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Effect of Increase User Fees in Accessing New Tuberculosis Diagnostic Services in the East Africa Public Health Laboratory Network Supported Project Sites Experience from Tanzania
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A5382 - Effect of Increase User Fees in Accessing New Tuberculosis Diagnostic Services in the East Africa Public Health Laboratory Network Supported Project Sites Experience from Tanzania
Author Block: E. H. Sandi1, E. S. Ngadaya2, S. G. Mfinanga3, G. D. Kimaro4, N. B. Mgina5, R. Shemtandulo1; 1Research, National Institute For Medical Research, Dar es Salaam, Tanzania, United Republic of, 2Research, National Institute for Medical Research, Dar es Salaam, Tanzania, United Republic of, 3Nimr Muhimbili Centre, Dar-Es-Salaam, Tanzania, United Republic of, 4Research, National Institute for Medical Research, Dar Es Salaam, Tanzania, United Republic of, 5Laboratory Research, National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania, United Republic of.
INTRODUCTION/ RATIONALE
In Tanzania, Tuberculosis (TB) services are mostly provided in the public health facilities. The main aim of the East Africa Public Health Laboratory Network (EAPHLN) project is to enhance access to diagnostic services for vulnerable groups to contain the spread of diseases in cross border areas among others. The project supported the healthcare facilities with the supply of Gene Xpert machines together with cartridges and training of laboratory healthcare staff to improve the diagnosis, management and surveillance of Tuberculosis and Mult Drug Resistant Tuberculosis. During project implementation some EAPHLN supported project satellites sites such as Musoma and Sumbawanga regional Hospitals increased the user fee. The former in an abrupt fashion while the later facility increased the fees in a cascade way, Mnazi Mmoja referral hospital did not increase. This paper therefore reports on effects of increasing user fees on the utilization of TB diagnostic services among the EAPHLN project supported satellite sites in Tanzania.
METHODS
We retrospectively analysed data on the utilisation of TB diagnostic services between July 2013 and June 2015 in these three facilities. User fees in Musoma was increased substantially from 2USD to 5USD in July 2014. In Sumbawanga hospital user fees was increased in step-wise starting from 1USD to 2USD in July 2014 and from 2USD to 3USD in January 2015. We compared TB services utilisation before and after change of user fees.
RESULTS
Overall, a total of 7483 presumptive TB patients were registered in all three facilities between July 2013 and June 2015; 50.2% were males. Fifty three percent (3969/7483) and 3514 (28%) of these patients were registered before and after the increase of user fee respectively. Of 3969, 1579 (39.8%) were from Musoma, 922 (23.2%) from Sumbawanga and 1468 (37.0%) from MMRH. Of 3514 patients, 983 (28%), 952 (27.1%) and 1579 (44.9%) were from Musoma, Sumbawanga and MMRH respectively. Number of presumptive TB patients seeking TB diagnostic services at Musoma decreased significantly by 38% (from 1579 to 983) after the increase of user fees (p=0.001). More females (817; 51.8% vs 458, 35.9%) attended Musoma before user fees was increased as compared to males whose attendance did not differ much (761; 48.2% vs 525; 53.4%); p=0.01. There was no significant decrease of number of patients utilizing TB diagnostic services at Sumbawanga and MMRH.
CONCLUSION
Increase of user fee decreased the utilisation of TB services significantly. Female patients were more affected by the change.
Author Block: E. H. Sandi1, E. S. Ngadaya2, S. G. Mfinanga3, G. D. Kimaro4, N. B. Mgina5, R. Shemtandulo1; 1Research, National Institute For Medical Research, Dar es Salaam, Tanzania, United Republic of, 2Research, National Institute for Medical Research, Dar es Salaam, Tanzania, United Republic of, 3Nimr Muhimbili Centre, Dar-Es-Salaam, Tanzania, United Republic of, 4Research, National Institute for Medical Research, Dar Es Salaam, Tanzania, United Republic of, 5Laboratory Research, National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania, United Republic of.
INTRODUCTION/ RATIONALE
In Tanzania, Tuberculosis (TB) services are mostly provided in the public health facilities. The main aim of the East Africa Public Health Laboratory Network (EAPHLN) project is to enhance access to diagnostic services for vulnerable groups to contain the spread of diseases in cross border areas among others. The project supported the healthcare facilities with the supply of Gene Xpert machines together with cartridges and training of laboratory healthcare staff to improve the diagnosis, management and surveillance of Tuberculosis and Mult Drug Resistant Tuberculosis. During project implementation some EAPHLN supported project satellites sites such as Musoma and Sumbawanga regional Hospitals increased the user fee. The former in an abrupt fashion while the later facility increased the fees in a cascade way, Mnazi Mmoja referral hospital did not increase. This paper therefore reports on effects of increasing user fees on the utilization of TB diagnostic services among the EAPHLN project supported satellite sites in Tanzania.
METHODS
We retrospectively analysed data on the utilisation of TB diagnostic services between July 2013 and June 2015 in these three facilities. User fees in Musoma was increased substantially from 2USD to 5USD in July 2014. In Sumbawanga hospital user fees was increased in step-wise starting from 1USD to 2USD in July 2014 and from 2USD to 3USD in January 2015. We compared TB services utilisation before and after change of user fees.
RESULTS
Overall, a total of 7483 presumptive TB patients were registered in all three facilities between July 2013 and June 2015; 50.2% were males. Fifty three percent (3969/7483) and 3514 (28%) of these patients were registered before and after the increase of user fee respectively. Of 3969, 1579 (39.8%) were from Musoma, 922 (23.2%) from Sumbawanga and 1468 (37.0%) from MMRH. Of 3514 patients, 983 (28%), 952 (27.1%) and 1579 (44.9%) were from Musoma, Sumbawanga and MMRH respectively. Number of presumptive TB patients seeking TB diagnostic services at Musoma decreased significantly by 38% (from 1579 to 983) after the increase of user fees (p=0.001). More females (817; 51.8% vs 458, 35.9%) attended Musoma before user fees was increased as compared to males whose attendance did not differ much (761; 48.2% vs 525; 53.4%); p=0.01. There was no significant decrease of number of patients utilizing TB diagnostic services at Sumbawanga and MMRH.
CONCLUSION
Increase of user fee decreased the utilisation of TB services significantly. Female patients were more affected by the change.
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