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 thanmale-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.
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