Controversies in implementing the exemption policy for the elderly healthcare services in Tanzania: experiences from the priority setting process in two selected districts.

Background: Health financing system in Tanzania changed in the early 1990s as a result of the introduction of cost-sharing policies by the 1990s health sector reforms. The reforms brought about user fees which has led to inequity in access to health care services and catastrophic health expenditure among the elderly. In efforts to reduce the inequity gap among vulnerable groups, in 1994, the government introduced an exemption and waiver policy. More than three decades later, inequity in health care services access has persisted with the elderly population being more affected. The latter poses questions on the implementation efficiency of the exemption policy. We aimed to assess the implementation of the exemption policy on access to health services among the elderly in Tanzania by learning from the experiences of the priority setting process in two districts of western Tanzania.

Methods: An exploratory qualitative case study adopting Key informant interviews (KIIs) was used to collect data in Nzega and Igunga districts. The key informants involved the representatives of the planning team and decision makers from the community, health facility and district level. Information saturation was attained after the 24th interview and thus data collection ended. The content analysis approach was used to analyse the data.

Findings: Although there is a designated office that deals with exemptions for the elderly in health facilities, there are challenges in accessing health services. The challenges include insufficient drugs, some laboratory tests not covered by the exemption, a lengthy process to access service, poor financial mechanisms for exempted services, inadequate information and clarity of the exemption categories, and limited to no involvement of different stakeholders in the exemption process.

Conclusion: The exemption policy was introduced to help disadvantaged groups, including the elderly. However, its implementation encountered challenges which burden both the elderly and the health facilities. Its implementation has thus become a controversy to its initial aim that was to relieve the elderly from high healthcare costs. Revisiting the policy through a thorough stakeholders' engagement and establishing alternative financing of the exemption policy are recommended.