Effectiveness of User Fee Exemption in Accessing Health Care Services Among Pregnant Women in Kondoa Town Council, Tanzania

This study assessed the effectiveness of user fee exemption in facilitating access to healthcare services among pregnant women in Kondoa Town Council, Tanzania. Specifically, the study examined pregnant women’s awareness of user fee exemption, healthcare services provided under the exemption policy, and the financial stability of healthcare facilities implementing the policy. A mixed-methods approach was employed using a cross-sectional case study design. Quantitative data were collected from 100 pregnant women selected through simple random sampling, while qualitative data were obtained from healthcare workers selected purposively as key informants. Questionnaires and key informant interviews were used for data collection. Quantitative data were analyzed using descriptive statistics with the aid of SPSS version 20, while qualitative data were analyzed thematically. The findings revealed that although many pregnant women attended facility-based briefing sessions and training on user fee exemption, overall awareness of the range of services covered by the exemption remained low. The study further found that pregnant women generally accessed antenatal care, facility-based delivery, medicines and vaccines, and emergency obstetric care through the exemption policy. However, access to some relatively costly services, particularly caesarean section services, remained limited, resulting in additional out-of-pocket payments. Findings from healthcare workers also indicated that inadequate government funding, shortages of medicines and medical equipment, limited infrastructure, and insufficient specialized health personnel constrained the effective implementation of the exemption policy. The study concludes that the user fee exemption policy has improved access to selected maternal healthcare services but has not fully eliminated financial barriers among pregnant women in Kondoa Town Council. The study recommends increased government financing, strengthened public-private partnerships, improved availability of essential medicines and health personnel, and intensified awareness programmes on the services and entitlements provided under the user fee exemption policy.

User fee exemption; healthcare access; pregnant women; maternal healthcare services; health financing.

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