State and persons with disability in Tanzania: impact of cost sharing in vocational rehabilitation training.

Realizing the importance of vocational (functional) skills for enhancement of independent living for persons with disability in the society, many countries in the world have established vocational rehabilitation training to meet such need. And to ensure access to all eligible persons, many of these countries have been providing the services free of charge. In Tanzania, also, vocational rehabilitation training for the concerned persons was provided freely from the time of its inception in 1953 up to 1986 when cost sharing was introduced. The giving of free social services was possible because then the economy was doing well, Unfortunately, the period from late 1970s to early 1980s saw Tanzania falling into a stiff socio-economic crisis. As there were no signs of early recovery Tanzania devised various strategies in an attempt to alleviate the crisis. Cutbacks of government allocation on social services like education (including vocational training), health, water, etc, and introduction of cost sharing to the beneficiaries of the services were to prevent the deteriorating service from total collapse. While such measures were necessary, they had a negative impact on the persons with disability who are perhaps the most marginalized and economically hardest hit in society. Thus the goal of this study is, first, to find out the extent to which cost sharing has affected access to vocational rehabilitation training and, second, to give suggestions on how to help those who are unable to share the costs and how the programme could be improved. The study is divided into five chapters. Chapter one deals with the background to the study, including the statement of the problem, purposes, objectives and significance of the study, definition of concepts, hypotheses, methodology and limitations of the study. Chapter two looks at the literature on disability and cost sharing in vocational rehabilitation training for persons with disability. It also discusses the causes of disability and the difference between disability, impairment and handicap. Furthermore, it situates the persons with disability in the community in which they live. The section also discusses various steps taken at a global level to restore the lost ability or to convert disability to ability. Such efforts relate to rehabilitation services of which vocational rehabilitation training is a part. The last aspect of the chapter deals with the conceptual framework for this study. Chapter three focuses on vocational rehabilitation training for persons with disability in Tanzania. The chapter tries to trace the history of vocational rehabilitation training for persons with disability in Tanzania assessing the needs against the available capacity. It also analyses the issue of training policy before and after the introduction of cost sharing. Chapter four demonstrates the impact of cost sharing on vocational rehabilitation training for persons with disability in Tanzania from the case study of nine governmental vocational rehabilitation colleges and centres. Much of the information in this chapter is generated from questionnaire survey, interviews and, to a less extent, from documents. Generally, the chapter reveals that cost sharing has seriously affected the access of persons with disability to vocational rehabilitation training. Chapter five concludes the study and gives recommendations. The basic recommendation is that implementation of the cost-sharing policy should take into account the assessment of the individual economic ability so as to ensure that those who can pay actually pay and those who cannot pay do not suffer deprivation of critical services. It emphasizes that government has the responsibility to provide for those who cannot provide for themselves.