This study explored the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania, using eight focus group discussions with 78 insured and uninsured elderly men and women 60 years of age or older who had utilised healthcare services in the past 12 months prior to the study. Elderly participants appreciated that health insurance had facilitated the access to healthcare and protected them from certain costs, but also complained that health insurance had failed to provide equitable access due to limited-service benefits and restricted use of services within schemes. Although elderly perspectives varied, insured individuals generally expressed dissatisfaction with their healthcare. The authors argue that the national health insurance policy should be revisited to improve its implementation, expand the scope of service coverage and improve service quality issues, including long administrative procedures related to health insurance.
Resource allocation and health financing
Countries globally are losing a total of $483 billion in tax a year to global tax abuse committed by multinational corporations and wealthy individuals – enough to fully vaccinate the global population against Covid-19 more than three times over. The State of Tax Justice 2021 – published by the Tax Justice Network, the Global Alliance for Tax Justice and the global union federation Public Services International – reports that of the $483 billion in tax that countries lose a year, $312 billion is lost to cross-border corporate tax abuse by multinational corporations and $171 billion is lost to offshore tax evasion by wealthy individuals. The 2021 edition of the State of Tax Justice documents how a small number of rich countries with de facto control over global tax rules are responsible for the majority of tax losses suffered by the rest of the world, with lower income countries hardest hit by these tax losses. The findings are galvanising calls to move rule-making on international tax from the OECD to the UN, and to adopt more equitable unitary systems of tax collection and disbursement that would apply total tax revenue on TNCs to where their production activities and revenue generation is taking place.
This qualitative study investigated the implementation of Tiba Kwa Kadi scheme in four urban districts of Tanzania using semi-structured interviews, focus group discussions and review of documents. While Tiba Kwa Kadi scheme contributed to access to health services, many challenges which hindered its performance, including frequent stock-out of drugs and medical supplies. This frustrated Tiba Kwa Kadi members and contributed to non-renewal of membership. The scheme was also affected by poor collections and management of the revenue collected from members, limited benefit packages and low awareness of the community. Similar to rural-based Community Health Fund, the Tiba Kwa Kadi scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. The authors recommend that government integrate or merge community-based health insurance schemes into a single national pool with decentralised arms.
This paper estimated per-day unit costs of COVID-19 case management for patients from costs in three public COVID-19 treatment hospitals in Kenya, and using input prices from a recent costing survey of 20 hospitals in Kenya and from market prices for Kenya. The paper details the per-day, per-patient unit costs for asymptomatic patients and patients with mild-to-moderate COVID-19 disease under home-based care, the significantly higher costs of managing the same patients in an isolation centre or hospital, and the per-day unit costs for patients with severe COVID-19 disease managed in general hospital wards and in intensive care units. COVID-19 case management costs were found to be substantial, ranging between two and four times the average claims value reported by Kenya’s public health insurer. The authors indicate that Kenya will need to mobilise substantial resources and explore service delivery adaptations to reduce unit costs.
The authors investigated what financial changes in low income countries (LICs) lead to childhood immunisation changes, controlling for population density, land area and female years of education. During 2014–2018, gross domestic product per capita, total or private health spending per capita and aggregated development assistance for health per capita were not significant predictors of vaccination coverage in LIC. Government health spending per capita and total/government spending per birth on routine immunisation vaccines were significant positive predictors of vaccination coverage.
This study analysed the gains from increased domestic financing for improving RMNCH outcomes in Sub-Saharan Africa (SSA). While there were significant gains from both domestic and external financing, the estimated elasticities suggest that the gains from domestic public financing were much stronger. The fiscal space options identified include tax revenue performance improvements, improved public financial management, and borrowing, at least in the short to medium term. The results show that fiscal space from improved tax systems ranged from US$34.6 per capita in Uganda to US$310.6 per capita in Nigeria. The authors recommend increased domestic financing for health through innovations in domestic resource mobilization, particularly by improving the performance of tax systems.
This study assessed the impact of introducing user fees on 28 601 births at Haydom Lutheran Hospital, Tanzania, comparing the period before introduction of fees from February 2010 through June 2013 and the period after from January 2014 through January 2017. The monthly number of births fell by 17.3% after fees were introduced. After the introduction of ambulance and delivery fees, the study found an increase in labour complications and caesarean sections and a decrease in newborns with low birthweight. The authors suggest that this might indicate that women delayed seeking skilled birth attendance or did not seek help at all, possibly due to financial reasons, and argue that free delivery care should be a high priority.
This study assessed the geographical distribution of comorbidity and its associated financial implications among commercially insured individuals in South Africa. The authors aggregated individual risk scores to determine the average risk score per district, also known as the comorbidity index, to describe the overall disease burden of each district The authors observed consistently high comorbidity index scores in districts of the Free State and KwaZulu-Natal provinces for all population groups before and after age adjustment. Some areas exhibited almost 30% higher healthcare utilization after age adjustment. Districts in the Northern Cape and Limpopo provinces had the lowest comorbidity index scores with 40% lower than expected healthcare utilization in some areas after age adjustment. The results show underlying disparities in the comorbidity index at national, provincial, and district levels.
This paper presents a qualitative study of perceptions and opinions regarding Chinese-supported health related activities in Africa through in-depth interviews among local African and Chinese participants in Malawi and Tanzania. The findings revealed shared experiences and views related to challenges in communication; cultural perspectives and historical context; divergence between political and business agendas; organization of aid implementation; management and leadership; and sustainability. Participants were broadly supportive and highly valued Chinese investment in health. However, they also shared common insights on challenges in communication between health teams; and limited understanding of priorities and expectations, and the need to improve needs assessments, rigorous reporting, and monitoring and evaluation systems.
To respond to the outbreak of the COVID-19 pandemic, the International Monetary Fund (IMF) has committed $1 trillion and so far provided $89 billion worth of financial assistance to countries around the world. Oxfam has tracked this COVID-19 financing and fiscal measures referenced in each of the 91 packages approved so far using official IMF reports for the respective countries. The tracker covers the amounts of funding IMF committed and disbursed to borrowing countries by region, types of financing instruments the Fund has employed, the borrowing countries’ current debt situation, fiscal policy measures, particularly social spending aimed at addressing the crisis, anti-corruption and transparency measures which countries have committed to undertake, and proposed fiscal measures for the recovery period. The text provided in this tracker is a compilation of select and relevant quotes/excerpts from official IMF reports while the debt data was drawn from the World Bank’s Debtor Reporting System. The tracker has been compiled for the benefit of persons and institutions wanting a snapshot view of what governments are borrowing, what they intend to do with these funds, what the IMF is encouraging countries to take during the pandemic and in the recovery period, and to give citizens and civil society a tool to hold their governments and the IMF accountable.