Contribution Of Social Transfer Interventions Towards Universal Health Coverage In Dodoma Region, Tanzania

ABSTRACT

This study examined the effects of social transfer programmes in facilitating access and utilization of health care services and its implications in attaining universal health coverage in Dodoma Region, Tanzania. A cross-sectional survey of 402 household beneficiaries of social transfer programmes was carried out using interviewer administered questionnaire. In addition, 18 focus group discussions were carried out with community members and 12 in-depth interviews were held with programme officials and district councils’ officials. Chi-square and Fisher’s exact test were used to test significance of quantitative data. Logistic regression analysis was employed to assess the determinants of enrolment in Community Health Fund (CHF) and utilization of outpatient and inpatient health services. Qualitative data were thematically analyzed using content analysis. Results indicate that the process of identifying and selecting beneficiaries was affected by low community participation, inclusion of non-poor households, stigmatization of beneficiaries and duplication of efforts. Furthermore, there was a significant difference between type of social transfer benefits and household engagement in productive investments. There was no significant difference in housing improvement and accumulation of durable and non-durable assets between categories of social transfer beneficiaries. Cash transfer had a significant positive effect on the uptake of CHF while in-kind transfer had a significant negative effect on the uptake of CHF. There was significant and positive relation between cash transfer beneficiary households and utilization of outpatient services while participation in in-kind transfer programmes significantly increased the use of inpatient services. It was also revealed that being a member of CHF was significant negatively associated with the use of outpatient care services while it had no significant effect on the use related to inpatient care. It is concluded that the supplyside failures lead to low uptake of CHF and less utilization of health services. More so, adequate investments in the health sector to ensure availability, accessibility, adequacy and acceptability of services are inevitable in order to increase CHF uptake and increase the use of services.