Affordability of cost sharing in public health services: a case study of Kilombero valley.

Abstract

This study describes the pattern of health care provision in Tanzania, from the colonial period up to the present. It further explains the reasons behind the introduction of cost sharing in public health services since the early 1990's, despite the government's commitment to provide free and equitable social services since the Arusha Declaration of 1967. The economic crisis leading to the underfunding has been traced as an underlying factor behind the obligation for this system which inter-alia aims at involving users in the maintenance and sustenance of respective health care services. Through the assessment of the affordability of cost sharing in Kilombero valley, the study brings to light the inter alia factors that influence the ability to pay (ATP), as explained by respondents in the study and other relevant works. Through the questionnaire survey, focus group discussions (FGD's), in-depth (formal and informal interviews, participatory research techniques, observation and documentary analysis this study comes out with the following general findings. The cost sharing system has been un-affordable to many people in rural areas, causing delays in their seeking health care for painful measures like going back home without prescribed services which represents some of cost sharing's negative impact. The most vulnerable groups specifically constitute women and children from disrupted families, abandoned pregnant girls and, later on their children, elders without children, and those ranked in the study area as poor and very poor (masikini na masikini sana). Even those with medium income (watu wa kawaida), are exposed to risks due to seasonal influence on income, as well as demand for labour and time during the most stressful period of the year, that is the rainy season (masika). Normally during the period, malaria and other health problems are at their peak in the study area. It is exposed in this study that the social network support among other efforts to mobilize resources for meeting health costs is extremely constrained. As a result people opt for coping mechanisms which do not sound favourable to the rural communities in the area of study. It is thus concluded that long term and short-term policy measures are necessary. All efforts to see sustainability in health care provision should provide a challenge for the sustainability of rural household's income. Finally, the study recommends the need for conducting studies that can lead to the introduction of locally appropriate indirect health care financing mechanisms, as a way of addressing the "health problems" as social risks that come regardless of one's cash, or any other form of saving.