After introducing user charges in government hospitals and the presence of similar charges in the private health sector, the Tanzanian government established a policy for protecting poorest and vulnerable populations from healthcare charges. By citing evidence on similar experience from other developing countries, this paper presents, although in descriptive form, findings from technical research reports based on recent studies in Tanzania and critically analyses the relationship between government policy and its translation into practice. Evidence from previous but recent local studies indicates that while the policy explicitly identifies people with certain medical conditions as vulnerable groups eligible for exemptions, the issue of 'waivers' has been left to be decided at the discretion of local community leaders and health workers on ground that they know better the lifestyles, backgrounds and health conditions of the people surrounding them. This was viewed as a way of decentralizing decisions to local government authorities in granting such mechanisms to eligible people at the existing rates of health-care payments. This policy failure to define 'who are the poor' or how the poor should be assessed has caused confusion among health-care providers in identifying people who are eligible for waivers. It has also been used as a loophole for some health administrators to ignore people who deserve waivers since some people eligible for exemptions or waivers still pay either directly at the counter or indirectly under the table in order to get the better services they need.
Other people delay or fail to contact health facilities due to lack of money or by avoiding the institutional bureaucracy in confirming who deserves a waiver. Some people do not benefit from exemptions because of lack of knowledge if they qualify and/or the procedures for presenting their claims. Meanwhile some exemptions are granted to people other than the targeted vulnerable groups. On the other hand, health workers hesitate to approve exemptions and waivers to avoid losing revenue on the side of their health facilities. Additional findings, discussions, conclusionand recommendations are presented.
