Utilization of health services after the introduction of cost sharing in Lushoto district Tanga region

A cross section study with descriptive and analytical component was conducted in Lushoto district, Tanga region, with the aim of assessing the utilization of public health facilities after the introduction of cost sharing in 1995 at the district hospital and at the health centers and dispensaries in 1999.The study consisted of two surveys, a household and hospital survey. In the household survey a total of 377 households from eight wards were covered. In the hospital survey outpatient public health utilization records were reviewed from Lushoto district hospital, Mlola,Mlalo and Mnazi health centers Son and Magamba dispensaries. A total of 120 outpatients attending these health facilities were also involved in the study. Findings revealed that, following the introduction of user charges, there has been a considerable decline in outpantient attendance in all public health facilities studied. In lower level health facilities out patient utilization dropped on average of 71.8% while at the district hospital it was 48.4%. Consequently, poor patients are not sure of getting free medical services for they cannot pay for their medical bills. Another important findings was that, many households 180(47.7%) were not well informed of the exemption mechanism and this could be a contributing factor to the observed decline in the outpatient utilization of public health facilities. It is recommended that, the introduction of cost sharing in public health facilities should go hand with mass educational campaigns to make sure that, health consumers know the importance of cost sharing in the overall improvement of the services.