PHA-Exch> EQUINET Discussion Paper 67: Evaluating the implementation of the Tanzanian National Voucher Scheme: A case study from the Ruvuma region, Tanzania

[Rene Loewenson]

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 prioritisation
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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