Accessibility and utilization of eye health services in tertiary hospitals in Dar es Salaam, Tanzania

Abstract

Background of study: Over 250 million people live with vision impairment worldwide. The majority are from low income countries where funds to facilitate eye health services are limited. In Tanzania, prevalence of vision impairment is around 1.9 percent of the total population and 2.8 percent for people above 50 years. Objective: To assess accessibility and utilization of eye health services in tertiary hospitals in Dar es Salaam. Methods: This was a cross-sectional study done at Muhimbili National Hospital and CCBRT. The study employed mixed approach; data was collected using survey questionnaire, in-depth interviews, small group discussion, and observation checklist. The population for this study included eye health patients (n=357) who were randomly selected, whereas eye health workers (n=13) were purposively selected. Quantitative data were analysed by SPSS software where continuous data were analysed using independent t Test and categorical variables were analysed by frequency. Thematic analysis was used to analyse qualitative data. Results: Nearly half (49.3%) of the study participants declared eye services affordability difficult. Over 40% of the study participants rated the overall availability of eye health services including health care workers, waiting hours and medicine difficult. Forty three percent (43%) of study participants had a monthly income of 100,000 TZS and below. One out of every two participants had health insurance, 1/5 of participants with insurance had cover for spectacles. Average transport time to MNH was 397minutes; waiting time was 255.10 minutes and average time taken in the Doctor’s room 28.51 minutes. Patients who visited CCBRT hospital had a longer travel time (458 minutes) average waiting time was shorter (141.13minutes) and time spent in the doctor’s room had no significance difference from that of MNH, 24.53 minutes. Conclusion: Affordability, availability and patient waiting time are greatly linked to accessibility and utilization of eye health services. Long waiting hours and lengthy queue due to inadequate human resource for eye health has been found to be a key issue hampering availability of services. Affordability is still a challenge to patients with health insurance and those who pay out of pocket. Tertiary hospitals can improve this by addressing these barriers when planning for eye health services