Efficiency and effectiveness of strategies for promoting access for the poor and vulnerable groups within user fee system: Mwanza and Misungwi districts

Abstract

The implementation of user fees while fostering equity in access of quality health services for the poor is still a problem in health facilities in Tanzania. A cross sectional exploratory descriptive study was conducted in Mwanza at Sekou- Toure (public) and Bukumbi (Voluntary) hospitals from 4th to 14th June 2002. The objective was to investigate the strategies for promoting access for the poor and vulnerable groups within their user fee systems. A convenient sample of 335 exit interviews, administrators and health providers were involved in a study using qualitative and quantitative methods. Documentary reviews and observations were done. Check list was used to assess equipment and infrastructures. Out of 150 respondents from each hospital, only 35.5% of the public and 26% of the voluntary hospitals respondents were aware of the existence of the exemption mechanism in those hospitals. Exempt respondents in public hospital increased in number for the past five years and are associated with a total loss of 37,027,633 Tsh while exempt respondents in a voluntary hospital were static and associated total loss of 4,625,633 Tsh. The public hospital exemption system, which looks better than voluntary hospital exemption system, is managed by about 15 people and is a 24 hours activity. The voluntary hospital exemption system is managed by only one person, and is only active during official hours. In conclussion, the findings from the study shows that the strategies implemented by the public and voluntary hospitals are not enough to effectively and efficiently identify the poor in their user fee system.

The implementation of user fees while fostering equity in access of quality health services for the poor is still a problem in health facilities in Tanzania. A cross sectional exploratory descriptive study was conducted in Mwanza at Sekou- Toure (public) and Bukumbi (Voluntary) hospitals from 4th to 14th June 2002. The objective was to investigate the strategies for promoting access for the poor and vulnerable groups within their user fee systems. A convenient sample of 335 exit interviews, administrators and health providers were involved in a study using qualitative and quantitative methods. Documentary reviews and observations were done. Check list was used to assess equipment and infrastructures. Out of 150 respondents from each hospital, only 35.5% of the public and 26% of the voluntary hospitals respondents were aware of the existence of the exemption mechanism in those hospitals. Exempt respondents in public hospital increased in number for the past five years and are associated with a total loss of 37,027,633 Tsh while exempt respondents in a voluntary hospital were static and associated total loss of 4,625,633 Tsh. The public hospital exemption system, which looks better than voluntary hospital exemption system, is managed by about 15 people and is a 24 hours activity. The voluntary hospital exemption system is managed by only one person, and is only active during official hours. In conclussion, the findings from the study shows that the strategies implemented by the public and voluntary hospitals are not enough to effectively and efficiently identify the poor in their user fee system.