Impact of user charges on government health facilities in Tanzania

Utilisation of outpatient services in government owned district hospitals in Dar es Salaam, declined by more than 50% following the introduction of user charges in these health facilities in mid July 1993. Outpatient attendances in the private health facilities studied remained constant throughout the year although these charged higher fees. Education and employment status were found to be major factors influencing utilisation of public versus private health facilities. Public facility users (62.8%) had five to eight years of formal education. Private facility users with five to eight years of education were 45.5% and those with more than years of education were 47.1%. While 68.6% of public facility users paid for their own healthcare, more than a quarter (27.3%) had their costs met by relatives or friends. The employer paid for 72% of private facility users, 49.2% of whom stated that this was the reason why they used private facilities. Despite introduction of charges in public hospitals, availability of prescribed medication was poor. Drugs were reported to be always available by only 27.3% of public health facility users compared to 80% of private health facility users.