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<p class=MsoNormal><tt><b><font size=2 color=maroon face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:maroon;font-weight:bold'>EQUINET
Discussion Paper 67: Evaluating the implementation of the Tanzanian National
Voucher Scheme: <span class=GramE>A</span> case study from the Ruvuma region,
Tanzania,</span></font></b></tt><U1:P></U1:P><O:P></O:P> <o:p></o:p></p>
<p class=MsoNormal><tt><b><font size=2 color="#660000" face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:#660000;font-weight:bold'>A <span
class=SpellE>Komba<ST1:PLACE u14:st="on"><ST1:PLACENAME u14:st="on"></ST1:PLACENAME><ST1:PLACETYPE u14:st="on"></ST1:PLACETYPE></ST1:PLACE></span></span></font></b></tt><U1:P></U1:P><O:P></O:P>
<b><font size=2 color="#660000" face=Arial><span style='font-size:10.0pt;
font-family:Arial;color:#660000;font-weight:bold'><br>
</span></font></b><br>
<tt><b><font size=2 color="#660000" face=Arial><span style='font-size:10.0pt;
font-family:Arial;color:#660000;font-weight:bold'>Cite as:</span></font></b></tt><tt><font
size=2 face="Courier New"><span style='font-size:10.0pt'> </span></font></tt><tt><font
size=2 color=purple face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:purple'>Komba A (2008) ‘Evaluating the implementation of the
Tanzanian National Voucher Scheme: A case study from the Ruvuma region, <st1:place
w:st="on"><st1:country-region w:st="on">Tanzania</st1:country-region></st1:place>,’
EQUINET Discussion Paper 67. EQUINET, CHP (Wits), HEU (UCT): <st1:City w:st="on"><st1:place
w:st="on">Harare</st1:place></st1:City>.</span></font></tt><b><font size=2
color="#660000" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#660000;font-weight:bold'><br>
<br>
<tt><font face=Arial><span style='font-family:Arial'>Available online at: </span></font></tt></span></font></b><font
size=2 color=purple face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:purple'><a href="http://www.equinetafrica.org/bibl/docs/DIS67komba.pdf">http://www.equinetafrica.org/bibl/docs/DIS67komba.pdf</a></span></font><br>
<font color=purple><span style='color:purple'><br>
</span></font><font size=2 color=purple face=Arial><span style='font-size:10.0pt;
font-family:Arial;color:purple'>In 2004, the Tanzanian government launched its
Tanzania National Voucher Scheme (TNVS). The scheme aimed to <span
class=SpellE>subsidise</span> 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 <span
class=SpellE>analyse</span> the power relations between key implementers of the
scheme and the mothers served in four rural district health facilities in
Namtumbo and Mbinga districts. </span></font><font size=2 color=purple
face=Arial><span lang=EN-GB style='font-size:10.0pt;font-family:Arial;
color:purple;mso-ansi-language:EN-GB;mso-bidi-font-style:italic'>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</span></font><font
size=2 color=purple face=Arial><span lang=EN-GB style='font-size:10.0pt;
font-family:Arial;color:purple;mso-ansi-language:EN-GB'> 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. <span
style='mso-spacerun:yes'> </span><span style='mso-spacerun:yes'> </span>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. <span style='mso-spacerun:yes'> </span>The
study, building on previous studies in <st1:country-region w:st="on"><st1:place
w:st="on">Tanzania</st1:place></st1:country-region> 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.</span></font><font
size=2 color=navy face=Arial><span lang=EN-GB style='font-size:10.0pt;
font-family:Arial;color:navy;mso-ansi-language:EN-GB'> <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><tt><b><font size=2 color="#993300" face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:#993300;font-weight:bold'>December
2008</span></font></b></tt><font size=2 color=maroon face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:maroon'><br>
<br>
</span></font><tt><font size=2 color=purple face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:purple'>/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\</span></font></tt><font
size=2 color=black face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:windowtext'><br>
<U1:P></U1:P><O:P></O:P><br>
<tt><font face=Arial><span style='font-family:Arial'>This email alerts to a new
publication from the Regional Network for Equity in Health in East and Southern
Africa (EQUINET).</span></font></tt><br>
<tt><font face=Arial><span style='font-family:Arial'>Further information on
EQUINET can be found at <a href="www.equinetafrica.org" moz-do-not-send=true><font
color=black><span style='color:windowtext'>www.equinetafrica.org</span></font></a>,
where all publications of the network can be found and downloaded.</span></font></tt><br>
<tt><font face=Arial><span style='font-family:Arial'>Comments and peer review
feedback on this or any other EQUINET publication are welcomed and should be
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