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

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.Although government expenditures for health in low- and middle-income countries are intended to ensure access to health care for the poor, they frequently disproportionately benefit wealthier citizens [1,2]. A review of public expenditures on health in 26 developing countries found that the poorest fifth of a population typically received less than a fifth of government expenditures on health [3]. Another study published by O'Donnell and colleagues found that the concentration index of public health spending--a measure of the wealth distribution of spending--in Asia was pro-rich in 7 of the 11 countries/regions studied: Nepal, Bangladesh, Indonesia, India, Vietnam, and Gansu and Heilongjiang provinces in China [4]. The most pro-rich financing was fou