Barriers to health services access among indigent and vulnerable populations in tanzania: perspectives of health service providers

Abstract

In the 1990s, Tanzania introduced exemptions and waivers to enhance access to healthcare among the indigent and vulnerable populations. To that effect, exemptions apply to pregnant women, children under five, and seniors over 60, while waivers provide temporary relief for those who cannot afford healthcare. However, there is an increasing concern around the globe that user fee exemptions alone cannot sufficiently enhance access to healthcare services among the indigent and vulnerable populations. In Tanzania, this concern constitutes a notable gap in the literature especially after introduction of user fee exemptions. This study borrows from the Levesque’s conceptual framework to examine five dimensions of access and utilization of healthcare among the indigent and vulnerable groups in public health facilities. The dimensions include availability, accessibility, accommodation, affordability, and acceptability. This article is a case study whereby data were collected using key informant interviews with health service providers. The collected data was then analysed thematically. A number of factors influence access to health care services among the indigent and vulnerable groups in public health facilities in Tanzania. The factors include inadequate health services, unfavourable transport, stigma, and male dominance in household decision-making. While user fee exemptions reduce financial burdens, they are insufficient to ensure equitable access to healthcare services among the indigent and vulnerable populations. Therefore, it is equally important to address structural and social barriers, including inadequate health services, transport costs, stigma, and gender disparities in decision-making. A comprehensive approach is also needed to integrate improved health services, transport, stigma-reduction strategies, and gender-sensitive policies to make exemptions more effectiveness and promote equitable access among the indigent and vulnerable populations.