A gendered users′ perspective on decentralized primary health services in rural Tanzania
Article first published online: 27 NOV 2013
Copyright © 2013 John Wiley & Sons, Ltd.
The International Journal of Health Planning and Management
How to Cite
Masanyiwa, Z. S., Niehof, A. and Termeer, C. J. A. M. (2013), A gendered users′ perspective on decentralized primary health services in rural Tanzania. Int. J. Health Plann. Mgmt.. doi: 10.1002/hpm.2235
- Article first published online: 27 NOV 2013
- Manuscript Accepted: 30 OCT 2013
- Manuscript Revised: 29 SEP 2013
- Manuscript Received: 31 MAY 2013
- health service users;
- primary healthcare
Since the 1990s, Tanzania has been implementing health sector reforms including decentralization of primary healthcare services to districts and users. The impact of the reforms on the access, quality and appropriateness of primary healthcare services from the viewpoint of users is, however, not clearly documented. This article draws on a gendered users' perspective to address the question of whether the delivery of gender-sensitive primary health services has improved after the reforms. The article is based on empirical data collected through a household survey, interviews, focus group discussions, case studies and analysis of secondary data in two rural districts in Tanzania. The analysis shows that the reforms have generated mixed effects: they have contributed to improving the availability of health facilities in some villages but have also reinforced inter-village inequalities. Men and women hold similar views on the perceived changes and appropriateness to women on a number of services. Gender inequalities are, however, reflected in the significantly low membership of female-headed households in the community health fund and their inability to pay the user fees and in the fact that women's reproductive and maternal health needs are as yet insufficiently addressed. Although over half of users are satisfied with the services, more women than men are dissatisfied. The reforms appear to have put much emphasis on building health infrastructure and less on quality issues as perceived by users. Copyright © 2013 John Wiley & Sons, Ltd.