Equity Implications of Health Sector User Fees in Tanzania.Do we retain the user fee or do we set the user f(r)ee?

"Equity means that everyone should, in practice, and not just in theory, be able to access and use appropriate health services. Health services should not only be for the dominant population group. This implies equitable access and use, given that some people will need more health care than others. It also means that we should seek to minimize inequalities in health outcomes. The main objective of the analysis was to examine how much is gained by the user fees in the health sector as compared to the impact of fees on the access of poor people to health care services, especially at the primary level of care. The analysis examined the following critical issues: 1. The impact of user fees in the overall health sector and more specifically in relation to (1) their contribution to the overall resource envelop, (2) resources generated and used at facility level, (3) contribution of generated revenue to improved services, (4) transaction costs and administration requirements, (5) payment of “unofficial fees” by the poor, (6) local ownership, accountability and provider responsiveness, (7) access to services for the poor, and (8) effectiveness of exemption and waiver mechanisms. 2. The potential impacts of further extension of user fees to the dispensary and health centre level in relation to the issues mentioned under 1. 3. Options that exist for revising the current user fee system to achieve greater equity and effectiveness."