maximillian � Health Economist WHO 44. Mr. Marcelina, Steven � Client in TADEPA Clinic Bukoba Regional Hospital 45. Mr. Mashanga, Sweetbert � Person with a disability 46. Ms. Masilingi, Grace � Person with a disability 47. Mr. Mbaleki, Gaspar � Client in TADEPA Clinic Bukoba Regional Hospital Equity Implications of Health Sector User Fees in Tanzania XXIII
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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
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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 and 122: ANNEX 5 TANZANIA COUNTRY PROFILE 1.
Page 123: 2. Tanzania Millennium Goals Countr
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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