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Urban Health in Tanzania: Questioning the Urban Advantage

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Abstract

How are health inequalities articulated across urban and rural spaces in Tanzania? This research paper explores the variations, differences, and inequalities, in Tanzania’s health outcomes—to question both the idea of an urban advantage in health and the extent of urban–rural inequalities in health. The three research objectives aim to understand: what are the health differences (morbidity and mortality) between Tanzania’s urban and rural areas; how are health inequalities articulated within Tanzania’s urban and rural areas; and how are health inequalities articulated across age groups for rural–urban Tanzania? By analyzing four national datasets of Tanzania (National Census, Household Budget Survey, Demographic Health Survey, and Health Demographic Surveillance System), this paper reflects on the outcomes of key health indicators across these spaces. The datasets include national surveys conducted from 2009 to 2012. The results presented showcase health outcomes in rural and urban areas vary, and are unequal. The risk of disease, life expectancy, and unhealthy behaviors are not the same for urban and rural areas, and across income groups. Urban areas show a disadvantage in life expectancy, HIV prevalence, maternal mortality, children’s morbidity, and women’s BMI. Although a greater level of access to health facilities and medicine is reported, we raise a general concern of quality and availability in health services; what data sources are being used to make decisions on urban–rural services, and the wider determinants of urban health outcomes. The results call for a better understanding of the sociopolitical and economic factors contributing to these inequalities. The urban, and rural, populations are diverse; therefore, we need to look at service quality, and use, in light of inequality: what services are being accessed; by whom; for what reasons?

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Notes

  1. Variations are found in reported figures based on the data source used: the data sources use different definitions of what defines urban and rural areas (see [20]). In 2002, the politico-administrative definition states an urbanization rate of 16.8%, whereas the density definition shows 33.5% (ibid.).

  2. http://www.tz.undp.org/content/tanzania/en/home/countryinfo.html

  3. This measures smoking prevalence based on current smoking habit—incorporating the number of cigarettes smoked in the past 24 h.

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Acknowledgements

We would like to acknowledge Ifakara Health Institute. In particular, we are grateful to Masuma Mamdani and Eveline Guebbels for their timely supervision, comments, and advice.

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  1. Ifakara Health Institute, Dar es Salaam, Tanzania

    Francis Levira & Gemma Todd

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  1. Francis Levira
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  2. Gemma Todd
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Correspondence to Gemma Todd.

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Francis Levira and Gemma Todd are both first authors

Appendix

Appendix

Appendix: List of abbreviations

AIDS—Acquired immune deficiency syndrome

ANC—Antenatal care

BCG—Bacillus Calmette-Guerin vaccine

BMI—Body mass index

DHS—Demographic health survey

DPT—Diphtheria-tetanus-pertussis vaccine

EA—Enumeration areas

EmOC—Emergency obstetric care

HBS—Household budget survey

HDSS—Health Demographic Surveillance Survey

HIV—Human immunodeficiency virus

ITN—Insecticide-treated net

LGA—Local government authorities

MDG—Millennium Development Goals (MDG)

MKUKUTA—National Strategy for Growth and Poverty Reduction (NSGPR)

MLHSD—Ministry of Lands and Human Settlement

NBS—National Bureau of Statistics

NPEH—National Package of Essential Health

PO-RALG—President’s Office-Regional Administration and Local Government

SAVVY—Sample Vital Registration with Verbal Autopsy

URT—United Republic of Tanzania

WQ—Wealth quintile

Table 7 Indicators of mortality and morbidity for urban and rural Tanzania
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Levira, F., Todd, G. Urban Health in Tanzania: Questioning the Urban Advantage. J Urban Health 94, 437–449 (2017). https://doi.org/10.1007/s11524-017-0137-2

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