Service provider's perceptions of the quality and accessiblity of health services under social health insurance in Dar-Es-Salaam

Abstract

Social health insurance is a form of health care financing that has gained increased attention in African countries in the past decade. Tanzania introduced social health insurance by the establishment of the National Health Insurance Fund (NHIF) in 1999 with, inter alia, the objective of improvement of the quality and availability of health services. The goal of this study was to determine the perceptions of services providers on the quality and accessibility of health services following the introduction of social health insurance. A qualitative approach was used to gain an insider's perspective from the service providers of how the services have changed following the introduction of the scheme. Individual interviews, observation and field notes were used to gather information on the quality and accessibility of health services under the policy of social health insurance. Data were analysed using Tesch's method of data analysis. The health workers generally perceived the fund as being beneficial to its members as it reduced the financial barriers to receiving health care. However, the objectives of the NHIF as a health financing mechanism were not adequately understood by the health workers. Although they perceived the quality of health services as having improved compared to previous years, they did not associate this improvement with the NHIF. The health workers also perceived accessibility of health services as having improved for insured patients but not for non-insured patients