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Public Reform and the Privatisation of Poverty: Some Institutional Determinants of Health Seeking Behaviour in Southern Tanzania

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Abstract

This paper explores the changing institutional context of health servicedelivery in rural Tanzania through an anthropological analysis of thekinds of healing strategies pursued by men and women when they are ill.In some rural districts popular dissatisfaction with state medicalprovision is not manifested in a rejection of the allopathic medicinewith which it is associated, but in increased reliance on an emerginginformal sector of private medical provision. Although this sectorprovides a valued and accessible service to certain categories ofclients it delivers poor quality treatment, serving to reinforce thecyclical relationship between poverty and ill health. Despite the bestintentions of major public sector reforms neither government nor otheragencies are able to meet rural demand for health services. Reliance onthe parallel market for medical provision is likely to continue, atleast in the short term, with negative consequences for health.

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REFERENCES

  • Allen, T. 1994 Closed Minds, Open Systems: Affliction and Healing in West Nile, Uganda. In A River of Blessings: Essays in Honour of Paul Baxter. D. Brokensha, ed. New York: Maxwell School of Citizenship and Public Affairs, 225-246.

    Google Scholar 

  • Ata-Okei, H.R. 1994 Maternal and Child Health Care in Teso, Uganda: Social Issues. In Gender Health and Sustainable Development. Wijeyaratne, P. et al., eds. Ottawa, International Development Research Centre, 205-210.

    Google Scholar 

  • Bloom, G. and M. Segall 1992 Expenditure and Financing of the Health Sector in Kenya. Abridged Report of A Study Performed for the Ministry of Health and the World Bank. IDS Commissioned Study 9, Brighton, Institute of Development Studies.

    Google Scholar 

  • Booth, D., F. Lugangira, P. Masanja, A. Mvungi, R. Mwaipopo, J. Mwami and A. Redmayne 1993 Social, Econimic and Cultural Change in Contemporary Tanzania: A People Oriented Focus. Stockholm: SIDA.

    Google Scholar 

  • Bryceson, D.F. 1995 Gender Relations in Rural Tanzania: Power Politics or Cultural Consensus. In Gender, Family and Household in Tanzania. Creighton, C. and C.K. Omari, eds. Aldershot: Avebury, 37-69.

    Google Scholar 

  • Caplan, P. 1997 African Voices, African Lives: Personal Narratives from a Swahili Village. London: Routledge.

    Google Scholar 

  • Chambers, R. 1983 Rural Development: Putting the Last First. London: Longman.

    Google Scholar 

  • Cresse, A. 1991 User Charges for Health Care: A Review of Recent Experience. Health Policy and Planning 16(4), 309-319.

    Google Scholar 

  • Crook, R. 1994 Four Years of the Ghana District Assemblies in Operation: Decentralization, Democratization and Administrative Performance. Public Administration and Development 14, 339-364.

    Google Scholar 

  • Doriye, J. 1992 Public Office and Private Gain: An Interpretation of the Tanzanian Experience. In Development Policy and Public Action.Wuyts, M.,M. Mackintosh and T. Hewitt, eds. Oxford: Open University Press, 91-113.

    Google Scholar 

  • Escobar, A. 1995 Encountering Development: The Making and Unmaking of the Third World. Princeton: Princeton University Press.

    Google Scholar 

  • The Express (uncredited) 1998 A Death Trap! The Express Dar es Salaam, 480, July 23-29.

  • Feierman, S. 1985 Struggles for Control: The Social Roots of Health and Healing in Modern Africa. African Studies Review 28(2/3), 73-147.

    Google Scholar 

  • Galabawa, J. 1994 Status and Challenges of the Tanzania Primary and Secondary Education. In Development Challenges and Strategies for Tanzania. Msambichaka, L. et al., eds. Dar es Salaam: Dar es Salaam University Press, 291-306.

    Google Scholar 

  • Good, B.J. 1994 Medicine, Rationality and Experience: An Anthropological Perspective. Cambridge: Cambridge University Press.

    Google Scholar 

  • Government of Tanzania 1983 United Republic of Tanzania: Statistical Abstracts 1982. Dar es Salaam: Ministry of Planning and Economic Affairs.

    Google Scholar 

  • 1988 Tanzania Sensa 1988. 1988 Population Census Preliminary Report. Dar es Salaam: Bureau of Statistics, Ministry of Finance, Economic Affairs and Planning.

    Google Scholar 

  • Green, M. 1993 The Construction of 'Religion' and the Perpetuation of 'Tradition' Among Pogoro Catholics. Southern Tanzania, Ph.D. thesis, University of London.

  • 1994 Shaving Witchcraft in Ulanga: Kunyolewa and the Catholic Church. In Witchcraft in Contemporary Tanzania. R.G. Abrahams, ed. Cambridge: African Studies Centre.

  • 1995 Why Christianity is the Religion of Business: Perceptions of the Church and Christianity among Pogoro Catholics in Southern Tanzania. Journal of Religion in Africa 35(1), 25-47.

  • 1996 Medicines and the Embodiment of Substances among Pogoro Catholics, Southern Tanzania. Journal of the Royal Anthropological Institute, NS 2, 1-14.

  • 1997 Witchcraft Suppression Practices and Movements: Public Politics and the Logic of Purification. Comparative Studies in Society and History 39(2), 319-345.

  • 1999 Trading on Inequality: Gender and the Drinks Trade in Southern Tanzania. Africa 69(3), 83-114.

  • The Guardian (uncredited) 1998 Untitled article. The Guardian, December 1: Dar es Salaam.

  • Harwood, A. 1970 Witchcraft, Sorcery and Social Categories among the Safwa. Oxford: Oxford University Press.

    Google Scholar 

  • Hirshchmann, D. and M. Vaughan 1983 Food Production and Income Generation in a Matrilineal Society: Rural Women in Zomba, Malawi. Journal of Southern African Studies 10(1), 87-85.

    Google Scholar 

  • Holmboe-Ottesen, G. and M. Wandel 1991 "Wife, Today I Only Had Money for Pombe." Gender and Food: Women's Bargaining Power and Agricultural Change in a Tanzanian Community. In Gender and Change in Developing Countries. Stolen, K. and M. Vaa, eds. Oslo: Norwegian University Press.

    Google Scholar 

  • Janzen, J. 1978 The Quest for Therapy in Lower Zaire. Berkeley, University of California Press.

    Google Scholar 

  • Kiwara, A. 1994 Health and Health Care in Structurally Adjusting Tanzania. In Development Challenges and Strategies for Tanzania: An Agenda for the 21st Century.

  • Msambichaka, L., P. Moshi and F. Mtatifikolo, eds. Dar es Salaam: Dar es Salaam University Press, 269-290.

  • Lennock, J. 1994 Paying for Health: Poverty and Structural Adjustment in Zimbabwe. Oxford: Oxfam.

    Google Scholar 

  • Lugalla, J. 1995 Adjustment and Poverty in Tanzania. Bremen: Informationzentrum Afrika.

    Google Scholar 

  • Ministry of Health 1999a Health Sector Reform Programme of Work. Dar es Salaam: Ministry of Health.

    Google Scholar 

  • 1999b Health Sector Public Expenditure Review. Dar es Salaam: Ministry of Health.

    Google Scholar 

  • 1997 Policy Implications of Adult Morbidity and Mortality: End of Phase One Report. Dar es Salaam, United Republic of Tanznaia.

    Google Scholar 

  • Moore, H.L. and M. Vaughan 1988 Cutting Down Trees: Gender, Nutrition and Agricultural Change in Northeast Zambia. London: James Currey.

    Google Scholar 

  • Munishi, G. 1995 Social Services Provision in Tanzania: The Relationship Between Political Development Strategies and NGO Participation. In Service Provision Under Stress in East Africa. Semboja, J. and O. Therkildsen, eds. London: Heinemann, 141-152.

    Google Scholar 

  • Mwenesi, H.A. 1994 Women and Decision Making for Their Children's Health Care. In Gender, Health and Sustainable Development. Wijeyaratne, P. et al., eds. Ottawa: International Development Research Centre, 117-126.

    Google Scholar 

  • Narayan, D. 1997 Voices of the Poor. Poverty and Social Capital in Tanzania. Washington D.C.: World Bank.

    Google Scholar 

  • Ngubane, H. 1977 Body and Mind in Zulu Medicine. London: Academic Press.

    Google Scholar 

  • Oths, K. 1994 Health Care Decisions of Households in Economic Crisis: An Example from the Peruvian Highlands. Human Organization 53(3), 245-254.

    Google Scholar 

  • Prins, G. 1989 But What Was the Disease? The Present State of Health and Healing in African Studies. Past and Present 124, 159-179.

    Google Scholar 

  • Puja, G. et al. 1994 Girls in Education and Pregnancy at School. In Chelewa, Chelewa: The Dilemma of Teenage Girls. Tumbo-Masabo, Z. et al., eds. Uppsala: Scandinavian Institute of African Studies, 54-75.

    Google Scholar 

  • Raikes, A. 1989 Women's Health in East Africa. Social Science and Medicine 28(5), 447-459.

    Google Scholar 

  • Scheper-Hughes, N. 1992 Death Without Weeping: The Violence of Everyday Life in Brazil. Berkeley: University of California Press.

    Google Scholar 

  • Semboja, J. 1995 State Financing of Basic Social Services During the Structural Adjustment Period in Tanzania. In Beyond Structural Adjustment Programmes in Tanzania: Successes, Failures and New Perspectives. Msambicha, L., A. Kilindo and G. Mjema, eds. Dar es Salaam: Economic Research Bureau, 149-168.

    Google Scholar 

  • Sender, J. and S. Smith 1990 Poverty, Class and Gender in Rural Africa: A Tanzanian Case Study. London: Routledge.

    Google Scholar 

  • Shen-Lang, T. et al. 1994 Financing Health Services in China: Adapting to Economic Reform. IDS Research Report 26. Brighton: Institute of Development Studies.

    Google Scholar 

  • Swantz, L. 1990 The Medicine Man Among the Zaramo of Dar es Salaam. Uppsala: Scandinavian Institute of African Studies.

    Google Scholar 

  • Tanzania Development Research Group (TADREG) 1997 Education, Health and Water: A Baseline Service Delivery Survey for Rural Tanzania. Dar es Salaam: TADREG Working Paper No 5.

  • Thaddeus, S. and D. Maine 1994 Too Far to Walk: Maternal Mortality in Context. Social Science and Medicine 38(8), 1091-1110.

    Google Scholar 

  • Thomas, I. 1983 Population and Health Facilities in Tanzania: A Description and Analysis of the Relative Location of Population and Health Facilities in 1978. Norwich: University of East Anglia Overseas Development Group.

    Google Scholar 

  • Tripp, A.M. 1997 Changing the Rules: The Politics of Liberalization and the Urban Informal Economy in Tanzania. Berkeley: University of California Press.

    Google Scholar 

  • Tumbo-Masabo, Z. and R. Liljestrom, eds. 1994 Chelewa, Chelewa: The Dilemma of Teenage Girls. Uppsala: Scandinavian Institute of African Studies.

    Google Scholar 

  • Turshen, M. 1984 The Political Economy of Health and Disease in Tanzania. New Brunswick: Rutgers University Press.

    Google Scholar 

  • Vaughan, M. 1991 Curing their Ills: Colonial Power and African Illness. Cambridge: Polity.

    Google Scholar 

  • Waddington, C. and K.A. Enyimayeu 1990 A Price to Pay: Part Two. The Impact of User Charges in the Volta Region of Ghana. International Journal of Health Policy and Management 15(4), 287-312.

    Google Scholar 

  • World Bank 1997 World Development Report 1997. Washington DC: World Bank.

    Google Scholar 

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  1. Department of Social Anthropology, University of Manchester, Manchester, U.K.

    Maia Green

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Green, M. Public Reform and the Privatisation of Poverty: Some Institutional Determinants of Health Seeking Behaviour in Southern Tanzania. Cult Med Psychiatry 24, 403–430 (2000). https://doi.org/10.1023/A:1005686728159

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