Health Care Dar Es Salam Health And Social Care Essay

Access to public facility is considered as the ease in accessing the available or provided services by a certain community or group of people , public facilities such as Health services are one of the most important services required for both urban and rural settlers, but large amount of the population are associated with low access to such services as a result of certain obstacles to the different users. Hayman classify such barriers into cultural , financial and distance factors. The presence of these factors contributes to underutilization of health services to certain groups in the society.

Components of access

The provision of health facility alone is not an end to the problem of access, but there is need to consider the five elements of access which influence the health seeking behaviour of users . Loue listed the elements as follows, Accessibility, Affordability, Availability, Accommodation and Acceptability, while Obrist et al, , replace Accommodation with Adequacy in describing the five dimension of access. Each of the following elements of access plays a vital role in the health seeking and utilization of health services.

Accessibility and availability are related to the spatial component of access while acceptability relate with attitude of consumer toward the service providers. Accommodation, as described by Loue, , relate to the policy and organisation of services and consumers ability to access the service at his convenience. Affordability is the non spatial aspect which relates more to socioeconomic status of individual users.

Utilization of Health facilities

Access and Utilization of health services to individuals in the society varies as some individuals are affected by certain barriers and some are not affected. Goudge et al., describes the issue of Affordability as one of the key barriers in Health services utilization which could directly affect the low income groups.

There is need for improvement in the health services sector, as large population of people living in the urban areas lack good access to services provided . The accessibility of services to people, irrespective of their income, age, health and geographical location is considered to be of great social importance.

Health care in underdeveloped countries

The nature of health care system and delivery in most underdeveloped countries is not very impressive, Philips expresses that majority of the population in underdeveloped countries do not have access to good health care system. The need for improvement in health care system in most developing countries is highly anticipated as there is constant population increase in both rural and urban settlement.

Dar es Salaam Population increase and Health Access.

Dar es Salaam is the fastest growing city in Tanzania and one of the fastest in Sub Saharan Africa. The population of the city grew from only about 3,500 in 1867 to 843,000 in 1978. , The 1988 census recorded the city’s population to be 1,360,850 and currently the city population is estimated at 2.5 million and is growing at 4.3% (Ibid). The relatively high population growth rate is due to increased in birth rates, immigration rates, and more significantly by transient population. Rapid increase in population in Dar es Salam directly leads to development of informal settlement, UNDP, 1992 in Ahmed , explains that over 70% of the population in Dar es salaam live in overcrowded informal settlement which results in chronic poverty and unhealthy living condition. Also, this situation give rise to social and spatial inequality in health status and reduces accessibility to health care services .

Cities all over the world require adequate provision of Health facility in order to aid in improving the quality of lives and wellness of the people; these could be achieved by providing equitable access to the general population irrespective of their socioeconomic status. This equitable access could be both spatial and financial in order to have effective utilization by the general public.


Studies on health facility mainly focused on accessibility to the facilities with relation to distance, White express distance and generalized cost of travel as factors that could influence utilization of facilities by individuals, Lowe made emphasis on the travel time of patient to facilities, and its relationship with the choice of facility to utilize, and also point out the problem of facility choice as essentially a spatial interaction problem(ibid). Nemet & Bailey , also identify the increase in distance between resident and service provider as contributing factor in low utilization of facilities.

Hayman, 2010, Ma & Chi, 2005) analysed the problems and causes of low access to health facilities by minority ethnic groups, they both elaborate on the attitude of service provider toward the minority group as a contributing factor of low utilization by the ethnic minority. Further research where done in access to health facility and the disparities in maternal mortality between the different groups in the society. The utilization of health facility is an important factor in defining access to services as it represents the outcome of access to facility . Kinman , noted that the outcome to measure equal access to health facilities could be regarded as the actual utilization of the facilities .

Analysis on socioeconomic status and utilization of public facility is an area which requires more attention and research in order to identify the socioeconomic factors

That directly and indirectly affects the utilization of the individuals in service utilization. Affordability as a non spatial element of access will be focused on as it relate to the socioeconomic aspect of the individuals.

Research problem

Utilization inconvenience

In planning of health facilities, most effort is made on the provision and locating the facilities, while little concern is made on the utilization of the facilities and factors that determine utilization of the facilities by the different socio economic groups in the society. The utilization of health facilities are faced with different obstacles known as barriers to individuals within the city, each group of individuals depending on their status are faced with different type of challenge which could alter their utilization rate .

Barriers in utilization

Ma & Chi , elaborates on utilization of facility by ethnic minority group in a certain communities is minimal when compared to the ethnic majority. This is as a result of certain barriers faced. Affordability to pay for Health service is a key issue to most low income groups it is believed that this factor of affordability affect the utilization of the health facility.

The cost involved in accessing health facility is said to affect the level of utilization of most low income group, as well as the ethnic minority in most cities. this situation force the affected group to seek for less specialised health care or non professionals . The main issue of concern is the barrier to health care utilization in relation to the affordability of service cost to low income groups.


Affordability may serve as the main barrier in utilization of health facility to certain socioeconomic groups.


To evaluate level of utilization of Primary Health care and the major causes of underutilization of health facilities across different socio economic groups in Dar es Salaam.


To examine the spatial location of Primary Health care facilities in Dar es salaam.

To identify the quality of services provided and the cost involved in accessing the facility.

To identify the health care sought attended by different socio-economic groups in Dar es Salaam and what determine the selection of health care attended.

Research Questions

1.1 How are the Primary Health facilities located?

1.2 How does spatial location affect utilization of facilities?

2.1 What is the level of service provided?

2.2 What is the cost involved in accessing the facilities by different users?

3.1 What are the factors that determine the utilization of certain type of facility?

3.2 What is the difference between the types of health facilities in Dar es Salaam in term of service delivery?

Conceptual framework

The framework for the research work is base on primary health care, and the two categories of health facilities mainly popular in Dar es Salaam. They include the public health care facilities and the private facilities. Direct focused will be made on the location of facilities and the distance to be covered in order to receive health care. The data collection methods include primary and secondary, and the socio economic data from different households. The data analysis will be both by interpretation (manual) and by computation method.

Observation from the analysis will indicate the outcome of utilization of the different facilities and the rate at which socioeconomic status and affordability influences the utilization of the health facilities. Recommendation will be made based on the output of the analysis made.

Primary Health Care.

Public and Private Health facility

Access to Healthcare






Identification of utilization outcome

Level of Utilization


Effect on population

Socioeconomic status.





Spatial location of facilities

Demographic data



Recommendation for policy makers

Figure 1: conceptual frame work

Research design

The figure below shows the procedures and processes that will be followed in the research work. The research work is about utilization of health facilities and how socioeconomic status of individuals affects their Access to health facilities.

The data to be use include aggregated and disaggregated data, household data will be base on the socio economic status of individuals and their perspective towered health delivery and their level of satisfaction toward the health services attended.

Real world problem

Demographic data

Data collection

Identify required data

Utilization of health facility

Access to health care

Develop indicators



Research problem


Research objectives & questions


Compilation & preparation of data

Utilization output

Data analysis

Conclusion recommendation



Fieldwork activities

Post fieldwork activities

(Thesis writing)

Figure 2: research design

Research matrix

Sub objective

Research question

Required data

Data source




*How is the primary health facilities located?

Health facilities and location

Dar es salaam municipal councils

Study the spatial location of health facilities and proximity to residence

Spatial analysis.

*How does distance & location affect utilization?

Distance to facility and socioeconomic data of household

Structured Household survey and health care management.

Comparizm between distance increase and utilization by low-income group.

Descriptive statistics.


*What is the level of service provided?

*what is the cost involved in accessing the facility?

Satisfaction derived from using the facility.

Cost required in accessing the facilities, purchase of medication, and transportation cost,

Household survey.

Facility user and the facility management.

Comparing perception of individuals from different socioeconomic groups

Direct comparizm to users income

Correlation coefficient

Descriptive, statistically.


*What are the factors that determine utilization of certain type of facility?

* What is the difference between the types of health facilities in term of service delivery?

Socioeconomic data

Data of facility types and capacity.

House hold survey

Existing literature on dare s salaam health facility and the health department of the city


Direct evaluation

Direct evaluation from the data.

Direct evaluation