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Beyond antimalarial stock-outs : implications of health provider compliance on out-of-pocket expenditure during care-seeking for fever in South East Tanzania

Mikkelsen-Lopez, Inez and Tediosi, Fabrizio and Abdallah, Gumi and Njozi, Mustafa and Amuri, Baraka and Khatib, Rashid and Manzi, Fatuma and de Savigny, Don. (2013) Beyond antimalarial stock-outs : implications of health provider compliance on out-of-pocket expenditure during care-seeking for fever in South East Tanzania. BMC health services research, Vol. 13 , 444.

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Official URL: http://edoc.unibas.ch/dok/A6194584

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Abstract

To better understand how stock-outs of the first line antimalarial, Artemisinin-based Combination Therapy (ACT) and other non-compliant health worker behaviour, influence household expenditures during care-seeking for fever in the Ulanga District in Tanzania.; We combined weekly ACT stock data for the period 2009-2011 from six health facilities in the Ulanga District in Tanzania, together with household data from 333 respondents on the cost of fever care-seeking in Ulanga during the same time period to establish how health seeking behaviour and expenditure might vary depending on ACT availability in their nearest health facility.; Irrespective of ACT stock-outs, more than half (58%) of respondents sought initial care in the public sector, the remainder seeking care in the private sector where expenditure was higher by 19%. Over half (54%) of respondents who went to the public sector reported incidences of non-compliant behaviour by the attending health worker (e.g. charging those who were eligible for free service or referring patients to the private sector despite ACT stock), which increased household expenditure per fever episode from USD0.14 to USD1.76. ACT stock-outs were considered to be the result of non-compliant behaviour of others in the health system and increased household expenditure by 21%; however we lacked sufficient statistical power to confirm this finding.; System design and governance challenges in the Tanzanian health system have resulted in numerous ACT stock-outs and frequent non-compliant public sector health worker behaviour, both of which increase out-of-pocket health expenditure. Interventions are urgently needed to ensure a stable supply of ACT in the public sector and increase health worker accountability.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Former Units within Swiss TPH > Health Systems and Policies (de Savigny)
UniBasel Contributors:Tediosi, Fabrizio and de Savigny, Donald
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:BioMed Central
ISSN:1472-6963
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:18 Jul 2014 09:09
Deposited On:18 Jul 2014 09:09

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