Urban Health in Tanzania: Questioning the Urban Advantage

Abstract

How are health inequalities articulated across urban and rural spaces in Tanzania? This research paper explores the variations, differences, and inequalities, in Tanzania's health outcomes-to question both the idea of an urban advantage in health and the extent of urban-rural inequalities in health. The three research objectives aim to understand: what are the health differences (morbidity and mortality) between Tanzania's urban and rural areas; how are health inequalities articulated within Tanzania's urban and rural areas; and how are health inequalities articulated across age groups for rural-urban Tanzania? By analyzing four national datasets of Tanzania (National Census, Household Budget Survey, Demographic Health Survey, and Health Demographic Surveillance System), this paper reflects on the outcomes of key health indicators across these spaces. The datasets include national surveys conducted from 2009 to 2012. The results presented showcase health outcomes in rural and urban areas vary, and are unequal. The risk of disease, life expectancy, and unhealthy behaviors are not the same for urban and rural areas, and across income groups. Urban areas show a disadvantage in life expectancy, HIV prevalence, maternal mortality, children's morbidity, and women's BMI. Although a greater level of access to health facilities and medicine is reported, we raise a general concern of quality and availability in health services; what data sources are being used to make decisions on urban-rural services, and the wider determinants of urban health outcomes. The results call for a better understanding of the sociopolitical and economic factors contributing to these inequalities. The urban, and rural, populations are diverse; therefore, we need to look at service quality, and use, in light of inequality: what services are being accessed; by whom; for what reasons?

The rural-urban divide in Tanzania: Residential context and socioeconomic inequalities in maternal health care utilization

“…This historical legacy reverberates in the form of a rural-urban divide in health care with the disproportionate distribution of MHC in urban areas [ 10 ]. The health infrastructures that currently exist in rural areas are likely to have inadequate drug supplies [ 11 ], lack maternal health experts, and be geographically isolated [ 12 , 13 ]. The presence of the unequal distribution of healthcare facilities between rural and urban areas [ 8 , 14 , 15 ], and the pyramidal health care system favors urban residents than rural residents in Tanzania [ 16 ].…”

“…A significantly higher percentage of women from urban areas (48.0%) used postnatal care than rural women (28.9%) [ 17 ]. Given the extreme disparities in health care resources between rural and urban populations [ 11 , 18 ], it is surprising that very little attention has been given to the role of the residential context in modifying socioeconomic status (SES) inequalities in MHC utilization in Tanzania.…”

Outcomes within a year following first ever stroke in Tanzania

“…of pocket payment for health services hinders timely health seeking behavior for stroke survivors [27]. Interestingly higher mortality rates have also been observed in the urban compared to rural areas of Asia (42% vs 30%) due to free annual lipid level screening offered for rural residents hence timely intervention for abnormal lipid levels and higher lipid levels were observed in urban area residents than rural residents [28,29].…”

"I was tricked": understanding reasons for unintended pregnancy among sexually active adolescent girls

“…With a lack of information comes limited autonomy and capacity among rural adolescents to negotiate protected sex compared to their urban counterparts. Previous studies have alluded to urban advantage in access to health care services in SSA [ 38 , 39 ]. Thus, higher unintended pregnancy among adolescent girls residing in rural areas may reflect rural disadvantages in access to family planning services.…”