Health Financing Policy Reform in Tanzania: Payment Mechanisms for Poor and Vulnerable Groups in Korogwe District

This report describes a study of health care financing mechanisms appropriate for the poor and vulnerable groups, performed by the Amani Medical Research Center, Tanzania, under a grant from the small applied research program of the Partnerships for Health Reform. The study was carried out in Korogwe District and used malaria, a relatively endemic public disease in the district, as a tracer disease. Data was collected through qualitative and quantitative techniques, adopting structured and semistructured interview approaches. Multistage sampling method was adopted for selecting study villages and health facilities. The study sampled households, exit patients, health personnel, central and local government officers, district health management team officers, traditional healers, shopkeepers, and religious leaders. More than 80 percent of the respondents perceived malaria as the major public disease, and some 70 percent said that modern health facilities are contacted for treatment. Nevertheless, selfmedication using modern and local medicines and traditional healers were also found to be an important source of care. More than 60 percent of the respondents reported their willingness to pay for health care at public and/or private facilities provided they are assured of good service, although they preferred different modes of payments. Cash payment was generally preferred to in-kind payment, both by the health care providers and the consumers. Women depended on farm crop sales as a source of money for medical care payments more than men (p-value < 0.05). Prepayment mechanisms were suggested as desirable for the poor who are not certain of a steady cash income. Waiver and exemption mechanisms seem to exist but the majority of the respondents had little knowledge of and faith in the way they were implemented, especially in the private sector. The study concluded that, although residents and officials in Korogwe district find payment for health care in public and private health facilities acceptable, many are concerned about how much they need to pay, why they should pay, and which means of payment they can use. To enhance community participation in payment for health care, efforts are needed to educate and sensitize the population regarding the cost-recovery programs that exist. In addition, a desirable definition of who is “poor” should be put in place, and local people involved in judging who is eligible for waivers.