Inequities Among the Very Poor: Health Care for Children in Rural Southern Tanzania

"Health inequity refers to health inequalities that are unjust according to some theory of social justice. Thus, the study of health equity involves a value judgment. Awareness is increasing of the importance of development efforts that not only improve the overall burden of disease, but also measure the proportion of this burden borne by poor people and the difference in burden between rich and poor. The aim of these efforts is to work towards keeping inequity to a minimum while health problems are tackled through new initiatives..."

A baseline household survey was performed in 2246 households in 115 rural clusters in 4 districts in an effort to identify inequities in health care on the basis of factors like sex and socioeconomic status for children living in poor rural areas of Tanzania. Questions focussed on the extent to which caregivers' knowledge of illness, efforts to pursue care outside the home, and care in health facilities were consistent with IMCI guidelines and messages. In this region, which has high morbidity and mortality rates, "the main difference between the poorest children and those who are better off is not in the likelihood of falling ill, but in the probability of obtaining suitable treatment once ill. Carers of children from wealthier families had better knowledge about danger signs, were more likely to bring their children to a health facility when ill, and were more likely to have had a shorter journey to the health facility than poorer families. Their children were more likely to have received antimalarials and antibiotics for pneumonia, and were more frequently admitted to a hospital."

"...[C]are-seeking behaviour is worse among poorer families than among the relatively rich, even within a rural Tanzanian society that might easily be assumed to be uniformly poor. Such evidence for health inequities should inform programmes aimed at reducing overall average burden of disease, so that they include strategic components aimed specifically at simultaneously improving health equity.

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