Tanzania sees universal health coverage as a goal for all its citizens—but, like many countries, struggles with implementation. Immediately after its independence in 1961, Tanzania instituted a free health care policy. By the early 1990s, it added user fees for many services, albeit with certain exemptions for the poor. Recent data suggest these exemptions do not go far enough, and resulting out-of-pocket expenses create a substantial financial burden on households.

Out-of-pocket costs constitute 23% of total health expenditures in the country, according to the World Bank, and account for about 2% of people’s income, on average. Even when certain things are deemed free-of-charge within the government system—such as contraceptive supplies—there are often out-of-pocket costs associated with the consultation and, in some cases, procedures performed.