Burns, M. and Mantel, M. (2006) Tanzania Review of Exemptions and Waivers. UNSPECIFIED. (Submitted)
MoHSW.pdf_(14).pdf - Submitted Version
Available under License Creative Commons Attribution Non-commercial.
The work which is presented in this report reflects a need identified by the Ministry of Health to improve the functionality of the exemptions and waivers systems which had been introduced to reduce the financial burden on groups of the population who need access to health care and who either cannot afford to contribute to the costs or who have an illness or disease which threatens the public good and for which no direct charges should be imposed. The exemptions and waivers systems, while potentially very effective in principle, were deemed not to be working well in practice. A significant body of work already exists on the health sector in Tanzania, with plenty of references to the exemptions and waivers systems. The task of the team undertaking this study was not to replicate the work of previous studies but rather to find ways to make some of the recommendations happen. The ‘how to’ element was seen as the most crucial aspect of the work, and the aspect which presented the greatest challenge. The results from all the available documentation were used, and were augmented by field visits to a number of regions and districts in the north and south of the country, where proposals for reinforcement of the waivers and exemptions systems could be tested with practitioners and users of the health sector. The strategy proposed in the document is divided into a long term strategy and an interim strategy. The long terms strategy is to have the whole population of Tanzania covered by one or another insurance scheme, from a selection of current and proposed schemes: the National Health Insurance Fund scheme for civil servants, the Social Security Fund health benefits scheme for formal sector employees, the proposed social insurance scheme for informal sector workers, the CHF or a scheme to cover those who are not eligible or cannot afford to participate in any of the others. The interim strategy identifies ways and means of strengthening the systems to ensure more equitable access to health services for those who are entitled to exemptions and waivers, with recommendations about how those systems can be refined to target those who most need them. Successful examples from the field are used to show the way forward. The interim strategy includes refinement of the exemptions system; expansion and consolidation of the Community Health Fund (CHF); development of TIKA, the urban equivalent of the CHF; the development of an ID card scheme for those who cannot afford to pay or to participate in any of the schemes; and the strengthening of the institutions which provide health care and which plan and monitor the services provided. The ID card scheme, being new to the stable of proposals for strengthening the exemptions and waivers systems, is fully elucidated from the rationale, through the principles behind it, to the identification process for those eligible, the issuing of the card, the roles of each of the institutions at leach level of the administrative structure, the financing of the scheme and the advocacy required to endure that it works the way it is intended by providing for those most in need. Inevitably, the proposals cannot be implemented in a vacuum and where there are risks involved, either general or specific, these have been identified.
|Keywords:||Exemptions and Waivers in Health;Tanzania|
|Subjects:||Health Systems > Health financing & economics|
|Depositing User:||Mr Joseph Madata|
|Date Deposited:||15 Nov 2012 08:16|
|Last Modified:||15 Nov 2012 08:16|
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