Browsing by Author "Ndunguru, Moses January"

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    Health insurance contribution to expansion of health services access to poor households in Tanzania: Experiences from implementing community base health insurance schemes in six Districts
    (University of Dar es Salaam, 2019) Ndunguru, Moses January
    In Tanzania, health insurance has features as a potential welfare tool for expanding access to health services to all people and achieving goals of the Universal Health Coverage since 1993. This study examined health insurance contribution to expiation of health services access to poor households in Tanzania, using experience from community-based health insurance schemes operating in six districts. It specifically assessed trends of enrolment; efforts made to make health services available, affordable and acceptable; poor people’s perception of availability, affordability, and acceptability of services; and factors that facilitated and limited access to services. The study adopted descriptive cross-sectional research design involving a sample of 433 respondents who were selected purposively and randomly. Data were collected through 384 household survey questionnaires, 49 in -depth interviews, 24 focus group discussions, documentary review, and observation; and analysed descriptively and thematically. Findings indicated that the trend of enrolment was low and declining. Although schemes claimed to make health services available through sensitization programmes, raising user fees, strengthening health facility organs, and enrolment of the elderly, majority (54.4%) of the respondents were dissatisfied due to frequent shortage of drugs, limited number of accredited health facilities, absence of referral services, shortage of health workers, and equipment; unattractive benefit packages; mismanagement and unfriendly rules of the schemes; poor accountability; abusive language; exemption policy; expiration of cards, frequent increase in premiums and extra-payments; unclear definition of unit of households; unstable household income; high cost of care; and households’ negative perception of health insurance. To expand access to health services to the poor in Tanzania, there is a need for the government, policy makers, health insurance scheme managers, and health facility managers to provide education about health insurance and its benefits; improve quality of health services in the accredidited health facilities by ending a great problem of frequent unavailability of prescribed drugs, all unnecessary access barriers; and modify enrolment criteria to accommodate more groups in need.