Aspects of Poverty and Health in Tanzania: Does Living in a Poor Area Matter?

Previous studies have consistently found that that there is an inverse relationship between householdlevel poverty and health status, and that poor people tend to live in poor communities. However, what is not well understood is whether and how the average economic status at the community level plays a role in the household poverty–health relationship. This study investigates the concentration of poverty at the community level in Tanzania and its association with the availability and quality of primary health care services, the utilization of primary health care services, and health outcomes among both poor and nonpoor households. The analysis uses an innovative approach of linking household-level data from 1996 Tanzania Demographic and Health Survey with facility information from the 1996 Tanzania Service Availability Survey. A principle component method is used to rank households separately by urban/rural status according to the reported levels of assets ownership and living conditions, and then classifies communities into three socioeconomic groups based on the proportion of households belonging the poorest wealth tercile. On average, both poor and non-poor households living in low poverty concentration areas were found to have better health outcomes and service utilization rates than their counterparts living in high poverty concentration clusters. Consistent with the finding is that high poverty concentration areas were farther way from facilities offering primary health care than were low poverty concentration areas. Moreover, the facilities closest to the high poverty concentration areas had fewer doctors, medical equipment, and drugs. Among poor communities in rural areas, the ten communities with the best women’s body mass index (BMI) measures were found to have access to facilities with a greater availability of equipment and drugs than the ten communities with the worst BMI measures. Although this study does not directly measure quality, the characteristics that differentiate high poverty concentration clusters from low poverty concentration clusters point to quality as more important than physical access among the study population.