Tanzania – Health reforms result in social exclusion of the urban poor
Reforms in health care systems can act as a powerful mechanism of social exclusion of the urban poor from decent health care services. This concludes WOTRO researcher Tausi Mbaga Kida. In her study she shows that the dual system of private and public health care delivery in Tanzania excluded urban poor from the better quality private care. But even more striking, also public care became less accessible for the poor due to the current subsidy structure.
In her study Tausi Kida analyses the systemic behaviour of the dynamics of the health care systems with its interaction with poverty. The deregulation and liberalisation of the health sector adopted in Tanzania from early 1990’s has brought about a dramatic shift in the system of health care delivery, from near exclusive ‘free’ public provisioning towards its extensive commercialisation that also include the liberalisation of private health care provision.
An influential view in the literature and in policy practice postulates that the commercialization of health care services will move the better off towards the private facilities in the public-private mix, thereby freeing the subsidized public health facilities for the use of the poor. However, contrary to policy intentions, this study finds out that the urban poor frequently find themselves excluded not only from (decent) private health care, but also from access to public health care, given the current subsidy structure.
Furthermore, this study reveals existence of segmentation in provision and access of health care services in the urban health care market. The segmentation mechanism is mainly the result of the systemic process of interaction of the demand and the supply sides of the health care market with widespread poverty. The study reveals that segmentation of health care delivery into a two-tier system is questionable to secure better access to health care especially for the urban poor. This is mainly because greater plurality of service provisioning in urban areas have weakened the pattern of public health care provision in general and of urban primary health care units in particular.
In this regard, this study proposes that the health reforms in practice have turned out to be quite powerful mechanisms of social exclusion of the urban poor from access to decent health care services i.e instead of being inclusionary as intended by policy. This study has therefore adopted “policy as process” approach, that has enabled a careful empirical investigation of both intended and unintended outcomes of prescribed policies – i.e. health reforms in the context of wide spread poverty.