Equity of inpatient health care in rural Tanzania: a population- and facility-based study

Grace A Ferry,Margaret E Kruk,Godfrey Mbaruku,Lynn P Freedman,Sean R Dickson

doi:10.1186/1475-9276-11-7

Abstract

ObjectiveTo explore the equity of utilization of inpatient health care at rural Tanzanian health centers through the use of a short wealth questionnaire.MethodsPatients admitted to four rural health centers in the Kigoma Region of Tanzania from May 2008 to May 2009 were surveyed about their illness, asset ownership and demographics. Principal component analysis was used to compare the wealth of the inpatients to the wealth of the region's general population, using data from a previous population-based survey.ResultsAmong inpatients, 15.3% were characterized as the most poor, 19.6% were characterized as very poor, 16.5% were characterized as poor, 18.9% were characterized as less poor, and 29.7% were characterized as the least poor. The wealth distribution of all inpatients (p < 0.0001), obstetric inpatients (p < 0.0001), other inpatients (p < 0.0001), and fee-exempt inpatients (p < 0.001) were significantly different than the wealth distribution in the community population, with poorer patients underrepresented among inpatients. The wealth distribution of pediatric inpatients (p = 0.2242) did not significantly differ from the population at large.ConclusionThe findings indicated that while current Tanzanian health financing policies may have improved access to health care for children under five, additional policies are needed to further close the equity gap, especially for obstetric inpatients.

Highlights

Government expenditures for health in lowand middle-income countries are intended to ensure access to health care for the poor, they frequently disproportionately benefit wealthier citizens [1,2]
Researchers have established that user fees contribute to inequities by decreasing the use of needed health services by the poor and near-poor [5,6,7]
This study assessed the wealth distribution of inpatients admitted to rural health centers in Tanzania to provide insight about equity of inpatient care in Tanzania under current fee exemption policies

Summary

Introduction

Government expenditures for health in lowand middle-income countries are intended to ensure access to health care for the poor, they frequently disproportionately benefit wealthier citizens [1,2]. A review of public expenditures on health in 26 developing countries found that the poorest fifth of a population typically received less than a fifth of government expenditures on health [3]. Out-of-pocket payments, at the point of care are used extensively to raise revenues in many poor countries. Kruk ME, Mbaruku G, Rockers PC, Galea S: User fee exemptions are not enough: out-of-pocket payments for ‘free’ delivery services in rural Tanzania. Goudge J, Gilson L, Russell S, Gumede T, Mills A: The household costs of health care in rural South Africa with free public primary care and hospital exemptions for the poor. Wilkinson D, Gouws E, Sach M, Karim SS: Effect of removing user fees on attendance for curative and preventive primary health care services in rural South Africa.

Methods

Results

Discussion

Conclusion