Affordability of Out-of-Pocket Payments in Private Health Services Among Low-Income Households in Peri-Urban Dar Es Salaam, Tanzania

Abstract

Background: Healthcare affordability remains a central policy challenge in low-income countries, where weak regulation and market-driven private provision increasingly constrain access to essential services, particularly for vulnerable groups. Objective: This study assesses the affordability of healthcare services for low-income households seeking care at private health facilities in peri-urban Dar es Salaam, Tanzania. Methods: A cross-sectional mixed-methods design was employed between December 2022 and September 2023 across three private health facilities, involving 1,030 respondents aged 18 years and above selected through random sampling. Data were collected using semi-structured interviews, surveys, and focus group discussions. Quantitative data were analyzed using SPSS, with t-tests and chi-square tests used to examine associations between healthcare affordability and socio-demographic characteristics. Results: Affordability remained limited across all facilities. At Cardinal Rugambwa Hospital, 37.14% of females and 31.43% of males reported being able to afford healthcare, while a smaller share reported partial affordability. No statistically significant association was found between affordability and gender at Cardinal Rugambwa Hospital (p = 0.870) or at Tabata Dispensary (p = 0.756). Affordability constraints disproportionately affected unemployed women, widowed, and divorced individuals. Heavy reliance on out-of-pocket payments imposed substantial financial strain, reinforcing household vulnerability and poverty. Conclusion: Reliance on out-of-pocket financing significantly undermines healthcare affordability in private facilities and exposes low-income households to financial risk. Strengthening financial protection mechanisms, enforcing regulations in private healthcare markets, and reducing import tariffs on essential medical supplies are critical to improving affordability, and accelerating progress toward universal health coverage (UHC). Keywords: Affordability; income; out-of-pocket payments; health insurance