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Equity of inpatient health care in rural Tanzania: a population- and facility-based survey

Grace A Ferry1*, Sean R Dickson2, Godfrey Mbaruku3, Lynn P Freedman4 and Margaret E Kruk5

Author Affiliations

1 Mathematica Policy Research 1100 1st Street Northeast Washington, DC 20011 USA

2 Department of Health Management and Policy University of Michigan School of Public Health 1415 Washington Heights Ann Arbor, MI 48109 USA

3 Ifakara Health Institute Plot 463, Kiko Avenue Mikocheni P.O. Box 78 373 Dar es Salaam Tanzania

4 Department of Population and Family Health Columbia University Mailman School of Public Health 60 Haven Avenue New York, NY 10032 USA

5 Department of Health Policy and Management Columbia University Mailman School of Public Health 600 West 168th Street New York, NY 10032 USA

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International Journal for Equity in Health 2012, 11:7  doi:10.1186/1475-9276-11-7

Published: 15 February 2012



To explore the equity of utilization of inpatient health care at rural Tanzanian health centers through the use of a short wealth questionnaire.


Patients admitted to four rural health centers in the Kigoma Region of Tanzania from May 2008 to May 2009 were surveyed about their illness, asset ownership and demographics. Principal component analysis was used to compare the wealth of the inpatients to the wealth of the region's general population, using data from a previous population-based survey.


Among inpatients, 15.3% were characterized as the most poor, 19.6% were characterized as very poor, 16.5% were characterized as poor, 18.9% were characterized as less poor, and 29.7% were characterized as the least poor. The wealth distribution of all inpatients (p < 0.0001), obstetric inpatients (p < 0.0001), other inpatients (p < 0.0001), and fee-exempt inpatients (p < 0.001) were significantly different than the wealth distribution in the community population, with poorer patients underrepresented among inpatients. The wealth distribution of pediatric inpatients (p = 0.2242) did not significantly differ from the population at large.


The findings indicated that while current Tanzanian health financing policies may have improved access to health care for children under five, additional policies are needed to further close the equity gap, especially for obstetric inpatients.