Public Expenditure Allocation and Incidence under Health Care Market Liberalization: a Tanzanian Case Study

Kida, Tausi; Mackintosh, Maureen

doi:10.1057/9780230523616_17

Cited by 10 publications

(5 citation statements)

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“…Even in Africa, where concern has been expressed about inequity of public health-care expenditure, spending was found to be redistributive in all of the 30 countries studied (Chu et al, 2004). Health-care spending reached those in the lowest income categories (Kida & Mackintosh, 2005).…”

Section: Health-care Financing -Tax and Insurancementioning

confidence: 89%

Closing the gap in a generation: health equity through action on the social determinants of health

Reading

2009

Child

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The Commission on Social Determinants of Health, created to marshal the evidence on what can be done to promote health equity and to foster a global movement to achieve it, is a global collaboration of policymakers, researchers and civil society, led by commissioners with a unique blend of political, academic and advocacy experience. The focus of attention is on countries at all levels of income and development. The commission launched its final report on 28 August 2008. This paper summarizes the key findings and recommendations; the full list is in the final report. The overarching recommendations are: Improve daily living conditions Improve the well‐being of girls and women and the circumstances in which their children are born, put major emphasis on early child development and education for girls and boys, improve living and working conditions and create social protection policy supportive of all, and create conditions for a flourishing older life. Policies to achieve these goals will involve civil society, governments and global institutions. Tackle the inequitable distribution of power, money and resources To address health inequities and inequitable conditions of daily living, it is necessary to address inequities – such as those between men and women – in the way society is organized. A strong, committed, capable and adequately financed public sector is needed. To achieve that requires more than strengthened government – it requires strengthened governance: legitimacy, space and support for civil society, for an accountable private sector, and for people across society to agree public interests and reinvest in the value of collective action. In a globalized world, the need for governance dedicated to equity applies equally from the community level to global institutions. Measure and understand the problem and assess the results of action Acknowledging that there is a problem and ensuring that health inequity is measured – within countries and globally – are essential for action. National governments and international organizations, supported by World Health Organization, should set up national and global health‐equity surveillance systems for routine monitoring of health inequity and the social determinants of health and should asses the health‐equity impact of policy and action. Creating the organizational space and capacity to act effectively on health inequity requires investment in training of policymakers and health practitioners, public understanding of social determinants of health, and a stronger focus on social determinants in public health research.

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Section: Health-care Financing -Tax and Insurancementioning

confidence: 89%

Closing the gap in a generation: health equity through action on the social determinants of health

Reading

2009

Child

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“…As a pioneering country of African socialism, Tanzania invested heavily in public healthcare provision particularly in rural areas during its first development programme (the Ujamaa project) in the 1960s and 1970s. In 1977, private health service provision was banned (Kida and Mackintosh 2005), and by 1978 around 90 per cent of the population was situated at a distance of no more than 10 km from a public health clinic (Thomas 1983, in Benson 2001. However, in the early 1980s, the country's health sector development was curtailed by public austerity policies introduced under the Structural Adjustment Programme, adopted owing to economic hardship experienced in the country.…”

Section: Background: Understanding Health Policy and Gender In The Ta...mentioning

confidence: 99%

Two decades of Tanzanian health policy: Examining policy developments and opportunities through a gender lens

Lambin¹,

Nyyssölä²

2022

WIDER Working Paper

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“…Just under 40 per cent of registered dispensaries in Tanzania in 2001 were in the private and non-profit sectors (URT, 2002). The 2001 Household Budget Survey suggested that about one in five visits to health facilities were to the non-governmental sectors in all wealth quintiles; furthermore the urban poor rely particularly heavily on non-governmental primary providers (Kida and Mackintosh, 2005). The Tanzanian Demographic and Health Survey of 1996 showed that of children taken for treatment for two common childhood illnesses, over 50 per cent on average were seen by non-governmental providers, with higher percentages in lower quintiles.…”

Section: Price Competition and Market Structure In Tanzanian Health Cmentioning

confidence: 99%

Competitive and Organisational Constraints on Innovation, Investment and Quality of Care in a Liberalised Low-income Health System: Evidence from Tanzania

Mackintosh

Tibandebage

2007

Eur J Dev Res

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International health policy proposals increasingly emphasise health system strengthening and innovation. In a context of liberalised provision, the scope for innovative health system rebuilding depends on the viability, effectiveness and capabilities of the non-governmental providers. Yet the research literature examining the market behaviour of private health care firms in developing countries, and the incentive structures and constraints they face, remain limited. We demonstrate here the extent of perverse health care market dynamics found in Tanzania in the late 1990s, in relation to patients' need for reliable health care, and show that the financial and operating fragility of the firms constrained investment and innovation. We aim to focus attention on the challenge for innovative approaches to poverty reduction represented by the current market and business structure of health care in low-income countries and to discuss some policy implications. Les propositions de politiques de sant� internationales mettent l'accent sur le renforcement des syst�mes de sant� et l'innovation. Dans un contexte de lib�ralisation des services, les possibilit�s pour la reconstruction de syst�mes de sant� innovants d�pendent de la viabilit�, de l'efficacit� et des capacit�s des fournisseurs non gouvernementaux. Pourtant, la litt�rature universitaire portant sur le comportement de march� des entreprises priv�es du syst�me de soins de sant� dans les pays en d�veloppement et les structures incitatives, de m�me que les contraintes auxquelles elles ont � faire face, reste limit�e. Nous montrons ici combien la dynamique de march� concernant le syst�me de soins est illogique, par rapport aux besoins des patients, en Tanzanie, � la fin des ann�es 1990. Nous montrons que la fragilit� financi�re et d'exploitation des firmes entrave l'investissement et l'innovation. Notre but est d'attirer l'attention sur les d�fis des approches innovantes envers la r�duction de la pauvret�, repr�sent�es par les structures productives et commerciales actuelles des soins de sant� dans les pays � faible revenu et d'examiner certaines mesures qui pourraient en d�couler.

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Public Expenditure Allocation and Incidence under Health Care Market Liberalization: a Tanzanian Case Study

Cited by 10 publications

References 0 publications

Closing the gap in a generation: health equity through action on the social determinants of health

Closing the gap in a generation: health equity through action on the social determinants of health

Two decades of Tanzanian health policy: Examining policy developments and opportunities through a gender lens

Competitive and Organisational Constraints on Innovation, Investment and Quality of Care in a Liberalised Low-income Health System: Evidence from Tanzania

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