This quantitative study aims to assess the need for inclusion in social protection among persons with disabilities compared to those without, within three districts in Tanzania. It finds that the need for health insurance and other social protection schemes among persons with disabilities was not matched by higher, and suggests that the expansion of social protection schemes to be inclusive of persons with disabilities may be an important steps towards achieving Universal Health Coverage.
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.
This quantitative study was carried out in three districts where GIZ are active: Nachingwea (Lindi Region), Muheza (Tanga Region) and Mbeya District Council (Mbeya Region). 45 clusters of 100 persons aged 5+ years were selected with probability proportionate to size sampling and screened for disability. A case-control study was undertaken, nested within the survey. Each cluster includes two households known to be members of the Community Health Fund (CHF). Fieldwork was conducted in August and September, 2014. This survey was accompanied by a qualitative survey of semi-structured interviews and focus group discussions with multiple stakeholders.
The findings are consistent with the general literature which demonstrates that persons with disabilities are more vulnerable to poverty, and often have higher health care needs:
- Overall prevalence across the three districts was 3.2% amongst sample of 4475, but 10% of households included a person with disabilities.
- Disability was more common with increasing age and among poorer households.
- Adults with disabilities were less likely to be literate or have attended schools, and children with disabilities were less likely to be be currently enrolled at school.
- Awareness and use of rehabilitation services and assistive devices was very low among persons with disabilities.
- Enrollment in social protection programmes was low overall, and unrelated to disability. Those households which were enrolled were significantly less poor than the general population and had a lower overall disability prevalence.
Recommendations
The controlled comparison highlights the greater need for social protection that is not reflected in enrollment on social protection schemes, where those better off and less likely to have disabilities had a higher rate of enrollment. Improving health insurance coverage among persons with disabilities may therefore necessitate specific targets, such as providing subsidies or awareness raising of the benefits of the scheme.
