Capabilities of public, voluntary and private dispensaries in basic health service provision

Abstract

A study is reported from the coastal region of the United Republic of Tanzania on the capabilities of public, voluntary and private dispensaries in the provision of peripheral health services. The implications for the future development and coordination of the different sectors are discussed.

PIP: Tanzania's primary health care strategy emphasizes the development of dispensaries and rural health centers, but economic, managerial, and organizational obstacles have delayed implementation of this plan. An evaluation of 18 dispensaries in the districts of Kibaha, Bagamoyo, and Kisarawe demonstrates that the voluntary and private sectors have worked closely with the public sector to strengthen services in this coastal region. To compare the quality of services offered by these three sectors, capability rates (the ratio of existing to expected resources) were calculated for each. The private dispensaries had more modern facilities, a broader range of auxiliary staff, and a higher infrastructure capability (86.1%) than public and voluntary facilities (both 76.1%). Capability for dealing with outpatient problems was 87.8% in the voluntary facilities, 71.2% in private ones, and 66.6% in public dispensaries. Overall, however, the highest capability for providing preventive and curative primary health care services was found in the public dispensaries. Capability in terms of the instruments necessary for delivery was 73.8% in the public dispensaries compared to 33.3% in voluntary and 14.2% in private facilities; the private dispensaries lacked delivery rooms and mother and child health rooms. All public facilities had the equipment necessary for immunizations; only half of the voluntary and none of the private ones were so equipped. The maternal-child health capabilities for the public, voluntary, and private dispensaries were 83.3%, 56.6%, and 13.3%, respectively. Sufficient numbers of mother and child aids were present only in the public sector. All the public dispensaries and two voluntary dispensaries offered at least one type of contraception; no family planning materials were found in the private facilities.