equity implications of health sector user fees in tanzania

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Health Sector Reforms: Strategic Plan The Plan of Work (POW) 1999-2002 provides an overview of the eight strategies for the Health Sector Reforms. The numbers of the different strategies are relevant for referential purposes in the sense that under these headings extensive policy documents, reports and studies have been published that provide in-depth information about the specific elements of the strategies. Table TP 4: Strategies in Plan of Work (POW) Health Sector Reforms 1999-2002 Strategies Focus of Strategies Strategy 1 Improve access, quality and efficiency of District Health Services � Address organisation, management, accountability and financial management � Address accountability of providers to the councils through the Council Health Boards � Address provision of services, referral system, provision of essential clinical and public health packages of services, inter-sectoral collaboration, provision of essential medical and non-medical supplies and community involvement � Address cost-effective health packages Strategy 2 Reorient Secondary and Tertiary Services � Address institutional management � Address linkages with not-for-profit hospitals � Address privatising some elements of hospital care not contained in the essential health package Strategy 3 Improve the capacity of the Central Ministry of Health � Address key management and administration issues, policy development, reorganisation of the MOH, integration of vertical programmes � Address necessary legislation in view of HSR, advocacy for HSR � Development of effective communication system in implementing health sector reforms Strategy 4 Human Resource Development � Focus on capacity building, formal in-service training and technical assistance � Reduction of unqualified and unproductive health workers Strategy 5 Strengthen Central Support Systems � Address personnel management, drugs and supplies management, management of medical equipment, management of physical infrastructure, transport management and communications � Address liberalisation of drug procurement Strategy 6 Increase Health Care Financing � Address financing health care through MOH and Ministry of Local Government � Address development of alternative cost-effective and sustainable health care financing, National health insurance, community health funds, donor funding and development of different options for funding Strategy 7 Promote Public/Private Mix � Address development and promotion of private practice participation, contracting out services, revise legislation and the role of different professional associations Strategy 8 Redefine Ministry of Health and donor relation ships � Address donor co-ordination, sector wide approach and review of progress by MOH and donors in joint funding of health Source: Danida HSPS II May 1999 Technical Paper 8
Indicators Public Health Sector Performance Profile Table TP 5: Overview of indicators Public Health Sector Performance Profile � Total GOT public allocation and donor allocation to health per capita � Recurrent expenditure at each level � Distribution of Medical Officers, AMOs, Public Health Nurses by staffing norms per health facility � % of GOT funds available for budgeted and actual district health activities against the total funds available for districts � Number of districts reporting and showing the use of HMIS and performance monitoring data in the health plans � Proportion of public health facilities in a good state of repair � Average number of public health facilities without any stock of 4 tracer drugs and 1 vaccine � Average number of days with no drug kits in public health facilities � Cost sharing feed collected in relation to the set targets Source: Public Health Performance Profile Draft 1: 2001 � Total OPD attendance per capita � Proportion of births attended by skilled persons � Proportion of children fully immunised under 1 year � Malaria cases as a percentage of all < 5 year cases presenting at the OPD � Top 6 causes of morbidity among OPD attendants � Consumer satisfaction with the quality of health services � IMR, MMR � Proportion of death among women due to maternal complications � Proportion of children with severe malnutrition (0-5 years) � Proportion of all under five fatality due to malaria � HIV prevalence among ANC attendees � Number of reported HIV/AIDS IEC interventions Technical Paper 9
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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
Page 21 and 22: III POVERTY AND HEALTH IN TANZANIA
Page 23 and 24: diseases, (3) reducing malnutrition
Page 25 and 26: VI HEALTH SECTOR STRATEGIES TANZANI
Page 27 and 28: Pro-poor observations Tanzania has
Page 29 and 30: V COST SHARING STRATEGIES TANZANIA
Page 31 and 32: eported income proportion for the h
Page 33 and 34: VI IMPACT OF USER FEES IN TANZANIA
Page 35 and 36: An indication of actual charges and
Page 37 and 38: Table 6.3: Critical observations re
Page 39 and 40: All in all, there is limited eviden
Page 41 and 42: User fee policy Stakeholders mostly
Page 43 and 44: persons suggested to design a polic
Page 45 and 46: eneficiaries such as identity numbe
Page 47 and 48: VII CONCLUSIONS Poverty and health
Page 49 and 50: Importance of the public PHC facili
Page 51 and 52: � In the absence of effective per
Page 53 and 54: LIST OF CONSULTED DOCUMENTS 50 Year
Page 55 and 56: Gilson, L. 1997. ‘The Lessons of
Page 57 and 58: Ministry of Health. 2003. Assessmen
Page 59 and 60: Schwerzel, P. 2001. Evaluation Repo
Page 61 and 62: World Bank. 2000. Poverty Reduction
Page 63: TECHNICAL PAPER
Page 66 and 67: 2. Groups with most regressive outc
Page 68 and 69: Although the primary purpose is to
Page 70 and 71: Technical Paper 6
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.
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2. Tanzania Millennium Goals Countr
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ANNEX 6 RESOURCE PERSONS Name of Re
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ANNEX 7 ITINERARIES 1. Itinerary Pa
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03-04-2004 � Continued desk study
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ANNEX 8 MAP OF TANZANIA Equity Impl
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