Supply Versus Demand of Health Care Facilities in a Competitive Context: Case of Tuberculosis Care in Douala-Cameroon

Abstract

Identifying the socio-economic factors associated with the supply and the demand of health facilities (HF), can contribute to the decision-making of the creation of the HF. This study aims to contribute to this issue, in the competitive context of the tuberculosis diagnosis and treatment centres (DTC), and to describe the spatial distribution of the residence of TB patients and DTC, to understand the DTC attendance' rate in the city of Douala, Cameroon. The Spatial analysis was performed to access the spatial-economic model hiding behind the distribution of the "observed" number of patients attending the DTCs compared to the "expected" number. Multivariate analysis using logistic regression and the analysis of variance were used to identify the factors associated to the demand and supply of DTCs respectively. The decentralization policy advocated by the national program against tuberculosis (NTP) is not always followed by the patients: The "expected" and the "observed" number of patients in DTCs are not correlated. The attendance of DTCs in Douala is in accordance with the spatialeconomic theory models of Salop and Hotelling, which is an artefact. Patients seeking treatment in DTCs closer to their residence are mainly women and patients from relative poor households, while attendance of DTC was associated with the quality of service and the level of the HF. Attendance HF is dictated by the spatial-economic theory models. The policy of creating HF for TB is not followed by patients in competitive context. Attendance of HF by TB patients is associated with socioeconomic factors;