Abstract:
A cross-sectional study was conducted in Dar-es-Salaam
with the objectives of investigating the influence of the
introduction of user charges and the effectiveness of the
exemption mechanism introduced in public health facilities on
utilization of health services.
Outpa ient utilization records were analyzed in 3 public
and 3 pri ate hospitals and 242 outpatient interviews were
group discussions were conducted to get public
done.
health workers opinions on the cost-sharing exercise and
exemption process. 362 households within the vicinities of
the public hospitals were surveyed.
The study found that utilization of public facilities
declined by 53% between the second and third quarters of 1994
following the introduction of user charges in mid July 1994.
The sharp drop could be attributed to demand shifting to
lower levels of the public referral system, or to the private
sector.
Income and cost of care were found to be important
factors in influencing choice of health faL:ility. Majority of
private users (73%) were paid for by their employer, while
\
most public users (70%) paid for themselves. Findings further
indicated that 30 % of public users interviewed indicated
inability to pay while the proportion exempted was small
ii
(3%). This could be due to the lengthy exemption procedure
and its inconveniences.
The number of years of formal education and the nature
of emploYment were found to have a substantial influence on
choice of health facility. Public users were less educated
and were self employed or unemployed. Closeness to ones' home
~
and quality of care were the-major reasons given for choosing
a public or private facility respectively. Age, sex, marital
status and household size were not significant factors
influencing choice of health facility.
It is recommended that the DCC reviews its user charge
policy and exemption guidelines, and the local community
involved to ensure that the indigent are not denied access to
health care.
