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Perception of citizens regarding health workers’ presence and quality of service since 2015

  • But lack of medicine and other essential supplies continues to be a major challenge
10 August 2016, Dar es Salaam: Just one out of five citizens (18%) say that doctor absenteeism has been an issue in their local health facility in the past three months. When asked whether the presence of doctors was a problem in 2015, almost half (43%) of the citizens said it was. Similarly, 3 out of 10 citizens (27%) feel that they did not get attention or respect from staff in 2016, compared to 42% complaining about this in 2015. The cleanliness of health facilities also seems to have improved: in 2016 11% saw this as an issue compared to 29% in 2015. Complaints about cost have also decreased: in 2015 34% of citizens felt that services were too expensive or that they were unable to pay whereas in 2016 19% thought that this was a problem. At the same time, there are still significant shortages of medicine and other supplies: in 2015, more than half of citizens (53%) reported this compared to 59% in 2016.

These findings were released by Twaweza in a research brief titled Signs of recovery? Citizens’ views on heath service provision by the new government. The brief is based on data from Sauti za Wananchi, Africa’s first nationally representative high-frequency mobile phone survey. The findings are based on data collected from 1,836 respondents across Mainland Tanzania (Zanzibar is not covered in these results) between 2 and 17 May 2016.

Most citizens (61%) seek treatment from government health facilities in 2016 compared to 47% in 2015 who reported visiting a government health facility the last time they were sick. At the same time there has been a reduction in the number of citizens visiting the pharmacy (from 19% in 2015 to 13% in 2016) or doing nothing (from 8% in 2015 to 2% in 2016) when they are sick.

Once at the health facility, three out of four citizens (73%) waited up to an hour to be seen. Once they were seen, the vast majority (92%) report that health professionals explained both their diagnosis and the medicines being prescribed (81%). Seven out of ten citizens (70%) report that they were able to get at least some of the medicine they needed at the health facility itself.

Alongside shortages of medicine and supplies in health facilities generally, citizens also report other significant problems in public hospitals. Of the citizens who have been admitted or accompanied someone to the hospital in the past year, 3 out of 10 said that there were not enough beds (31%), bed sheets (27%), or mosquito nets (29%) in the ward to which they were assigned. And 36% of citizens report that they witnessed bed-sharing in hospitals compared to 30% in 2015.

In addition, policy states that treatment at government health facilities should be provided for free to pregnant women, children under five and those aged over 60 years. However, many citizens report that these groups appear to be paying for treatment: 41% of citizens know of elderly patients who paid for treatment, 35% know of children under five who were asked to pay and 27% know of pregnant women being charged for treatment.

Aidan Eyakuze, Executive Director of Twaweza, said 
“These data hint at some positive changes in the health sector in a fairly short space of time. Citizens are noticing that health workers are more present, more attentive to and more respectful of patients. Facilities appear cleaner too. Yet shortages of medicine and supplies, including beds in hospitals, continue to be a challenge. In the long run we will need a holistic approach to reforming health care to ensure that both staff and supplies are readily available. We will need to carefully consider the evidence – what has worked where and why, what we can learn; incentives – of all those in the chain to deliver health services from the frontlines of doctors and nurses, to the people who order medicines and deliver them, to the staff in the Ministry who make policy decisions; and monitoring – making sure we independently know what is really going on and what citizens are experiencing. For now, these signs of improvement are worthy of praise.”
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