equity implications of health sector user fees in tanzania

PART 3 BACKGROUND INFORMATION TO CHAPTER 3
Background information on Health Sector Reforms
Table TP 2: Stages of development towards Health Sector Reform Tanzania
� First phase:
1961- mid
1970’s
� Second
phase:
End of the
1970’s to the
early 1990’s
� Current
phase:
From 1990
onwards
The post-independence focus was on ensuring availability and accessibility to health
facilities for all citizens. The first strategic plan, adopted an expansionary strategy for
facilities, especially rural health facilities.
In the 1980s the Government increasingly faced the problem of not being able to meet
the costs of free health services and was confronted with a serious deterioration of the
government health services. Vertical programmes dominated the health service
provision. Community based health care gradually lost its momentum. The health
strategy focused on the need for multi-sectoral collaboration in the implementation of
health plans, and recognized the contribution of various sectors towards health
development.
This is the period of the contemporary health reforms. The Population and Health
Sector Review (World Bank) pointed out that although the network of health services
infrastructure was high, the quality of health services was still very poor. A study of
health financing in East African revealed that although Tanzania was allocating more
to health services than other East African countries, the impact on health status was
the same. These results encouraged the government to re-examine its approach to
health. The outcome of this examination was the development of the health sector
reform strategies which form the core of the current health policy and strategies.
Source: extracted from MOH/SDC, PER 2001(draft) and Schwerzel, e.a., 2003.
Overview of the National Policy Planning Process
Tanzania is part of the global effort of poverty eradication, led by the World Bank. In the policy
planning process there are several steps, which are reflected in the table below.
Table TP 3: National Policy Planning Process
Policy Planning Initiative Objective
Vision 2025 National vision of economic and social objectives: Tanzania wants to
be a mid-income country by 2025, with no pockets of abject poverty
National Poverty Eradication National Strategy for Poverty Eradication by 2010
Strategy (NPES)
Tanzania Assistance Strategy
(TAS)
Poverty Reduction Strategy
Paper (PRSP)
Medium-term strategy of government and international community. The
framework agrees on important issues of good governance, like sound
financial management, efficient public service, anti-corruption
measures, domestic resource mobilisation, and partnership with local
government and civil society organisations.
Medium-term strategy of poverty reduction through broad consultation
of all stakeholders, in the context of the HIPC initiative. The strategy of
poverty reduction is to define clear objectives and target and channel
funds as much as possible to district and grass root level. The poverty
reduction is an integral part of government reforms.
The three objectives are:
� To reduce income poverty
� To improve the human capabilities, survival and social-well-being
� To reduce the extreme vulnerability among the poor
Source: Schwerzel et. al., Cordaid Tanzania Health Sector Plan 2003.
Technical Paper 7