Households’ socio-demographic and health-related characteristics are not expected to hinder progress toward attaining Universal Health Coverage (UHC). The government of Tanzania, in collaboration with other stakeholders in the health sector, has been working hard to improve health services delivery to community members at an affordable cost and accessible environment.
Some of the efforts, among others, include improving the provision of primary healthcare which is easily accessible, affordable, sustainable, and gender considerate. The efforts have been emphasized in the National Health Policy of 2017 and other policy documents. Several studies in Tanzania have assessed the influence and/association of social, economic and demographic characteristics on healthcare financing, access to specific healthcare services, health insurance membership, among others. However, there is paucity of empirical knowledge depicting differences between categories of households’ sociodemographic characteristics and UHC attainment in Kilimanjaro Region. Hence, perceived progress towards attaining UHC in the study area was determined by assessing perceived differences between households’ socio-demographic, health-related characteristics, and UHC factors (accessibility, affordability, and service delivery quality). The study employed a cross-sectional design involving 384 households and 30 health facilities selected through multi-stage and purposive sampling approaches, respectively. Data from households and health facilities were collected through survey questionnaires. UHC and universal access do not mean exactly the same thing but UHC cannot be attained without universal access to health services. It is a norm that households’ socio-demographic and health-related characteristics should not be a hindrance to services access and, thus, to UHC. However, it was shown from the results of this study that households were likely not able to access health services due to falling into certain categories of socio-demographic and healthrelated characteristics. The households’ heads, especially those with low average monthly income and mostly involved in subsistence agriculture, those with no or with low level of education, those without health insurance, and those with non-communicable illnesses were more likely to be deprived of access to the needed healthcare services. Moreover, health checkup behaviour was found to be low among households as most of them sought medical check-up only when they felt sick. High cost of regular health check-up and health insurance nonmembership were among the reasons for poor health check-up. In this case, it becomes difficult to diagnose and control non-communicable diseases.
Moreover, results indicated that the level of UHC service coverage in the study area was 69.9% about the WHO’s threshold of 80%. This score implies that the selected health facilities in the four districts of Kilimanjaro Region had a coverage level of about 70% of health services provision. This score was highly contributed by the domains (Reproductive, Maternal, Newborn, and Child Health domain (RMNCH) and Communicable Diseases Control) which scored above 80%. The reason is that these two domains involve services provided in most of the health
facilities, including health centres. The RMNCH services are highly subsidized by the government in both government and private (especially faith-based) health facilities. For child immunization services, for example, the score was 100%, implying that the services were available at the required level in all the health facilities in the study area. The other two domains (Non-Communicable Diseases Control domain and Services Capacity and Access domain) scored below the WHO’s recommended threshold of 80% where most of them scored low in the
health centres. This is because most of the services falling under the non-communicable diseases control domain were mostly attended to in hospitals which had more healthcare personnel, medical equipment, drugs, and technology.
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