Patients' perception of public, voluntary and private dispensaries in rural areas of Tanzania.

Eighty percent of rural dispensaries are run by the government and 19% by voluntary organisations that charge for some services. After the re-legalisation of the private health sector in 1991, private dispensaries are also emerging in villages. Privatisation is among the health reform policies of the country. Moreover, cost-sharing will be introduced at public dispensaries soon. Perception of 320 patients in the Coast Region of Tanzania on services delivered by the three health sectors has been investigated. Results show that patients are generally satisfied with the services and they would go back to the same dispensaries for treatment. Polydrug prescription was common in all sectors, while lack of prescribed drugs was a main complaint among public dispensaries patients. Voluntary dispensaries patients were less satisfied with long waiting time and with staff that did not give them enough information about the treatment. Currently, health service in public dispensaries is free but cost-sharing will be introduced soon. Most of voluntary and private dispensaries patients stated that the fees for service were moderate. The paper discusses the need for monitoring the implementation of cost sharing in public dispensaries to ensure equity in access to services by rural patients.

Capabilities of public, voluntary and private dispensaries in basic health service provision.

A study is reported from the coastal region of the United Republic of Tanzania on the capabilities of public, voluntary and private dispensaries in the provision of peripheral health services. The implications for the future development and coordination of the different sectors are discussed.

PIP: Tanzania's primary health care strategy emphasizes the development of dispensaries and rural health centers, but economic, managerial, and organizational obstacles have delayed implementation of this plan. An evaluation of 18 dispensaries in the districts of Kibaha, Bagamoyo, and Kisarawe demonstrates that the voluntary and private sectors have worked closely with the public sector to strengthen services in this coastal region. To compare the quality of services offered by these three sectors, capability rates (the ratio of existing to expected resources) were calculated for each. The private dispensaries had more modern facilities, a broader range of auxiliary staff, and a higher infrastructure capability (86.1%) than public and voluntary facilities (both 76.1%). Capability for dealing with outpatient problems was 87.8% in the voluntary facilities, 71.2% in private ones, and 66.6% in public dispensaries. Overall, however, the highest capability for providing preventive and curative primary health care services was found in the public dispensaries. Capability in terms of the instruments necessary for delivery was 73.8% in the public dispensaries compared to 33.3% in voluntary and 14.2% in private facilities; the private dispensaries lacked delivery rooms and mother and child health rooms. All public facilities had the equipment necessary for immunizations; only half of the voluntary and none of the private ones were so equipped. The maternal-child health capabilities for the public, voluntary, and private dispensaries were 83.3%, 56.6%, and 13.3%, respectively. Sufficient numbers of mother and child aids were present only in the public sector. All the public dispensaries and two voluntary dispensaries offered at least one type of contraception; no family planning materials were found in the private facilities.