Journal Article

An assessment of equity in the distribution of non-financial health care inputs across public primary health care facilities in Tanzania

Kuwawenaruwa, August, Remme, Michelle, Borghi, Josephine, Mtei, Gemini

2017

Overview

Background There is limited evidence on how health care inputs are distributed from the sub-national level down to health facilities and their potential influence on promoting health equity. To address this gap, this paper assesses equity in the distribution of health care inputs across public primary health facilities at the district level in Tanzania. Methods This is a quantitative assessment of equity in the distribution of health care inputs (staff, drugs, medical supplies and equipment) from district to facility level. The study was carried out in three districts (Kinondoni, Singida Rural and Manyoni district) in Tanzania. These districts were selected because they were implementing primary care reforms. We administered 729 exit surveys with patients seeking out-patient care; and health facility surveys at 69 facilities in early 2014. A total of seventeen indices of input availability were constructed with the collected data. The distribution of inputs was considered in relation to (i) the wealth of patients accessing the facilities, which was taken as a proxy for the wealth of the population in the catchment area; and (ii) facility distance from the district headquarters. We assessed equity in the distribution of inputs through the use of equity ratios, concentration indices and curves. Results We found a significant pro-rich distribution of clinical staff and nurses per 1000 population. Facilities with the poorest patients (most remote facilities) have fewer staff per 1000 population than those with the least poor patients (least remote facilities): 0.6 staff per 1000 among the poorest, compared to 0.9 among the least poor; 0.7 staff per 1000 among the most remote facilities compared to 0.9 among the least remote. The negative concentration index for support staff suggests a pro-poor distribution of this cadre but the 45 degree dominated the concentration curve. The distribution of vaccines, antibiotics, anti-diarrhoeal, anti-malarials and medical supplies was approximately proportional (non dominance), whereas the distribution of oxytocics, anti-retroviral therapy (ART) and anti-hypertensive drugs was pro-rich, with the 45 degree line dominating the concentration curve for ART. Conclusion This study has shown there are inequities in the distribution of health care inputs across public primary care facilities. This highlights the need to ensure a better coordinated and equitable distribution of inputs through regular monitoring of the availability of health care inputs and strengthening of reporting systems.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Ambulatory Care Facilities / Antibiotics / Antihypertensives / Budgets / Catchment areas / Child, Preschool / Decentralization / Delivery of Health Care / Distribution / Drugs / Equality and Human Rights / Equipment and Supplies / Equity / Female / Health care / Health care access / Health care facilities / Health care inputs / Health Care Surveys / Health Facilities / Health insurance / Health Personnel / Health Policy / Health promotion / Health Promotion and Disease Prevention / Health Resources / Health services / Health Services Research / Healthcare Disparities / Human resources / Humans / Infant / Local government / Male / Management / Medical care / Medical equipment / Medical personnel / Medical supplies / Medicine / Medicine & Public Health / Mortality / Patients / Pharmaceutical Preparations / Politics / Polls & surveys / Population / Poverty / Primary care / Primary Health Care / Principal components analysis / Public Health / Public Sector / Resource Allocation / Rural Health Services / Rural Population / Social Class / Social Justice / Social Policy / Socioeconomic factors / Tanzania / Vaccines / Workforce planning