Health system structure in Tanzania and the characteristics in the study area

There is hierarchically a public health care system in Tanzania that is made of dispensaries, Health Centers (HCS), District Hospitals (DH), Regional Hospitals (RH) and tertiary Hopstals (TH) at zonal and national levels. In line with that, national treatment guidelines specify what health services should be offered at which facility type, and in which cases treatment should be referred to a higher facility level. Dispensaries are the health posts at the grassroot and first point of contact with the health system. Most common illnesses are therefore treated at this level and somewhat at Health Centers before they are refered up wards in case of relatively more severe cases. Any conditions thus, which require in-patient care are referred from the dispensaries to next level, the Health Centers (HCs) and then further up. Formal distinction between dispensaries and Health Centers (HC) is that while the former exclusively provide out-patient care, the later should be able to provide around-the-clock care to patients. Hospitals at the districts and further higher up have extra capacity along with much more sofisticated services as the levels goes up.

The study area, HDSS, covered 25 villages (13 in Kilombero and 12 in Ulanga) districts and constituted more than 124,000 people (Majige, majige). There were six and eight health facilities in Kilombero and Ulanga HDSS areas respectively [14]. Saint Francis Designated District Hospital (SFDDH) is the district hospital for Kilombero, serves a population of 331,167 and is located at Ifakara town. The population in town, Ifakara, which were not part of the HDSS, was 45,700 during the study period, according to the national census of 2002 [14].

Kilombero had only two non-governmental hospitals both located around 75 km apart in the northern part of the district. SFDDH has a capacity of 372 beds and provides in patient services to people not only from Kilombero district but also to those from the neighboring districts, Ulanga, Kilosa and Morogoro rural [15]. For Kilombero and Ulanga districts as a whole, beyond HDSS area, there was one district hospital in Ulanga, seven [7] HCs and 41 dispensaries all together [16].