University of Twente Student Theses


Evaluation of access to primary healthcare : a case study of Dar es Salaam

Kalimenze, Deogratias D. (2011) Evaluation of access to primary healthcare : a case study of Dar es Salaam.

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Abstract:Access to primary healthcare is a primary aim of ensuring quality of life. Many authorities aimed at achieving equitable primary healthcare but achieving the goal has remained a desire for many health planning authorities. Different methodological approaches have been used to evaluate access to primary healthcare. But, in this study access concept composed of accessibility, availability, affordability, acceptability and adequacy were used evaluate access to primary healthcare between different socio economic groups. Evaluation of access to primary healthcare was done using collected data both primary and secondary data. The primary data was collected using structured households survey and household was the unit of analysis. Therefore, variation of access to primary healthcare was measure using both objective and subjective indicators. Access was evaluated between types of primary healthcare facilities, users of healthcare and identified socio economic groups using network analysis, service area analysis and descriptive statistics. Moreover, the obtained results were compared for evaluation of changes over time and identified socio economic groups. Furthermore, policies objectives were compared with identified issues on access components. The results showed that, variations exist between settlement types and socio economic groups. The vulnerable households are predominant in informal settlements than formal settlements. But accessibility and acceptability were not problematic in the study area; this was because of implementation of health policy objective on public private partnership. The mixed characteristics of people and beliefs influenced the level of acceptability. Furthermore, long waiting time, drug shortage and human resource inadequacy were major challenges on availability. Furthermore, medication and overall healthcare costs were also challenging factors of affordability to primary healthcare. Unfriendly behaviour of health personnel and medical ability under adequacy perceived to be challenge especially in government facilities than non-government facilities. Furthermore, socio economic groups have shown significant difference between different indicators of access components. Perceptions on waiting time, drug availability, medication cost, possession of health insurance card and medical ability have shown significant differences between socio economic groups, but households belonging to vulnerable groups are the most affected one. The evaluation of changes over time showed that, government health facilities have remained the main providers of primary healthcare over 15 years. On the same note, affordability and distance remained to be strong motives of attending government facilities and drug availability and distance for non-government facilities. Apart from that, walking also remained to be a major mode of transport used by majority of respondent but more people walk now than as it was in 1995. The identified issues have shown significant variations with policy objectives. Most of issues identified where not well addressed as required from the policy document, only physical accessibility was observed to satisfy the policy objective. Much more has to be done to reduce the identified gap between existing status of PHC and policy documents. Key words: Access, socio economic status, primary healthcare, dimensions of access, policy, changes overtime.
Item Type:Essay (Master)
Faculty:ITC: Faculty of Geo-information Science and Earth Observation
Programme:Geoinformation Science and Earth Observation MSc (75014)
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