This report presents and analyses data obtained during qualitative interviews, which sought to understand the perceptions and experiences of persons with disabilities and the extent to which existing social protection programmes in Tanzania are inclusive of persons with disabilities. It finds that there is an absence of specific targeted efforted to enrol or collect data on persons with disabilities, and suggests improved communication of services and training for district medical staff.
It is part of a larger two-county project ‘Applied Research Concerning the Inclusion of Persons with Disabilities in Systems of Social Protection’ in Peru and Tanzania. In Tanzania, the focus country of this report, the study had a specific focus on Community Health Funds (CHF) – health insurance schemes run by local authorities at district level – and Tanzania Social Action Fund (TASAF) – a semi-autonomous government agency.
This qualitative study was carried out in three districts where GIZ are active: Nachingwea (Lindi Region), Muheza (Tanga Region) and Mbeya District Council (Mbeya Region). Semi-structured interviews and focus group discussions were conducted in the sample districts with persons with disabilities, government representatives, NGOs, disabled people’s organisations (DPOs), GIZ programme coordinators, TASAF coordinators and CHF coordinators. In each district, 15 clusters (villages) were covered. Fieldwork was conducted in August and September, 2014.
Findings
- The definition of disability provided by government officials is characterised by disempowering language, and whilst they noted the benefits of better data to improve services did not see it as their responsibility to collect it.
- The majority of persons with disabilities interviewed had heard of, but not accessed, the available social protection programmes. A very small minority of these were aware that those who were unable to pay were entitled to free membership.
- Health services were unanimously seen as being too expensive at the point of use, with prohibitive costs related to hospitals and transports, and the lack of access to drugs leading to high costs when purchased through pharmacies. Interviewees reported a number of unsustainable and problematic coping mechanisms to address this: local herbs; not using services at all; and partial treatment supported by family members or paid using installments.
- Services were generally considered physically accessible, but distance to dispensaries and lack of specialist services created an additional barrier, with costs beyond CHF membership required to access them.
- In relation to CHF: a range of interviewees highlighted a distinct lack of coordination and of clear responsibilities for facilitating access to CHF amongst persons with disabilities, and mixed levels of satisfaction for those enrolled.
- In relation to TASAF: enrolment was extremely low, but those enrolled generally expressed high levels of satisfaction. Interviewees expressed nee for support beyond healthcare and in the areas of livelihood opportunities and TASAF activities.
Recommendations
- Improved, more systematic approaches to exemption from payment for membership/user fees may facilitate greater inclusion of persons with disabilities in CHF. Many did not enrol in CHF because they did not perceive its benefits to outweigh its costs.
- Training on disability rights for district level staff to ensure persons with disabilities are treated with respect and can offer knowledge of specialised services for onward referrals. Whilst officials were aware of relevant national policies, they lacked a rights-based knowledge of disability which perhaps contributes towards the limited emphasis on disability in public health and social protection programmes in the districts.
- Consideration should be given to improving the accessibility of information on all social protection programmes within the district. There was extremely limited awareness of the CHF Act amongst the interviewees and the entitlement to free membership for those who cannot afford to pay.