An assessment of factors affecting the implementation of exemption policy among the older people a case study of Ligula referral hospital - Mtwara – Tanzania.

Abstract

Background Universal health coverage mechanism to protect most vulnerable and poor population is not a new thing in most developed and developing countries. USA initiated Obama Care/Affordable Care Act (ACA) to cover those most vulnerable and poor population. In Africa introduction of free exemption policy is one of the mechanisms to protect most vulnerable groups like older people and poor population from failing to access basic health care services- however the implementation of exemption policy in most African countries including Tanzania is very challenging. Challenges like lack of fund to implement the policy as well as weak monitoring and evaluation system hinder smooth implementation of the policy. Objective of the study The aim of the study was to explore factors affecting the implementation of exemption policy among the older people at Ligula Referral Hospital in Mtwara, Tanzania. Methodology A study was conducted at Ligula referral hospital-Mtwara-Tanzania. Qualitative study design was employed where by three Focus group discussions (FGDs) and six in-depth interviews(IDIs) from key informants were conducted to explore factors affecting the implementation of exemption policy among the older people at Ligula Referral Hospital. Purposively sampling was employed where by three departments out of seven departments at Ligula Referral Hospital were selected, therefore four units from those three departments were selected to participate in In-depth interview. In Focus group discussion one district from seven districts of Mtwara Region was selected, therefore two wards out of ten wards of Mtwara urban division were selected to participate in FGD. Tape recorder and interview guide were used as tools for data collection. All interviews were audio recorded and transcribed, thematic approach was employed to analyse data. Findings A total of 24 participants in FGDs and 6 key informants participated in the study. The study found that there are various factors affecting the implementation of exemption policy for older people. These included lack of constant supply of drugs, long waiting time, health care staff‟s negative attitudes towards exemption policy for older people, shortage of fund and denial of health care services to the older people. Other factors affecting the implementation policy include lack of training of health staffs on exemption policy and insufficient funds. Furthermore, the study revealed that awareness on exemption policy among older people was relatively low and there was a communication gap among community leaders and exemption policy implementers at the hospital level which hindered the smooth implementation of exemption policy among the older people at Ligula Referral Hospital. Conclusion and Recommendations Despite the effort made by the government to put in place exemption policy to exempt older people from paying for health care services, implementation of this policy is still a challenge. Administration at Ligula Referral Hospital should provide on job trainings to the health care workers on exemption policy. The MOHCDGEC should strengthen financial capacity by increasing budget allocation to the Referral Hospitals. Moreover regular public meetings should be used on health promotion and regular meetings between hospitals administration and community leaders specifically to discuss about implementation of exemption policy which in turn can reduce the communication gap between implementers of exemption policy at the hospital level and community leaders. Furthermore, exemption policy should be familiarised to both health providers and also primary beneficiaries so as to reduce barriers in its implementation.