Abstract
BackgroundThe Tanzanian government recommends women who attend antenatal care (ANC) clinics to accept receiving intermittent preventive treatment against malaria during pregnancy (IPTp) and vouchers for insecticide-treated nets (ITNs) at subsidized prices. Little emphasis has been paid to investigate the ability of pregnant women to access and effectively utilize these services.ObjectivesTo describe the experience and perceptions of pregnant women about costs and cost barriers for accessing ANC services with emphasis on IPTp in rural Tanzania.MethodsQualitative data were collected in the districts of Mufindi in Iringa Region and Mkuranga in Coast Region through 1) focus group discussions (FGDs) with pregnant women and mothers to infants and 2) exit-interviews with pregnant women identified at ANC clinics. Data were analyzed manually using qualitative content analysis methodology.FindingsFGD participants and interview respondents identified the following key limiting factors for women's use of ANC services: 1) costs in terms of money and time associated with accessing ANC clinics, 2) the presence of more or less official user-fees for some services within the ANC package, and 3) service providers' application of fines, penalties and blame when failing to adhere to service schedules. Interestingly, the time associated with travelling long distances to ANC clinics and ITN retailers and with waiting for services at clinic-level was a major factor of discouragement in the health seeking behaviour of pregnant women because it seriously affected their domestic responsibilities.ConclusionA variety of resource-related factors were shown to affect the health seeking behaviour of pregnant women in rural Tanzania. Thus, accessibility to ANC services was hampered by direct and indirect costs, travel distances and waiting time. Strengthening of user-fee exemption practices and bringing services closer to the users, for example by promoting community-directed control of selected public health services, including IPTp, are urgently needed measures for increasing equity in health services in Tanzania.
Highlights
The Tanzanian government recommends women who attend antenatal care (ANC) clinics to accept receiving intermittent preventive treatment against malaria during pregnancy (IPTp) and vouchers for insecticidetreated nets (ITNs) at subsidized prices
Accessing and costing transportation From more than half of the women interviewed at clinic level and from the majority of the Focus Group Discussions (FGDs), concerns were raised about long travel distances to ANC clinics
Long travel and waiting time for service at the clinic appears to be a major concern to pregnant women and a key factor influencing decision on (i) whether to seek ANC services or stay at home, (ii) whether to register for ANC services early or late in pregnancy, and (iii) they type of health facility/provider to approach
Summary
The Tanzanian government recommends women who attend antenatal care (ANC) clinics to accept receiving intermittent preventive treatment against malaria during pregnancy (IPTp) and vouchers for insecticidetreated nets (ITNs) at subsidized prices. In 2000 the government recommended that each pregnant woman attending MCH clinics should be given a voucher for procuring an ITN at a subsidized price This step is line with the Abuja target of ensuring increasing coverage of pregnant women sleeping under ITNs [5]. Despite this equity-oriented political will renown as the government’s long-term strategic principle of ensuring equity and universal access to primary health care [8,9], previous evaluations reports indicate that the free medical policy (user-fee exemption policy) is poorly adhered to due to lack of clear, feasible and/or disseminated guidelines [10,11,12,13,14]
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