Poor People's Experiences of Health Services in Tanzania

Abstract

This literature review examines key findings on poor people's experiences of health services and the barriers to access among the very poor. It was first published in 2004 by the Women's Dignity Project/Utu Mwanamke, PO Box 79402, Dar es Salaam, Tanzania. E-mail: 〈[email protected]〉 and is reprinted here, almost in full, with their kind permission.

Notes

* The country has an extensive network of 5031 health facilities (4412 dispensaries, 402 health centres, 217 hospitals and 100 training institutions). 60% are government-owned; the remainder are voluntary, parastatal and privately owned.

* The CHF was first introduced in December 1995 on a pilot basis in Igunga district (MoH 2003). By the end of 2003, the CHF was operating in 37 districts, and another 90 districts had been sensitized and were ready to implement the scheme. A household (husband, one wife and all children under 18 years old) joins the CHF by paying an annual membership fee, usually between Tshs. 5,000 and 10,000, which provides unlimited access throughout the year to outpatient services at CHF-participating facilities. The CHF is essentially a district-level pre-payment scheme for primary care services targeted at the rural population and those working in the informal sector. It is designed to serve the majority of the poor in a more equitable way.

* In Kondoa district, for example, more than three-fourths (81%) of the expected 16,469 deliveries in 1996 were delivered at home and only a handful of these with the assistance of a trained TBA and/or a health staff.

† DHS 1996 and 1999 data analysed by income quintile.

* The CHF accounted for 10% of the total district health budget in 2001; it contributed to less than 20% of the total fees collected at health facilities for health care services (Chee et al 2002). The majority of the contribution of the preceding two years was from user fees and this continued to grow, from 20% of fees collected in 1999 to 77% in 2001.

† Community Health Service Boards (CHBs) are one of the tools of devolving authority and ownership to the LGAs and taking over responsibility for management decisions for district health services. They are being rolled out to all LGAs and the district hospitals (MoH 2003). At lower levels in the health system, Health Facility Committees are being established.

* The absolute per capita amounts of allocations for health services were US$ 3.40 in 1998/99 and US$ 6.60 per capita in 2003/04 (MoH September 2003). The target for the MoH has been to reach US$9 per capita to ensure delivery of the essential health package, though US$12 has been agreed as the international threshold.