title: Access and utilisation of healthcare services in rural Tanzania: A comparison of public and non-public facilities using quality, equity, and trust dimensions.
abstract: This study compared the access and utilisation of health services in public and non-public health facilities in terms of quality, equity and trust in the Mbarali district, Tanzania. Interviews, focus group discussions, and informal discussions were used to generate data. Of the 1836 respondents, 1157 and 679 respondents sought healthcare services on their last visit at public or non-public health facilities, respectively. While 45.5% rated the quality of services to be good in both types of facilities, reported medicine shortages were more pronounced among those who visited public rather than non-public health facilities (OR = 1.7, 95% CI 1.4, 2.1). Respondents who visited public facilities were 4.9 times less likely than those who visited non-public facilities to emphasise the influence of cost in accessing and utilising health care (OR = 4.9, CI 3.9-6.1). A significant difference was also found in the provider-client relationship satisfaction level between non-public (89.1%) and public facilities (74.7%) (OR = 2.8, CI: 1.5-5.0), indicating a level of lower trust in the later. Revised strategies are needed to ensure availability of medicines in public facilities, which are used by the majority of the population, while strengthening private-public partnerships to harmonise healthcare costs.
authors.affiliation: a National Institute for Medical Research , Dar es Salaam , Tanzania.|b Centre for International Health , University of Bergen , Bergen , Norway.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Shayo
authors.affiliation: a National Institute for Medical Research , Dar es Salaam , Tanzania.
authors.forename: Kesheni P
authors.initials: KP
authors.lastname: Senkoro
authors.affiliation: c Primary Healthcare Institute , Iringa , Tanzania.
authors.forename: Romanus
authors.initials: R
authors.lastname: Momburi
authors.affiliation: b Centre for International Health , University of Bergen , Bergen , Norway.|d Stavanger University Hospital , Stavanger , Norway.
authors.forename: Øystein E
authors.initials: ØE
authors.lastname: Olsen
authors.affiliation: e DBL - Centre for Health Research and Development, Faculty of Life Sciences , University of Copenhagen , Frederiksberg , Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Byskov
authors.affiliation: a National Institute for Medical Research , Dar es Salaam , Tanzania.|b Centre for International Health , University of Bergen , Bergen , Norway.
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Makundi
authors.affiliation: f Institute of Development Studies , University of Dar es Salaam , Dar es Salaam , Tanzania.
authors.forename: Peter
authors.initials: P
authors.lastname: Kamuzora
authors.affiliation: a National Institute for Medical Research , Dar es Salaam , Tanzania.
authors.forename: Leonard E G
authors.initials: LE
authors.lastname: Mboera
mesh_terms: D003906:Developing Countries; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017060:Patient Satisfaction; D017149:Private Sector; D011633:Public Facilities / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D011795:Surveys and Questionnaires; D013636:Tanzania; D035502:Trust
keywords: Health care; Tanzania; access; quality; utilisation