Universal health coverage for women of reproductive ages: a survey-based comprehensive assessment of service utilisation and health expenditure in Tanzania
Introduction Universal health coverage (UHC) for women of reproductive ages is a critical component of country and global health strategies but most evidence in high-fertility settings is limited to maternity care. Our study aimed to comprehensively assess women’s health service utilisation and expe...
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| Format: | Article |
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/3/1/e000672.full |
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| author | Jim Todd Ties Boerma Peter Binyaruka Mark Urassa Milly Marston Sophia Adam Kagoye Charles Mangya Coleman Kishamawe |
| author_facet | Jim Todd Ties Boerma Peter Binyaruka Mark Urassa Milly Marston Sophia Adam Kagoye Charles Mangya Coleman Kishamawe |
| author_sort | Jim Todd |
| collection | DOAJ |
| description | Introduction Universal health coverage (UHC) for women of reproductive ages is a critical component of country and global health strategies but most evidence in high-fertility settings is limited to maternity care. Our study aimed to comprehensively assess women’s health service utilisation and expenditure, including an equity dimension.Methods We conducted a household survey among 15–49 years as a nested study within the Magu health and demographic surveillance study, northwest Tanzania, during 2020–2021. Data were collected on self-reported health, fertility, utilisation of health services, health expenditure and health insurance. We analysed key indicators by household wealth quintiles, place of residence and health insurance, using logistic regression models controlling for age and other confounders.Results Among 8665 women aged 15–49 years (response rate 81%), 3.0% reported poor or very poor health, 13% gave birth in the preceding year, and health insurance coverage was 5.1%. Coverage of antenatal (99.5%) and institutional delivery care (88%) were high; 7.3% of women reported at least one outpatient visit in the last 4 weeks, of which 81% were for their own non-maternal healthcare; 9.3% had been admitted to a hospital during the last year, and 74% of these admissions were for deliveries. The total average annual health expenditure per woman was about TZS 16 860 (US$7.50), of which 82% was for her own healthcare and 18% for maternity care. Additionally, women spent about TZS 23 172 (US$10.00) per year on self-treatment. The poorest women had poorer self-reported health, lower coverage of maternity care, lower utilisation of services for their own healthcare and lower health insurance coverage, and limited their expenditure by making greater use of nearby public services than richer women.Conclusion Women spent more financial resources on their own non-maternal healthcare than maternity care with poorer women still facing disadvantages for their own healthcare. Health insurance programmes were hardly but were associated with an increase in service use. Comprehensive assessments of women’s health needs, service use and expenditures with an equity focus are crucial for shaping UHC strategies tailored to women of reproductive ages. |
| format | Article |
| id | doaj-art-7d8de33a66844302b32666585a88862e |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Public Health |
| spelling | doaj-art-7d8de33a66844302b32666585a88862e2025-01-17T08:25:09ZengBMJ Publishing GroupBMJ Public Health2753-42942025-01-013110.1136/bmjph-2023-000672Universal health coverage for women of reproductive ages: a survey-based comprehensive assessment of service utilisation and health expenditure in TanzaniaJim Todd0Ties Boerma1Peter Binyaruka2Mark Urassa3Milly Marston4Sophia Adam Kagoye5Charles Mangya6Coleman Kishamawe7Department of Population Health, London School of Health and Tropical Medicine, London, UKCommunity Health Sciences, University of Manitoba, Winnipeg, Manitoba, CanadaIfakara Health Institute, Dar es Salaam, Tanzania, United Republic ofNational Institute for Medical Research Mwanza Research Centre, Mwanza, Tanzania1London School of Hygiene and Tropical MedicineNational Institute for Medical Research Mwanza Research Centre, Mwanza, Mwanza, Tanzania, United Republic ofNational Institute for Medical Research Mwanza Research Centre, Mwanza, Mwanza, Tanzania, United Republic ofNational Institute for Medical Research Mwanza Research Centre, Mwanza, Mwanza, Tanzania, United Republic ofIntroduction Universal health coverage (UHC) for women of reproductive ages is a critical component of country and global health strategies but most evidence in high-fertility settings is limited to maternity care. Our study aimed to comprehensively assess women’s health service utilisation and expenditure, including an equity dimension.Methods We conducted a household survey among 15–49 years as a nested study within the Magu health and demographic surveillance study, northwest Tanzania, during 2020–2021. Data were collected on self-reported health, fertility, utilisation of health services, health expenditure and health insurance. We analysed key indicators by household wealth quintiles, place of residence and health insurance, using logistic regression models controlling for age and other confounders.Results Among 8665 women aged 15–49 years (response rate 81%), 3.0% reported poor or very poor health, 13% gave birth in the preceding year, and health insurance coverage was 5.1%. Coverage of antenatal (99.5%) and institutional delivery care (88%) were high; 7.3% of women reported at least one outpatient visit in the last 4 weeks, of which 81% were for their own non-maternal healthcare; 9.3% had been admitted to a hospital during the last year, and 74% of these admissions were for deliveries. The total average annual health expenditure per woman was about TZS 16 860 (US$7.50), of which 82% was for her own healthcare and 18% for maternity care. Additionally, women spent about TZS 23 172 (US$10.00) per year on self-treatment. The poorest women had poorer self-reported health, lower coverage of maternity care, lower utilisation of services for their own healthcare and lower health insurance coverage, and limited their expenditure by making greater use of nearby public services than richer women.Conclusion Women spent more financial resources on their own non-maternal healthcare than maternity care with poorer women still facing disadvantages for their own healthcare. Health insurance programmes were hardly but were associated with an increase in service use. Comprehensive assessments of women’s health needs, service use and expenditures with an equity focus are crucial for shaping UHC strategies tailored to women of reproductive ages.https://bmjpublichealth.bmj.com/content/3/1/e000672.full |
| spellingShingle | Jim Todd Ties Boerma Peter Binyaruka Mark Urassa Milly Marston Sophia Adam Kagoye Charles Mangya Coleman Kishamawe Universal health coverage for women of reproductive ages: a survey-based comprehensive assessment of service utilisation and health expenditure in Tanzania BMJ Public Health |
| title | Universal health coverage for women of reproductive ages: a survey-based comprehensive assessment of service utilisation and health expenditure in Tanzania |
| title_full | Universal health coverage for women of reproductive ages: a survey-based comprehensive assessment of service utilisation and health expenditure in Tanzania |
| title_fullStr | Universal health coverage for women of reproductive ages: a survey-based comprehensive assessment of service utilisation and health expenditure in Tanzania |
| title_full_unstemmed | Universal health coverage for women of reproductive ages: a survey-based comprehensive assessment of service utilisation and health expenditure in Tanzania |
| title_short | Universal health coverage for women of reproductive ages: a survey-based comprehensive assessment of service utilisation and health expenditure in Tanzania |
| title_sort | universal health coverage for women of reproductive ages a survey based comprehensive assessment of service utilisation and health expenditure in tanzania |
| url | https://bmjpublichealth.bmj.com/content/3/1/e000672.full |
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