equity implications of health sector user fees in tanzania

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Type of service Clarifications Referral Regional District Hospital Hospital Hospital 1. Registration Fee charged for first attendance per year 1,000/= 500/= 300/= 2. Drugs and infusions 3. Medical examinations Fee charged at 50% of the real cost according to prices of the "Medical store department’ (a) Students joining school 500/= 500/= 500/= (b) Employee first appointment 1,500/= 1,500/= 1,500/= (c) Special tests 3,000/= 3,000/= 3,000/= (d) Workman's compensation 4,000/= 4,000/= 4,000/= (e) Insurance Filling forms for life insurance 4,000/= 4,000/= 4,000/= (f) Medical board 4. Laboratory tests and other tests The cost will be covered by the employer 20,000/= 20,000/= 20,000/= (a) BS, Urine, Stool Grade I & II 300/= 200/= 200/= Grade III 100/= 100/= 100/= (b) WBC, ESR, Grouping & Grade I &. II 500/= 200/= 200/= Cross Matching Grade III 200/= 100/= 100/= (c) VDRL test, Widal test, Pregnancy test, and Grade I & II 500/= 400/= 400/= Other biochemistry tests Grade III 400/= 300/= 200/= (d) X-Ray (per exposure) Grade I &.II 1,000/= 700/= 500/= Grade III 750/= 500/= 400/= (e) Special tests (Ultra sound, ECG, ECHO, Barium meal Grade I & II 3,000/= 1,500/= 1,000/= etc) 5. Dental services Grade III 1,000/= 1,000/= 500/= (a) Extraction of permanent Grade I & II: per tooth 1,000/= 800/= 500/= teeth Grade III: per tooth 500/= 500/= 500/= (b) Extraction of deciduous Grade I & II 500/= 400/= 300/= teeth Grade III 300/= 300/= 300/= (c) Filling permanent teeth Grade I & II per surface 1,000/= 800/= 500/= Grade III per surface 500/= 500/= 500/= (d) Filling deciduous teeth Grade I & II: per surface 500/= 500/= 500/= Grade III per surface 300/= 300/= 300/= (e) Root canal treatment Grade I & II 5,000/= 4,000/= 2,000/= Grade III 2,000/= 1,500/= 1,000/= (f) Denture full plastic bases Grade I & II 15,000/= 13,000/= 10,000/= each upper & lower Grade III 12,000/= 10,000/= 8,000/= (g) Dentures: partial plastic Grade I & II 5,000/= 4,000/= 3,000/= base Grade III 3,000/= 3,000/= 3,000/= (h) Repairs of dentures or Grade I & II 5,000/= 4,000/= I,000/= orthodontic appliance Grade III 3,000/= 2,000/= 1,000/= (i) Orthodontic appliance Grade I & lI 15,000/= 12,000/= 10,000/= Grade III 13,000/= 11,000/= 10,000/= (ii) Scaling per visit Grade I & II 1,500/= 1,500/= 1,000/= Grade III 5,000/= 5,000/= 5,000/= (k) Gingivectomy tooth Grade I & II 1,500/= 1,000/= 500/= Grade III 500/= 500/= 500/= (I) Oral surgical operations Grade I & II 10,000/= 8,000/= 4,000/= Grade III 7,000/= 6,000/= 4,000/= (m) Gold inlays excluding the Grade I & II 5,000/= 5,000/= 4,000/= cost of gold Grade III 4,000/= 4,000/= 4,000/= (n) Gold crowns excluding the Grade I & II 8,000/= 6,000/= 5,000/= cost of gold Grade III 5,000/= 5,000/= 5,000/= (o) Jacket crowns & post crowns: porcelain, Grade I & II 15,000/= 10,000/= 7,500/= Technical Paper 18
onded or acrylic Grade III 7,500/= 5,000/= 3,000/= 6. Admission fee Grade I Grade III Paid daily food, laboratory test and other tests fees Grade III The fee charged once for the whole period of admission but excluding drug, laboratory test and other test fees 3,000/= 1,500/= 1,200/= 1,500/= 1,000/= 750/= 2,000/= 1,000/= 500/= 7. Surgery Major operation: Any surgical procedure under anesthesia Grade I &II 15,000/= 10,000/= 5,000/= Grade III 3,000/= 2,000/= 1,000/= Minor operation: Any surgical procedure under anesthesia Grade I & II 3,000/= 2,000/= 1,000/= Grade III 1,000/= 500/= 300/= 8. Normal delivery Grade I & II per day 1,000/= 500/= 300/= 9. Physiotherapy 10. Mortuary fee Grade I & II only per day 500/= 300/= (a) Post mortem 1,000/= 1,000/= 1,000/= (b) Storage 500/= 200/= 200/= 11. Fees for foreigners Payments shall be by US dollar or equivalent Tanzanian Shillings US$ US$ US$ (a) Consultation fee 20 20 20 (b) Appointment consultation 20 20 20 (c ) Admission fee: daily fee 30 30 30 (d) Investigation 10 10 10 (e) Special tests 50-200 50-200 50-200 (f) Major Operation 200-2,000 200-2,000 200-2,000 (g) Minor Operation 50 50 50 (h) Post-mortem 100 100 100 (i) Mortuary (storage) fee 30 30 30 Note/clarifications (Cost-sharing programme, 1999) � Please read carefully, note the fee schedule indicated in the table and apply them accordingly. � Poor people and other vulnerable groups should be exempted/waived user fees. � Special hospitals should follow the fee schedule for district hospitals. � Caesarian section for grade III shall be free. � Mortuary fee: o There shall be a grace period of three days for deaths occurred in the respective hospital. For deaths that occurred somewhere else shall pay from the first day. o There shall be a grace period of one day for a dead body brought for postmortem � Patients referred to government hospital from private hospitals shall follow the fee schedule for grade I. � The actual cost (prices) of drugs front the Medical Store Department that shall be used for calculating the 50% of drug fees. Revenue collections from drug fee shall be used to purchase drugs on basis of "drug revolving fund”. Technical Paper 19
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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
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 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 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 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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