Access to Health Care Facilities in Dar es Salaam City
The objective of this paper is to examine access to health care facilities under the public-private model in urban areas. It focuses specifically on the way issues related to equitable access to health care facilities areaddressed under the public-private model in a rapidly urbanising context. Equitable access to health care has been central agenda in health policy and national development strategies since national political independence. However, the paradigm shift from centralised to decentralised models in health care service delivery has brought out multiple actors in health service delivery, raising concerns on how equitable access to health care services is addressed. The concept of equity is thoroughly discussed and its variables extracted in order to develop a conceptual framework for equitable access to health care services. A case study area is purposively selected from one of the administrative wards in peri-urban areas of Dar es Salaam, to grasp the context of rapid urbanisation and spatial location and utilisation of health care facilities. This paper has found that proliferation of uncoordinated private health care facilities and shrinking of urban public health care services limit equitable access to health care facilities in Dar es Salaam city. In addition, skewed distribution of health care facilities contributes largely to spatial and vertical inequities in access to health care facilities. Although in some extent, the private sector has improved access to health care in urban areas, strong incentives, spatial regulations and clear structure on the modality of engagement and responsibility need to be considered to realise equitable access to urban health care services.
Key words: Hierarchy, administrative units, inner-city, peri-urban areas, public-private model and population.