Ifakara Health Institute, Dar es Salaam, Tanzania.
Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
PLoS One. 2024 Nov 22;19(11):e0312258. doi: 10.1371/journal.pone.0312258. eCollection 2024.
The rapid increase in chronic non-communicable diseases (NCDs) poses a major challenge to already strained health systems in sub-Saharan Africa. This study investigates the factors associated with seeking and receiving NCD services in Tanzania, using a household survey and client exit interview data from Kilombero and Same districts. Both districts are predominantly rural, with one semi-urban area called Ifakara town and Same town. Of the 784 household survey respondents, 317 (40.4%), 37 (4.7%), and 20 (2.5%) were diagnosed with hypertension, diabetes mellitus, and other NCDs, respectively, of whom 69% had sought care in the past six months. After controlling for covariates, those enrolled in the National Health Insurance Fund (NHIF) and those who received a user fees waiver were more likely to use health services. However, even when NCD patients managed to access the care they needed, they were likely to receive incomplete services. The main reason for not receiving all services at the health facility visited on the day of the survey was drug stock-outs. Among health care users, those registered with the improved Community Health Funds (iCHF) were less likely to receive all prescribed services at the health facility visited than uninsured patients. The findings of this study highlight the need to strengthen both primary care and social health protection systems to improve access to needed care for NCD patients.
慢性非传染性疾病（NCDs）的迅速增加对撒哈拉以南非洲地区本已紧张的卫生系统构成了重大挑战。本研究利用基利莫贝罗和萨马地区的家庭调查和客户退出访谈数据，调查了坦桑尼亚寻求和获得 NCD 服务的相关因素。这两个地区主要是农村地区，有一个半城市地区叫伊法卡拉镇和萨马镇。在 784 名接受家庭调查的受访者中，分别有 317 人（40.4%）、37 人（4.7%）和 20 人（2.5%）被诊断患有高血压、糖尿病和其他 NCD，其中 69%在过去六个月内寻求过治疗。在控制了协变量后，那些参加国家健康保险基金（NHIF）的人和那些获得费用豁免的人更有可能使用卫生服务。然而，即使 NCD 患者设法获得了所需的护理，他们也可能无法获得完整的服务。在调查当天访问的卫生机构没有获得所有服务的主要原因是药品缺货。在卫生保健使用者中，与未参保患者相比，注册改进社区卫生基金（iCHF）的患者在访问的卫生机构获得所有规定服务的可能性较小。本研究的结果强调需要加强初级保健和社会健康保障系统，以改善 NCD 患者获得所需护理的机会。
