Universal Health Coverage in Low-Income Countries : Tanzania's Efforts to Overcome Barriers to Equitable Health Service Access

During the past decade, Tanzania has experienced steady economic growth, with average annual growth rates of between 6 and 7 percent. Despite this positive trend in the economy, poverty rates have not decreased accordingly; more than one-fourth of Tanzania's 53 million inhabitants live below the poverty line and almost 10 percent live in extreme poverty. The health sector has been identified as a policy priority area in Tanzania. The main purpose of this case study is to describe Tanzania's efforts to promote universal health coverage (UHC) inclusive of the poor, and to identify challenges and opportunities for the health system to advance on this path in a coherent and integrated fashion. Given the large number of interventions implemented in the health sector, efforts were selected based on their potential to address the challenges to the equitable access to health services, namely the poor quality of health services and the limited financial protection. The paper is organized as follows: section one gives introduction. Section two describes supply-side efforts and features the devolution of health services, the primary health care (PHC) strengthening program, and results-based financing. Section three analyzes Tanzania's social protection program and synthesizes the country's experience with user fees, as well as their impact on financial protection. Section four features the community health funds, Tanzania's most explicit effort to increase financial protection in health. Section five assesses the implementation of these initiatives. Section six highlights some opportunities to include the poor and address the challenges to pro-poor UHC in Tanzania