Baraka, Jitihada

Borgi, Josephine

Kuwawenaruwa, August

Manzi, Fatuma

Patouillard, Edith

Ramsey, Kate

English

Digital Library of the Tanzania Health Community

Multi-level stakeholder perceptions of poverty identification criteria for a pro-poor health Insurance scheme in Tanzania 
Jitihada  Baraka1,Fatuma Manzi1, Kate Ramsey2, August Kuwawenaruwa1, Edith Patouillard1,3, Josephine Borgi1,3 
1 Ifakara Health Institute, Dar es Salaam, Tanzania,  2Columbia University Mailman School of Public Health, New York, USA,          
  3London School of Hygiene and Tropical Medicine, London, UK, 
iHEA, 9th World Congress; July 10 – 13, 2013. Sydney–Australia 
  In  Tanzania,  as  in  other  low  income  countries,  vulnerable  groups,  notably  pregnant 
women, infants and children often pay for services despite the existence of exemption 
policies. The Tanzanian National Health Insurance Fund (NHIF) with technical support 
from  donors  has  developed  a  pilot  scheme  which  involves  providing  NHIF  health 
insurance  cards  to  poor  pregnant  women  in  two  regions  (Mbeya  and  Tanga).  It  is 
hypothesized  that  the  cards  will  increase  service  use  among  the  poor  by  removing 
financial  barriers,  offering  greater  provider  choice,  and  improve  service  quality.  Poor 
pregnant women are identified based on  specific  criteria (See table 1). 
 
Introduction   Key findings 
An intervention (Mbarali) and control (Kilolo) district were purposively selected. 
In-depth interviews (IDI - 38) were conducted at baseline with:  
            - Health workers and facility managers 
            - District Management staff: 
            - NHIF staff and Managers and other Implementing Actors 
            - Focus group discussions were also conducted (FGD - 6)  
Table 1: Criteria for Identifying the Poor 
Conclusion 
  
  
 
y 
•Stakeholder’s perceptions of each of the  poverty criteria vary  across  groups.   
 
•Health facility providers supported per capital income  as the main poverty criteria, 
“…..if the mother is earning lower than 1500 shillings per day it means she is poor, 
she cannot  manage to support the family….”  
 
•In  terms  of  firewood,  community  respondents  perceived  that  it  cannot  capture 
poverty directly since in  rural areas it is freely accessed.  
“.... in village life firewood and charcoal is the means of cooking. One cannot be 
determined  to  be  poor  because  of  the  use  of  firewood  unless  the  firewood  or 
charcoal is sold and the family is failing to buy the firewood....”  
 
•District Management Staff: They had believed that certain criteria capture factors 
related  to structural  constraints  rather  than  individuals.  For  example,  the  distance 
criteria to the facility relate more to government decisions regarding placement of 
facilities rather than individual poverty.  
 
 
 
 
 
 
                                                                  
 
 
“....One  can  have  nice  house  with  iron  sheets  but  they  do  not  have  food  to  eat, 
maybe they inherited  the house from  their fore fathers…….Others they have mud  
and thatched  houses but they have plenty of cattle and more food in the storage…” 
(FGD, Kilolo)  
In  order to ensure  local  relevance ,Centrally developed  poverty  targeting criteria 
may  require  more  localized  adaptations  based  on  input  from  community 
stakeholders,  particularly  local  implementers  and  potential  beneficiaries.  These 
groups  will  be  crucial  to  successful  program  implementation  as  subjective 
understanding  of  the  criteria  may  result  in  wide  variations  in  their  application.  
Additionally,  in  order  to  individually  target  the  most  vulnerable  population,  more 
work may be needed to differentiate between the poor and the extreme poor . 
 Mud thatched house from Control Site (Kilolo) 
  
•Village NGO’s perceived the nature 
of the house to be unreliable criteria 
as houses may be inherited or people 
may  choose  not  to  invest  in  their  
house but still be well off. 
Indicator  Scoring 
1             (poor)   2          (average)   3            (rich) 
 
Housing 
 
Mud/thatched roof 
 
Mud/iron roof 
 
Brick 
  
Access to health services 
 
>60 mins walk 
 
30-60 mins walk 
 
< 30 mins walk 
  
Water source 
   
 River 
 
Community tap 
 
Treated/ Accessible 
  
Fuel for cooking 
 
Illegal firewood 
 
Firewood/ charcoal 
 
Charcoal/ kerosene 
  
Sanitation 
 
Bush 
 
Shared latrine 
 
Pit latrine 
 
Daily income 
 
<1500 Tsh 
 
1500-3000 Tsh 
 
>3000 Tsh 
 
Average meals / day 
 
1 Meal 
 
 2 meals 
 
 3meals 
 
Children /child health 
>4 children ; 1 w/ 
disability 
 
 3-4 children 
 
< 3 children 

Multi-Level Stakeholder Perceptions of Poverty Identification Criteria for a Pro-Poor Health Insurance Scheme in Tanzania

http://ihi.eprints.org/1812/1/E_poster_presentation__Jitihada_Baraka.pdf

Multi-Level Stakeholder Perceptions of Poverty Identification Criteria for a Pro-Poor Health Insurance Scheme in Tanzania

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