Year: 2026 | Month: July | Volume: 13 | Issue: 7 | Pages: 114-138
DOI: https://doi.org/10.52403/ijrr.20260715
Catastrophic Health Expenditures in Urban Tanzania: Magnitude, Determinants, and Financial Risk Across Healthcare Delivery Systems
Omar J Ame1,Prof. Dr. Alphonce G. Kyessi 2 Prof. Dr. Wilbard J Kombe3
1Institute of Human Settlement Studies - Ardhi University, Dar es Salaam Tanzania
2Institute of Human Settlement Studies - Ardhi University, Dar es Salaam Tanzania
3Institute of Human Settlement Studies - Ardhi University, Dar es Salaam, Tanzania .
Corresponding Author: Omar J Ame
ABSTRACT
Background: Achieving Universal Health Coverage (UHC) requires equitable access to healthcare without exposing households to financial hardship. Despite health financing reforms in Tanzania, evidence on healthcare affordability and catastrophic health expenditure (CHE) across healthcare delivery levels remains limited. This study assessed healthcare affordability, catastrophic health expenditure, and determinants of financial vulnerability among outpatient users attending referral, private, and city-led healthcare facilities in Dar es Salaam.
Methods: A comparative cross-sectional design was employed in five healthcare facilities representing referral, private, and city-led healthcare systems. Data were collected from outpatient users using a structured questionnaire. CHE was measured as the proportion of household income spent on healthcare. Descriptive statistics assessed affordability and CHE, while multiple linear regression examined the influence of household income and healthcare expenditure on financial risk.
Results: Findings revealed variations in CHE across facility types. Most respondents experienced low-to-moderate CHE; however, low-income households, unemployed individuals, widows, and households with large dependency burdens were disproportionately affected. Referral facilities exhibited a higher risk of catastrophic expenditure than primary healthcare facilities. Regression analysis showed that household income was negatively associated with CHE, whereas healthcare expenditure was positively associated with CHE across all facility categories (p < 0.001). Model explanatory power ranged from R² = 0.629 to R² = 0.857, indicating that household income and healthcare expenditure were the principal determinants of financial hardship. Primary healthcare facilities recorded lower CHE levels, suggesting improved affordability and financial protection.
Conclusion: Healthcare affordability in urban Tanzania is strongly influenced by household economic capacity and healthcare costs. Strengthening primary healthcare financing, expanding insurance coverage, reducing out-of-pocket payments, and implementing targeted financial protection measures are critical for reducing CHE and accelerating progress toward Universal Health Coverage.
Keywords: Healthcare; Affordability; Catastrophic Health Expenditure; Financial Risk Protection; Universal Health Coverage..
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