Global Public Health
Volume 11, Issue 4, 2016
http://www.tandfonline.com/toc/rgph20/current

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Articles
Access and utilisation of healthcare services in rural Tanzania: A comparison of public and non-public facilities using quality, equity, and trust dimensions
pages 407-422
Elizabeth H. Shayo, Kesheni P. Senkoro, Romanus Momburi, Oystein E. Olsen, Jens Byskov, Emmanuel A. Makundi, Peter Kamuzora & Leonard E.G. Mboera
DOI:10.1080/17441692.2015.1132750
Published online: 17 Feb 2016
ABSTRACT
This study compared the access and utilisation of health services in public and non-public health facilities in terms of quality, equity and trust in the Mbarali district, Tanzania. Interviews, focus group discussions, and informal discussions were used to generate data. Of the 1836 respondents, 1157 and 679 respondents sought healthcare services on their last visit at public or non-public health facilities, respectively. While 45.5% rated the quality of services to be good in both types of facilities, reported medicine shortages were more pronounced among those who visited public rather than non-public health facilities (OR = 1.7, 95% CI 1.4, 2.1). Respondents who visited public facilities were 4.9 times less likely than those who visited non-public facilities to emphasise the influence of cost in accessing and utilising health care (OR = 4.9, CI 3.9–6.1). A significant difference was also found in the provider–client relationship satisfaction level between non-public (89.1%) and public facilities (74.7%) (OR = 2.8, CI: 1.5–5.0), indicating a level of lower trust in the later. Revised strategies are needed to ensure availability of medicines in public facilities, which are used by the majority of the population, while strengthening private–public partnerships to harmonise healthcare costs.

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The impact of global health initiatives on the health system in Angola
pages 475-495
Isabel Craveiro & Gilles Dussault
DOI:10.1080/17441692.2015.1128957
Published online: 13 Jan 2016
ABSTRACT
We assessed the impact of global health initiatives (GHIs) on the health care system of Angola, as a contribution to documenting how GHIs, such as the Global Fund, GAVI and PEPFAR, influence the planning and delivery of health services in low-income countries and how national systems respond. We collected the views of national and sub-national key informants through 42 semi-structured interviews between April 2009 and May 2011 (12 at the national level and 30 at the sub-national level). We used a snowball technique to identify respondents from government, donors and non-governmental organisations. GHIs stimulated the formulation of a health policy and of plans and strategies, but the country has yet to decide on its priorities for health. At the regional level, managers lack knowledge of how GHIs’ function, but they assess the effects of external funds as positive as they increased training opportunities, and augment the number of workers engaged in HIV or other specific disease programmes. However, GHIs did not address the challenge of attraction and retention of qualified personnel in provinces. Since Angola is not entirely dependent on external funding, national strategic programmes and the interventions of GHIs co-habit well, in contrast to countries such as Mozambique, which heavily depend on external aid.