Impact of cost and perceived quality on utilisation of primary health care services in Tanzania: rural-urban comparison

A cross-sectional study was carried out to assess the impact of perceived quality and cost of utilisation of primary health care services, in relation to malaria, in rural and urban districts in Tanzania. This study intended to explore whether there are differences between rural and urban users in terms of their perceptions of quality of health services and how these perceptions affect household decisions in utilising health services. The findings showed that socio-economic variables such as gender, income, education, wealth and household size were important in determining users’ decision making on the amount and appropriate time to seek care and also mitigates effectively on the extent to which cost and perception of quality of care affect rural and urban users of health care services. The majority of rural households spent more time at the facility while waiting to be attended than urban users of health services. Female-headed households were more likely to use health care services more frequently than male-headed households. It was also shown that urban households used health care more frequently than rural ones; and lack of money was not as important as perceived quality both in relation to frequency in using nearby health facilities, and to the delay in seeking care. In conclusion, the perceived quality of health care services is a strong determinant of health care utilisation and it has a differential impact on utilisation of