A deadlock in health service delivery: Examining revenues lost from implementation of user fee exemption policy in Tanzania

Abstract

<title>Abstract</title> <bold>Background: </bold>Tanzania, like other low and middle-income countries (LMICs), introduced user-fee exemptions in early 1990s for the purpose of increasing access to health care services for the poor and the most vulnerable groups. User-fee exemptions are granted to pregnant women, children under 5, persons above 60 years and patients with chronic diseases.<bold> </bold>While there is consensus on the effects of user fee exemptions on access to health care services, there are growing concerns that user fee exemptions are the source of poor quality of health services in public health facilities. However, studies on exemptions have predominantly focused on the demand side, looking into whether the poor and vulnerable groups receive the required health care services. Therefore, there is scant knowledge of the effects of user fee exemptions on the supply side. This study examined revenues lost due to implementation of user-fee exemptions in public health facilities in Tanzania. <bold>Methodology: </bold>This study employed a case study design, and used documentary reviews and in-depth interviews in data collection. Thematic analysis approach was used to analyse qualitative data, whereas Microsoft Word Excel application was used to analyse the quantitative data extracted from documentary reviews. <bold>Results: </bold>The findings indicate that<bold> </bold>public health facilities lost substantial revenues mainly from service functions such as medicines, medical consultation, laboratory, and delivery services. However, there were no mechanisms in place to offset the revenues lost by health facilities. Consequently, the loss significantly jeopardised provision of health care services. <bold>Conclusion</bold> The study concludes that public health facilities in Tanzania lose a substantial amount of revenues due to the implementation of user fee exemption policy, which significantly jeopardises provision of health care services. The government should increase subsidies to public health facilities and increase efforts to effectively implement health insurance schemes because they are viable and reliable sources of revenues for improving service delivery.