Doctoral thesis
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.