Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey

Abstract

ObjectiveThis study was performed to explore the factors associated with accumulation of multiple problems in accessing healthcare among women in Tanzania as an example of a low-income country.DesignPopulation-based cross-sectional survey.SettingNationwide representative data for women of reproductive age obtained from the 2015–2016 Tanzania Demographic and Health Survey were analysed.Primary outcome measuresA composite variable, ‘problems in accessing healthcare’, with five (1-5) categories was created based on the number of problems reported: obtaining permission to go to the doctor, obtaining money to pay for advice or treatment, distance to a health facility and not wanting to go alone. Respondents who reported fewer or more problems placed in lower and higher categories, respectively.ResultsA total of 13 266 women aged 15–49 years, with a median age (IQR) of 27 (20–36) years were interviewed and included in the analysis. About two-thirds (65.53%) of the respondents reported at least one of the four major problems in accessing healthcare. Furthermore, after controlling for other variables included in the final model, women without any type of health insurance, those belonging to the poorest class according to the wealth index, those who had not attended any type of formal education, those who were not employed for cash, each year of increasing age and those who were divorced, separated or widowed were associated with greater problems in accessing healthcare.ConclusionThis study indicated the additive effects of barriers to healthcare in low-income countries such as Tanzania. Based on these results, improving uptake of health insurance and addressing social determinants of health are the first steps towards reducing women’s problems associated with accessing healthcare.

Factors associated with perceived barriers of health care access among reproductive-age women in Ethiopia: a Secondary data analysis of 2016 Ethiopian Demographic and Health Survey

“…Thus, women who reside in rural areas the odds of perceived barriers of health care access were two times higher compared to urban dwellings. This finding was consistent in previous studies in Tanzania, Ghana and South Africa [11,17,29]. This could be because rural areas are associated with lower geographical accessibility of health facilities.…”

“…Divorced/separated women had an increased perceived barriers of health care access compared to married one. This finding was in line with previous studies [13,14,17]. This could be explained by those married women who may have better economic and psychosocial support from their partners to access health care [30].…”

“…However, the current study result showed that higher magnitude of perceived barriers, despite the global efforts for universal health access for all peoples of the world. Moreover, this finding was higher than study reports from Tanzania 65% [17] and 64.5% in South Africa [29]. This could be explained socio-cultural and economic difference among countries which may affect health-seeking behaviors.…”

“…If a woman faced at least one or more of the problems (money, distance, companionship, and permission) we considered as there is perceived barriers to health care access and coded as "1", whereas if she didn't report money, distance, companionship, and permission related barriers we considered as no perceived barrier of health care access and coded as "0" [3,17].…”

“…It agreed that socio-demographic, cultural, and geographical and literacy level and economic conditions plays a vital role to affect the accessibility and utilization of health care services among women [11][12][13][14][15]. Reproductive, maternal, newborn and child health are indictors of equity in health care access in the country [16][17][18][19][20]. Difficulties to access health care among reproductive-age women may lead to different negative health outcomes such as unwanted pregnancies resulted from low family planning use, maternal and child mortality from home delivery [7,9,[19][20][21].…”