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Health Policy Plan. 2020 Jan 13. pii: czz173. doi: 10.1093/heapol/czz173. [Epub ahead of print]

The effects of medicines availability and stock-outs on household's utilization of healthcare services in Dodoma region, Tanzania.

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Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, PO Box 78 373, Dar es Salaam, Tanzania.
Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.
University of Basel, Basel, Switzerland.
Swiss Centre for International Health (SCIH), Basel, Switzerland.
Health promotion and System Strengthening (HPSS), Dodoma, Tanzania.
School of Public Health and Social Sciences (SPHSS), Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.


Low- and middle-income countries have been undertaking health finance reforms to address shortages of medicines. However, data are lacking on how medicine availability and stock-outs influence access to health services in Tanzania. The current study assesses the effects of medicine availability and stock-outs on healthcare utilization in Dodoma region, Tanzania. We conducted a cross-sectional study that combined information from households and healthcare facility surveys. A total of 4 hospitals and 89 public primary health facilities were surveyed. The facility surveys included observation, record review over a 3-month period prior to survey date, and interviews with key staff. In addition, 1237 households within the health facility catchment areas were interviewed. Data from the facility survey were linked with data from the household survey. Descriptive analysis and multivariate logistic regressions models were used to assess the effects of medicine availability and stock-outs on utilization patterns and to identify additional household-level factors associated with health service utilization. Eighteen medicines were selected as 'tracers' to assess availability more generally, and these were continuously available in ∼70% of the time in facilities across all districts over 3 months of review. The main analysis showed that household's healthcare utilization was positively and significantly associated with continuous availability of all essential medicines for the surveyed facilities [odds ratio (OR) 3.49, 95% confidence interval (CI) 1.02-12.04; P = 0.047]. Healthcare utilization was positively associated with household membership in the community health insurance funds (OR 1.97, 95% CI 1.23-3.17; P = 0.005) and exposure to healthcare education (OR 2.75, 95% CI 1.84-4.08; P = 0.000). These results highlight the importance of medicine availability in promoting access to health services in low-income settings. Effective planning and medicine supply management from national to health facility level is an important component of quality health services.


Dodoma; Medicines availability; Tanzania; healthcare utilization


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