Mosha Peter Elia, Msengwa Amina S, Selemani Majige
Department of Population Studies, Institute of Rural Development Planning, Dodoma, Tanzania.
Department of Statistics, University of Dar Es Salaam, Dar Es Salaam, Tanzania.
BMC Public Health. 2025 Aug 26;25(1):2920. doi: 10.1186/s12889-025-22909-8.
Healthcare accessibility remains a critical challenge in many low-and middle-income countries, where disparities between rural and urban areas persist. This study, conducted in Dodoma region, Tanzania, models the determinants of healthcare accessibility, aiming to generate evidence that informs policy interventions for equitable healthcare service delivery in underserved populations.
A cross-sectional survey design was adopted. Data were collected from 1,009 households (urban 556; rural 453) across four selected districts withing Dodoma region, Tanzania, using a structured questionnaire digitized and implemented through KoboToolbox. The bivariate analysis and binary logistics regression were used to assess the determinants of healthcare accessibility. Fairlie decomposition was also used to assess and explain the healthcare accessibility disparity between urban and rural areas.
Among the 1,009 households surveyed, 45% had access to healthcare services, with urban households having higher access compared to rural households. Significant determinants of healthcare accessibility included healthcare insurance cover [(AOR = 72.006 p < 0.001), CI:19.573 - 264.895], household size [(AOR = 0.713, p < 0.05), CI: 0.536 - 0.947], age of the head of household [(AOR = 0.830 p < 0.001), CI:0.785 - 0.878], and Out-of-pocket costs used for the last illness episodes [(AOR = 0.404 p < 0.01), CI:0.139 -1.167]. Additionally, decision-making authority within households, payment methods, and the presence of chronic illness showed significant or partial influence on accessibility. Fairlie's decomposition revealed that health insurance and the age of the head of household account for the largest (93.4%) share of the disparity in healthcare accessibility between urban and rural households. These findings underscore the complexity of healthcare access, providing actionable insights for policy interventions to address rural-urban disparities.
The study highlights the importance of health insurance coverage in improving healthcare access, emphasizing the need for targeted policy interventions to address rural-urban disparities and improve health outcomes, considering unique rural household needs.
在许多低收入和中等收入国家，医疗服务可及性仍然是一项严峻挑战，城乡差距持续存在。本研究在坦桑尼亚多多马地区开展，对医疗服务可及性的决定因素进行建模，旨在生成证据，为在服务不足人群中公平提供医疗服务的政策干预提供参考。
采用横断面调查设计。使用通过KoboToolbox数字化实施的结构化问卷，从坦桑尼亚多多马地区四个选定地区的1009户家庭（城市556户；农村453户）收集数据。采用双变量分析和二元逻辑回归评估医疗服务可及性的决定因素。还使用Fairlie分解法评估和解释城乡之间的医疗服务可及性差距。
在接受调查的1009户家庭中，45%能够获得医疗服务，城市家庭的可及性高于农村家庭。医疗服务可及性的重要决定因素包括医疗保险覆盖情况[调整后比值比（AOR）=72.006，p<0.001，可信区间（CI）：19.573 - 264.895]、家庭规模[AOR=0.713，p<0.05，CI：0.536 - 0.947]、户主年龄[AOR=0.830，p<0.001，CI：0.785 - 0.878]以及上次患病期间的自付费用[AOR=0.404，p<0.01，CI：0.139 - 1.167]。此外，家庭内部的决策权、支付方式以及慢性病的存在对可及性有显著或部分影响。Fairlie分解显示，医疗保险和户主年龄在城乡家庭医疗服务可及性差距中占最大比例（93.4%）。这些发现凸显了医疗服务可及性的复杂性，为解决城乡差距的政策干预提供了可操作的见解。
该研究强调了医疗保险覆盖在改善医疗服务可及性方面的重要性，强调需要有针对性的政策干预来解决城乡差距并改善健康结果，同时考虑农村家庭的独特需求。
