The Girl-Child and Government Service Provision.pdf - Tanzania ...

Shortages of drugsFour out of the five dispensaries visited during the study donot charge any fees. All services rendered are free. (However,under the ongoing health reforms, all health facilitieseventually will operate either under a system of user feesor a community health fund.) The main problem cited inthese four centres is a chronic shortage of drugs. “It usuallytakes the first seven days of the month to finish our monthlyallocations of drugs,” revealed one health official during theinterviews. Thus, for approximately three weeks of eachmonth those who visit the dispensary, whether children oradults, will be reviewed by the health worker on duty. If theyneed drugs, they will be given the prescription and asked tobuy the medicine in a pharmacy. Because of this, many parentsdon’t take their children to the health facilities, especiallyafter the seventh day of the month.CorruptionRespondents indicated that corruption still exists in districtand regional hospitals and is one of the main problemsthey face. “You must give something for your child toreceive attention and services at these centres,” explainedone respondent. In one community where 20 memberswere interviewed, 12 respondents described the servicesthey receive in the village dispensary as very poor. Whenasked why, they indicated that it is because of corruption.To receive service in that particular dispensary, you mustgive something, they reported. “No giving, no service.”Slow serviceDue to overcrowding, one has to spend long hours in longqueues before receiving services. A person may spend upto six hours in the dispensary waiting for services. Underhealth-sector reforms in Tanzania, a dispensary is supposedto provide health services to 6,000–10,000 people. In oneparticular incidence a dispensary is currently serving over18,000 residents from five villages. Lines and waits are particularlylong in the first few days of the month, whendrugs are available. In fact, once the month’s drug allotmentis gone, very few community members attend dispensaries.The Impact of poor health serviceson girlsPoor health service provision has a very serious, albeit indirect,impact on girls. When a family member is ill, girlsstay at home and take care of the family while the mothertakes the patient to the clinic. The time-cost of accessinghealth services is therefore a further pressure that reducesthe quality of a girl’s experience of education.Distance to the health facility affects not only health serviceprovision but also the time that girls must devote tocaring for family members. Some people have to walk orride a bicycle up to 40 kilometres to reach a health facility.Table 2–4 presents the distances people in the five areasstudies have to traverse to reach a health facility.Poor quality of servicesThe quality of services offered through government healthfacilities locally and at districts and regional hospitals wasrated by 87 per cent of respondents as “average” or“poor” quality. Respondents reported lack of medicine,shortages of health workers and inadequate facilities. Badattitude and unfriendly attention from health workerswere common. Centres did not have places to sit andlacked water. However, in one visited within MoshonoADP in Arusha, the majority of those interviewed indicatedthat though the dispensary needed to be improvedfor better service delivery, they receive very good attentionfrom health workers. The respondents praised theservices that they receive there from health workers.Table 2–4. Estimated distances from home to health facilityHealth facilityMisima dispensary(Misenyi ADP)Kinyamshindo dispensary(Kwamtoro ADP)Kabale dispensary(Lweru ADP)Nduruma health centre(Moshono ADP)Usanda dispensary(Samuye ADP)Furthest villageserved40 kilometres8 kilometres15 kilometres10 kilometres10 kilometresSource: The Girl Child Research Study 200346 The Girl-Child and Government Service Provision