DOES PREVENTIVE HEALTH CARE HAVE A CHANCE IN THE CHANGING HEALTH SECTOR IN TANZANIA?

ABSTRACTObjective: To investigate the status and practice of preventive health care (relativeto curative) in the health delivery system at the time when the health sectorreforms are taking place.Design: A cross-sectional, descriptive study. Health services that were considered to bepreventive included child immunisation, chemoprophylaxis, dental care, family planningservices and provision of health and nutrition education- Curative health servicesincluded chemotherapy, psychotherapy, physiotherapy, surgical treatment andradiography.Setting: The study was conducted in Morogoro District between January and May 1999whereby thirty-tour health facilities of varying nature were selected using purposivesampling technique. Care was taken to include all types of health facilities availableand operating in the area.Subjects: Eighty-six medical personnel and two hospital administrators from thirty-fourhealth facilities. The health facilities included twenty-five dispensaries, five health centresand four hospitals. Care was also taken to include health facilities owned by variousinstitutions and organisations, including governmental and Non governmental.Results: Generally, preventive health received little attention compared to the curativehealth measures whereby more than 80% of the medical personnel in some of thefacilities were assigned to curative services. Health personnel reported to spend anaverage of up to 6 hours per day providing curative services such as chemotherapy,surgical treatment, psychotherapy and radiography. On the contrary, they spent about4 hours or less on providing child immunisation and education on nutrition, health andfamily planning. As expected, the type of ownership of a health facility influenced theextent to which preventive measures were included. For example, while all thegovernment owned facilities did provide child immunisation, nutrition education andfamily planning services, some non-governmental facilities were lacking such services.Conclusion: It is obvious that while the provision of curative health care can be leftto the hands of the private suppliers, that of preventive health care needs stronggovernment involvement. It is suggested that deliberate efforts be taken to shift resourcesfrom curative to preventive measures. One way in which such a strategy can be attainedis for the government to set, as a condition for private operators, a minimum levelof preventive measures to be provided by every operator before a permit is issued.However, caution should be taken to ensure that such deliberations do not discourageinvestors in the health sector