Abstract
BackgroundLike other African countries, Tanzania has in recent years, been implementing various exemptions and targeting programmes to protect and ensure equitable access to health care by poorer segments of the population. A body of evidence indicates that exemption policies, while potentially effective in principle, are ineffective in implementation. However, there is evidence that some districts, despite the challenges, perform better than others in terms of identifying the poor and allocating funds for the poor and vulnerable groups.MethodsDrawing from the review of minutes, health facility visits, and key informant interviews with the community representatives and the district health managers, the study explored why exemption policies in Tanzania are relatively better implemented in some districts than in others.ResultsThe findings indicate that in Lindi district the pro-poor exemption mechanism was ineffective in implementation. There were no clear ways of identifying and protecting the poor household members. In contrast, in Iramba district the policy was relatively better implemented. The poor were identified at the village, ward, health facility and district levels. In some villages, the poor were grouped in 10s to form one household. Then, using the village funds, the Community Health Fund cards were purchased for them. Personal initiatives of the key district leaders, commitment of the district health management team and local government officials, regular supervisory visits, as well as incentives to the health facility committees and boards were the main factors that facilitated the implementation of the pro-poor exemption policy.ConclusionsIt is concluded from this study that management and leadership practices including personal initiatives of the key district leaders, effective supervision mechanisms, commitment of the district health management team and local government officials, as well as incentives for the health facility committees and board members are pivotal for the implementation of the pro-poor exemption policies.
Highlights
Equitable access to primary health care is vital to the overall health and development of a country
The exemption and waiver system was expanded with the introduction of the Community Health Fund (CHF)a scheme which aimed at improving access to health care and to protecting people against financial cost of illness in an environment with shrinking budgets for the health sector
The following section presents the main findings of the study organised in three major themes: the process of exempting the poor; innovations to improve the performance of the pro-poor exemption policy; and challenges constraining the implementation of the pro-poor exemption policy
Summary
Equitable access to primary health care is vital to the overall health and development of a country. Like many other African countries, has been implementing user fee policy in its health sector since the early 1990s. Studies have shown that user fees contributes to catastrophic expenses [1] and reduce people’s access to health services especially the poor and the most vulnerable groups of the society on grounds of ability to pay [5]. The exemption and waiver system was expanded with the introduction of the Community Health Fund (CHF)a scheme which aimed at improving access to health care and to protecting people against financial cost of illness in an environment with shrinking budgets for the health sector. The Village Council will issue a Community Health Fund membership card to the identified households. Like other African countries, Tanzania has in recent years, been implementing various exemptions and targeting programmes to protect and ensure equitable access to health care by poorer segments of the population. There is evidence that some districts, despite the challenges, perform better than others in terms of identifying the poor and allocating funds for the poor and vulnerable groups
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