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Exploring the Effects of Out-of-Pocket Payments on Healthcare Utilization in Rural and Urban Tanzania: A Gender Perspective

DOI: 10.4236/jss.2023.116013, PP. 180-202

Keywords: Out-of-Pocket, Health Expenditure, Healthcare Access and Utilization, Rural and Urban, Tanzania

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Abstract:

Out-of-Pocket Payments (OPPs) have serious consequences for access to and utilization of health care and are particularly devastating for the poor. Although women constitute the majority of the poor in Tanzania and globally, the implications of user fees for access to health care from a gender perspective have received little attention. This study aimed to fill this gap by using a combination of quantitative and qualitative analyzes to investigate the gendered impact of OOPs on health care utilization in Kondoa District in both rural and urban areas. 206 households were interviewed and six single-sex focus groups were held. The study found that female-headed households (FHH) had higher cost burdens from seeking care and untreated morbidity than male-headed households (MHHs. Direct payment was the main means of payment for health care for both households. Households in both rural and urban areas bear catastrophic burdens on health expenditure as it constitutes more than 10% of household income. Borrowing money was the main strategy applicable significantly in both rural and urban areas to cover health expenses. Out-of-pocket health expenditure had a significant relationship with untreated morbidity, medical visits, and coverage of treatment costs. There was also a significant inclusion of all household members, male and female, regarding health care decisions in all parameters assessed. It is therefore recommended to consider the introduction of affordable public health insurance schemes to ensure health insurance coverage for all individuals in both rural and urban areas. The vulnerability of women is also of particular concern and efforts to improve their access to health care should be encouraged. Health policies should also consider rural dwellers as a vulnerable group seeking affordable health services. On the other hand, the quality of public health expenditure must be improved by strengthening budget execution performance and better monitoring of public expenditure.

References

[1]  Albanesa, S. N., Ekirapa, E. K., Peterson, S., Okui, O., Rahman, M. H. et al. (2017). Access to and Utilisation of Health Services for the Poor in Uganda: A Systematic Review of Available Evidence. Transactions of the Royal Society of Tropical Medicine and Hygiene, 102, 1067-1074.
https://doi.org/10.1016/j.trstmh.2008.04.023
[2]  Asante, A., Wasike, W. S. K., & Ataguba, J. E. (2020) Health Financing in Sub-Saharan Africa: From Analytical Frameworks to Empirical Evaluation. Applied Health Economics and Health Policy, 18, 743-746.
https://doi.org/10.1007/s40258-020-00618-0
[3]  Boex, J., Fuller, L., & Malik, A. (2015). Decentralized Local Health Services in Tanzania. Urban Institute.
https://www.urban.org/sites/default/files/publication/51206/2000215-Decentralized-Local-Health-Services-in-Tanzania.pdf
[4]  Breman, J. G., Alilio, M. S., & Mills, A. (2004). Conquering the Intolerable Burden of Malaria: What’s New, What’s Needed: A Summary. American Journal of Tropical Medicine and Hygiene, 71, 1-15.
https://doi.org/10.4269/ajtmh.2004.71.2_suppl.0700001
[5]  Brinda, E. M., Andrés, R. A., & Enemark, U. (2014). Correlates of Out-of-Pocket and Catastrophic Health Expenditures in Tanzania: Results from a National Household Survey. BMC International Health and Human Rights, 14, Article No. 5.
https://doi.org/10.1186/1472-698X-14-5
[6]  Ebaidalla, E. M., & Ali, M. E. M. (2019). Determinants and Impact of Household’s Out-of-Pocket Healthcare Expenditure in Sudan: Evidence from Urban and Rural Population. Middle East Development Journal, 11, 181-198.
https://doi.org/10.1080/17938120.2019.1668163
[7]  Eze, P., Lawani, L. O., Agu, U. J., Amara, L. O., Okorie, C. A., & Acharya, Y. (2022). Factors Associated with Catastrophic Health Expenditure in Sub-Saharan Africa: A Systematic Review. PLOS ONE, 17, e0276266.
https://doi.org/10.1371/journal.pone.0276266
[8]  Furuta, M., & Salway, S. (2006). Women’s Position within the Household as a Determinant of Maternal Health Care Use in Nepal. International Family Planning Perspectives, 32, 17-27.
https://doi.org/10.1363/3201706
[9]  Gulamhussein, M. A., Sawe, H. R., Kilindimo, S. et al. (2023). Out-of-Pocket Cost for Medical Care of Injured Patients Presenting to Emergency Department of National Hospital in Tanzania: A Prospective Cohort Study. BMJ Open, 13, e063297.
https://doi.org/10.1136/bmjopen-2022-063297
[10]  Kitole, F. A., Lihawa, R. M., & Mkuna, E. (2023). Equity in the Public Social Healthcare Protection in Tanzania: Does It Matter on Household Healthcare Financing? International Journal for Equity in Health, 22, Article No. 50.
https://doi.org/10.1186/s12939-023-01855-0
[11]  Lee, B., Tarimo, K., & Dutta, A. (2018). Tanzania’s Improved Community Health Fund: An Analysis of Scale-up Plans and Design. Health Policy Plus.
http://www.healthpolicyplus.com/ns/pubs/10259-10469_TanzaniaiCHFScaleUpbrief.pdf
[12]  Leive, A., & Xu, K. (2015). Coping with Out-of-Pocket Health Payments: Empirical Evidence from 15 African Countries. Bulletin of the World Health Organization, 86, 849-856.
https://doi.org/10.2471/BLT.07.049403
[13]  Maluka, S. (2017). Primary Healthcare Systems (PRIMASYS) Comprehensive Case Study from United Republic of Tanzania. World Health Organization.
http://apps.who.int/bookorders
[14]  Manzi, F., Schellenberg, J. A., Adam, T. et al. (2005). Out-of-Pocket Payments for under Five Health Care in Rural Southern Tanzania. Health Policy and Planning, 20, i85-i93.
https://doi.org/10.1093/heapol/czi059
[15]  Manzi, Y., Selvaraj, S., & Subramanian, S. V. (2014). Health Care and Equity in India. The Lancet, 377, 505-515.
https://doi.org/10.1016/S0140-6736(10)61894-6
[16]  Masanyiwa, Z. S, Niehof, A., & Termeer, C. J. A. M (2013). A Gendered Users’ Perspective on Decentralized Primary Health Services in Rural Tanzania. The International Journal of Health Planning and Management, 30, 285-306.
https://doi.org/10.1002/hpm.2235
[17]  Morgan, R., Ayiasi, R. M., Barman, D. et al. (2018). Gendered Health Systems: Evidence from Low- and Middle-Income Countries. Health Research Policy and Systems, 16, Article No. 58.
https://doi.org/10.1186/s12961-018-0338-5
[18]  Mpambije, C. J. (2017). Decentralisation of Health Systems and the Fate of Community Health Fund in Tanzania: Critical Review of High and Low Performing Districts. Science Journal of Public Health, 5, 136-144.
https://doi.org/10.11648/j.sjph
[19]  Ozer, M. (2023). Socioeconomic Determinants of Out-of-Pocket Health Care Expenditures in Turkey. Fiscaoeconomia, 7, 1196-1211.
https://doi.org/10.25295/fsecon.1239845
[20]  Peters, D. H., Garg, A., Bloom, G., Walker, D. G., Brieger, W. R., & Rahman, M. H. (2008). Poverty and Access to Health Care in Developing Countries. Annals of the New York Academy of Sciences, 1136, 161-171.
https://doi.org/10.1196/annals.1425.011
[21]  Prinja, S., Jagnoor, J., Sharma, D. et al. (2019). Out-of-Pocket Expenditure and Catastrophic Health Expenditure for Hospitalization due to Injuries in Public Sector Hospitals in North India. PLOS ONE, 14, e0224721.
https://doi.org/10.1371/journal.pone.0224721
[22]  Rahman, T., Gasbarro, D., & Alam, K. (2022). Financial Risk Protection from Out-of-Pocket Health Spending in Low- and Middle-Income Countries: A Scoping Review of the Literature. Health Research Policy and Systems, 20, Article No. 1.
https://doi.org/10.1186/s12961-022-00886-3
[23]  Sahu, K. S. (2014). Out of Pocket Health Expenditure in Maternal and Neonatal Health and Coping Strategy in Urban Slum of Bhubanesura, Odisha. MSc. Thesis, Achutha Menon Centre for Health Science Studies.
[24]  Swai, O. W., Mbwambo, J. S., & Magayane, F. T. (2013). Gender and Perception on Climate Change in Bahi and Kondoa Districts, Dodoma Region, Tanzania. Journal of African Studies and Development, 4, 218-231.
https://doi.org/10.5539/jsd.v5n12p65
[25]  UNICEF (2020). Health Budget Brief 2020, Tanzania Mainland. UNICEF.
https://www.unicef.org/esa/media/8416/file/UNICEF-Tanzania-Mainland-2020-Health-Budget-Brief.pdf
[26]  UNIFEM (2018). Women, Poverty and Economics. UN Women and Gender Issues. UNICEF.
[27]  USAID (2015). Prospects for Sustainable Health Financing in Tanzania: Baseline Report.
https://www.healthpolicyproject.com/pubs/788_ProspectsforSustainableHealthFinanciFINAL.pdf
[28]  Van Wijk, C. M. T. G., van Vliet, K. P., & Kolk, A. M. (1996). Gender Perspectives and Quality of Care: Towards Appropriate and Adequate Health Care for Women. Social Science and Medicine, 43, 707-720.
https://doi.org/10.1016/0277-9536(96)00115-3
[29]  Whitehead, M., Dahlgren, G., & Evans, T. (2016). Equity and Health Sector Reforms: Can Low-Income Countries Escape the Medical Poverty Trap? The Lancet, 358, 833-836.
https://doi.org/10.1016/S0140-6736(01)05975-X
[30]  WHO (2016). Women’s Health: A Strategy for the African Region. World Health Organization.
[31]  WHO (2019). Out-of-Pocket Payments, User Fees and Catastrophic Expenditure.
http://www.who.int/health_financing/topics/financial-protection/out-of-pocket-payments/en/
[32]  WHO (2020). World Health Statistics 2020: Monitoring Health for the SDGs, Sustainable Development Goals. World Health Organization.
https://apps.who.int/iris/handle/10665/332070
[33]  Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J., & Murray, C. J. (2003). Household Catastrophic Health Expenditure: A Multicountry Analysis. Lancet, 362, 111-117.
https://doi.org/10.1016/S0140-6736(03)13861-5

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