The Systematic Integration of Health Care Market and Urban Poverty in Tanzania

This study analyses the systemic behaviour of the dynamics of a health care system in its interraction with poverty. Specifically, this study ex- amine how urban poverty (including the spatial dimension of poverty) shapes the functioning of the commercialised health care system, in terms of the interplay between the institutional design, the operation of health care providers and micro-level household behaviour – in partic- ular people’s health seeking behaviour . The deregulation and liberalisa- tion of the health sector adopted in Tanzania from early 1990’s has brought about a dramatic shift in the system of health care delivery, from near exclusive ‘free’ public provisioning towards its extensive commer- cialisation that includes the liberalisation of private health care provision. The prevalence of commercialized health care in this sense: fee based, requiring out of pocket payment in all sectors, in the context of wide spread poverty raises issues concerning access of the poor to health care services. In this respect, an influential view in the literature and in policy practice – postulates that the commercialization of health care services will move the better off towards the private facilities in the public-private mix, thereby freeing the subsidized public health facilities for the use of the poor (Gwatkin 2003). However, contrary to policy intentions, this study finds out the urban poor frequently find themselves excluded not only from (decent) private health care, but also from access to public health care, given the current subsidy structure, its use within an exten- sively fee-based (commercialized) health system – in both public and private sectors – and the prevalence of widespread poverty. Furthemore, this study reveals existence of segmentation in provision and access of health care services in the urban health care market. Th

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