Resource allocation, equality of access and health

Based upon the experience of Tanzania, this paper relates resource allocation in the health sector to the output of health, by contrasting access to and utilization of available health services by urban and rural populations. The writer argues that increased health expenditures alone cannot yield an efficient health care return unless the additional expenditure is spread ‘thinly’, in keeping with the realities of population distribution, transport possibilities, and disease patterns in most poor countries. Detailed data are presented for recurrent and capital expenditures for health facilities at different levels, and the output of those institutions is considered in terms of the volume of services offered. Those services are then measured according to their utilization by urban and rural populations. Because referral systems are found to function only marginally, it is argued that further building of large hospitals is not justified in the present situation of most poor countries. Specifically, the writer describes the ways in which Tanzania is changing its inefficient and unjust health care system. The paper concludes that the major obstacles to change are not shortages of resources or technologic ignorance but social systems that do not place high value upon the health care needs of rural peasants. It is in this way that the professional and elitist interests of the few are often destructive of the needs of the many.