EQUINET Discussion Paper 67: Evaluating the implementation of the Tanzanian National Voucher Scheme: A case study from the Ruvuma region, Tanzania
A Komba
Cite as: Komba A (2008) 'Evaluating the implementation of the Tanzanian National Voucher Scheme: A case study from the Ruvuma region, Tanzania,' EQUINET Discussion Paper 67. EQUINET, CHP (Wits), HEU (UCT): Harare.
Available online at: http://www.equinetafrica.org/bibl/docs/DIS67komba.pdf
In 2004, the Tanzanian government launched its Tanzania National Voucher Scheme (TNVS). The scheme aimed to subsidise the cost of anti-malaria nets for pregnant women and children across the country. But has the implementation of the scheme so far been equitable? This study used a case study approach to analyse the power relations between key implementers of the scheme and the mothers served in four rural district health facilities in Namtumbo and Mbinga districts. The study found that despite the scheme's impact in reducing severe malaria cases, inadequate national prioritization of malaria is affecting implementation, leading to inadequate funding, felt most severely at facility level. No resources were allocated specifically for voucher distribution, resulting in periodic shortages, while health workers involved in the scheme had other competing demands on their time. A top-down managerial approach to implementation allowed health workers to exercise unfair power over mothers and pregnant women seeking nets and treatment and women were asked to pay for vouchers in some areas, when they are actually entitled to get them free. The study, building on previous studies in Tanzania and elsewhere, demonstrated that a top-down approach to policy intervention is contributing to implementation gaps. The voucher scheme is not just a tool for ensuring access and equity in health care delivery – it must be carefully considered in the context of those entrusted with the task of overseeing its implementation.
December 2008
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