Objectives:

• To review current policies and application of exemptions to ensure that the most vulnerable groups are exempted while those who are able to pay and currently also exempted are made to pay
• To recommend various options on how to improve waivers and exemption systems to make them cover the poor and vulnerable groups effectively
• To suggest how exemption and waivers should be reinforced in their implementation
• To suggest how poor people can be protected against catastrophic health events
• To analyse and suggest incentives to motivate health staff in facilities to make exemptions and waivers work and reduce demand for bribes

Content:

The provision of health services in the country is guided by the National Health Policy whose vision is to improve the health and well being of all Tanzanians, with a focus on those at risk, and to encourage the health system to be more responsive to the needs of the people. The Government of Tanzania introduced health financing strategy as part of health reforms in order to mobilize resources (domestic and foreign) to reduce the financial gap. Domestic sources of funding were also introduced such as Community Health Fund (CHF), National Health Insurance Fund (NHIF), user fees and drug revolving fund to complement funds provided by the government. The government policy and stand is to ensure that during implementation of new financial schemes, special attention will be given to protect the needs of the poor and vulnerable groups to ensure that they have access to health services. A cost sharing operationalisation manual that clearly spells out exempted conditions and waivers as well as categories of the intended beneficiaries has been in operation since 2002. Although the government has put in place clear guidelines on waiver and exemption procedures, there are justified concerns over the functioning of exemptions and waiver mechanisms in support of the poor and vulnerable. Hence, the MOH asked for a consultancy to assist the MOH to strengthen current operation mechanisms in place for exemptions and waivers in order to eliminate present deficiencies being experienced.

• Health system financial systems design;
• Review of relevant guidelines, documents and studies undertaken in Tanzania on operational modalities and experiences with exemptions and waivers;
• Field visits to selected health facilities both public run and faith owned to assess operations of Community Health Fund, user fees and how identification of who qualifies and how actual granting of waivers and exemptions are done;
• Conduction of interviews with various stakeholders at Central, Regional and District level (PO-RALG, MoH, faith based health providers, NGOs and civil society groups)
• Conduction of interview with clients/users of health facilities residing in localities close to dispensaries, health centres and district hospital
• To identify weaknesses with current applications of waivers and to come up with practical recommendation on how poor people can be identified better and cushioned from cost recovery negating factors that potentially could reduce the poor from accessing health services;
• Practical recommendations on how exemptions could be further refined to ensure that exemptions go towards the needy not subsidizing the rich and those who can be paid for through their health insurance coverage;
• Consultancy report.