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Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey
  1. Deogratius Bintabara1,2,
  2. Keiko Nakamura1,
  3. Kaoruko Seino1,3
  1. 1 Division of Public Health, Department of Global Health Entrepreneurship, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
  2. 2 Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
  3. 3 Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Professor Keiko Nakamura; nakamura.ith{at}


Objective This study was performed to explore the factors associated with accumulation of multiple problems in accessing healthcare among women in Tanzania as an example of a low-income country.

Design Population-based cross-sectional survey.

Setting Nationwide representative data for women of reproductive age obtained from the 2015–2016 Tanzania Demographic and Health Survey were analysed.

Primary outcome measures A composite variable, ‘problems in accessing healthcare’, with five (1-5) categories was created based on the number of problems reported: obtaining permission to go to the doctor, obtaining money to pay for advice or treatment, distance to a health facility and not wanting to go alone. Respondents who reported fewer or more problems placed in lower and higher categories, respectively.

Results A total of 13 266 women aged 15–49 years, with a median age (IQR) of 27 (20–36) years were interviewed and included in the analysis. About two-thirds (65.53%) of the respondents reported at least one of the four major problems in accessing healthcare. Furthermore, after controlling for other variables included in the final model, women without any type of health insurance, those belonging to the poorest class according to the wealth index, those who had not attended any type of formal education, those who were not employed for cash, each year of increasing age and those who were divorced, separated or widowed were associated with greater problems in accessing healthcare.

Conclusion This study indicated the additive effects of barriers to healthcare in low-income countries such as Tanzania. Based on these results, improving uptake of health insurance and addressing social determinants of health are the first steps towards reducing women’s problems associated with accessing healthcare.

  • access to health care
  • women
  • Tanzania

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  • Contributors DB originated the design of the study, performed statistical analysis, interpretation and drafted the manuscript. KN contributed to the design of the study and the interpretation advice of data. KS contributed to interpretation advice of data and drafted the manuscript. Both DB, KN and KS critically revised the draft manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The original TDHS-MIS protocols were reviewed by the Institution al Review Board (IRB) of ICF Macro at Calverton in the USA and by the National Institute of Medical Research (NIMR) IRB in Tanzania.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets used for the current analysis were generated from the original survey of Tanzania DHS-MIS datasets available from within the DHS programme repository: