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Health Check: A citizen diagnosis of health sector challenges

Archive 29 Aug 2017 hot | Sauti za Wananchi

When injured or ill, 6 out of 10 citizens (61%) seek treatment at a government health facility. This proportion has risen from 45% in 2014 although it has stayed steady since 2016. 

This is in large part due to a drop in people diagnosing or treating themselves by going to a pharmacy (9%), a grocery store for medicine (7%), doing nothing (1%) or seeking other forms of treatment (5%). Data collected since 2014 show a declining use of these alternatives. Citizens using private, church or NGO facilities has remained steady over this period (16% in 2017).

Despite an increasing number of patients, the trend since 2014 has been of more and more citizens waiting for an hour or less to be seen by the doctor. Seven out of ten citizens (70%) waited for an hour or less in 2014 compared to 3 out of 4 (76%) in 2017. However, patients are more likely to wait for an hour or less at private/church/NGO facilities (88% waited for this time) than in government ones (74% waited for an hour or less).

These findings were released by Twaweza in a research brief titled Health check: citizens diagnose health sector challenges. The brief is based on data from Sauti za Wananchi, Africa’s first nationally representative high-frequency mobile phone survey. The findings are based on data collected from 1,801 respondents across Mainland Tanzania (Zanzibar is not covered in these results) in May 2017.

More and more citizens are also satisfied with the cleanliness of facilities (those reporting this as an issue dropped from 29% in 2015 to 9% in 2017) and the level of respect and attention they receive from staff (42% complained about this in 2015 compared to 26% in 2017).

Despite these improvements, citizens continue to experience major challenges in accessing health services. Three out of ten citizens who accompanied someone to the hospital in the past year (29%) found two or more patients sharing beds or mattresses. This is an improvement from 2016 when close to four out of ten (36%) witnessed bed/mattress sharing. 

The trend is more worrying when it comes to accessing medicines and other supplies. Since 2015, there has been a steady increase of citizens reporting that they encountered shortages during their last visit (in the previous three months) to a government health facility. Similarly, increasing numbers of citizens are also complaining about waiting times, up from 53% in 2015 to 63% in 2017.

When it comes to the availability of doctors and the cost of services, progress is mixed. There was a sharp drop in citizens complaining about these issues between 2015 and 2016, but in 2017 the numbers are again rising.

  • Absent doctors was an issue for 43% in 2015, falling to 18% in 2016 and climbing back up to 29% in 2017
  • The cost of services was a problem for 34% of citizens in 2015, 19% in 2016 and 28% in 2017

Twaweza also asked citizens whether, in their experience, government policy is being practiced.

  • Children under five, the elderly and pregnant women are entitled to free treatment in government health facilities. Since 2016 there have been small increases in the number of people in these groups who receive these services for free but a high portion is still forced to pay. Among citizens who accompanied members of these groups to a health facility, 35% were forced to pay for a child under five, 28% were asked to pay for a pregnant woman and 37% had elderly patients who also had to pay.
  • Despite government pronouncements and massive public support (84%) for the victims of accidents, fights or other injuries to be treated before obtaining police clearance, 6 out of 10 citizens who accompanied victims to seek treatment were required to get police clearance before being treated.
  • Insurance, particularly through the Improved Community Health Fund, is a major strategy for the government to expand access to health services. Between 2014 and 2017 the share of people with health insurance rose from 21% to 27%. In total, 13% of citizens report being members of the (Improved) Community Health Fund. At the current rate of increase, Tanzania will achieve universal health insurance coverage in roughly 40 years, around 2055

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