VU Research Portal
Health care for chronic diseases in rural Tanzania
Mwangome, M.N.
2016
document version
Publisher's PDF, also known as Version of record
Link to publication in VU Research Portal
citation for published version (APA)
Mwangome, M. N. (2016). Health care for chronic diseases in rural Tanzania: Including non-communicable
diseases in primary care towards health for all.
General rights
Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain
• You may freely distribute the URL identifying the publication in the public portal ?
Take down policy
If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
E-mail address:
vuresearchportal.ub@vu.nl
Contents
ŚĂƉƚĞƌϭ'ĞŶĞƌĂů/ŶƚƌŽĚƵĐƟŽŶ 11
Background 16
1.1 Health care system in Tanzania 16 1.2 Health status and government strategies 16 ϭ͘ϰWƵďůŝĐĂĚŵŝŶŝƐƚƌĂƟŽŶŝŶdĂŶnjĂŶŝĂ 17 ϭ͘ϲ,ĞĂůƚŚƐĞƌǀŝĐĞŽƌŐĂŶŝnjĂƟŽŶ 20 1.7 HIV care and treatment in Tanzania 21 1.8 Diabetes care and treatment in Tanzania 22
References 23
ŚĂƉƚĞƌϮdŚĞŽƌĞƟĐĂůĐŽŶĐĞƉƚƐ 31
2.1 The concepts of health care services, primary care and primary health care 33
2.2. Conceptual framework for the thesis 34
References 38
Chapter 3 Research design 41
ϯ͘ϭĞŶƚƌĂůƌĞƐĞĂƌĐŚƋƵĞƐƟŽŶĂŶĚƐƵďͲƋƵĞƐƟŽŶƐ 43 3.2 Research approach 45
3.3. Study area 47
3.4. Research design 48 3.5 Trustworthiness of the research 53 ϯ͘ϲ ƚŚŝĐĂůĐŽŶƐŝĚĞƌĂƟŽŶƐ 54 3.7. Outline of the thesis 55
References 56
ŚĂƉƚĞƌϰ&ĂĐƚŽƌƐ/ŶŇƵĞŶĐŝŶŐůŽŽĚ^ƵŐĂƌŽŶƚƌŽůĂŶĚĚŚĞƌĞŶĐĞƚŽŝĂďĞƚĞƐ ĂƌĞWƌĂĐƟĐĞƐŝŶZƵƌĂůdĂŶnjĂŶŝĂŶWĂƟĞŶƚƐZĞŐŝƐƚĞƌĞĚĨŽƌĂƌĞĂŶĚdƌĞĂƚŵĞŶƚ͗
ĂDŝdžĞĚDĞƚŚŽĚƐ^ƚƵĚLJ 59
/ŶƚƌŽĚƵĐƟŽŶ 61
Research design and methods 62
Results 66
Discussion and Conclusion 73
ŚĂƉƚĞƌϱ͞/ĚŽŶ͛ƚŚĂǀĞŽƉƟŽŶƐďƵƚƚŽƉĞƌƐĞǀĞƌĞ͘͟ džƉĞƌŝĞŶĐĞƐĂŶĚƉƌĂĐƟĐĞƐ ŽĨĐĂƌĞĨŽƌ,/sĂŶĚĚŝĂďĞƚĞƐŝŶƌƵƌĂůdĂŶnjĂŶŝĂ͗ĂƋƵĂůŝƚĂƟǀĞƐƚƵĚLJŽĨƉĂƟĞŶƚƐ
and family caregivers 81
Abstract 82 /ŶƚƌŽĚƵĐƟŽŶ 83 Methodology 86 Results 88 Discussion 96 References 100
Chapter 9 General discussion and conclusion 175 ϵ͘ϭ͘^ƵŵŵĂƌLJŽĨƚŚĞŵĂŝŶĮŶĚŝŶŐƐ 177 ϵ͘ϭ͘ϭDŝĐƌŽůĞǀĞů 178 ϵ͘ϭ͘ϮDĞƐŽůĞǀĞů 180 ϵ͘ϭ͘ϯDĂĐƌŽůĞǀĞů 181 ϵ͘Ϯ͘/ŵƉůŝĐĂƟŽŶƐŽĨƚŚĞŵĂŝŶĮŶĚŝŶŐƐ 182 ϵ͘Ϯ͘ϭKƌŐĂŶŝnjĂƟŽŶŽĨƐĞƌǀŝĐĞƐ 183 ϵ͘Ϯ͘Ϯ^ĞůĨͲŵĂŶĂŐĞŵĞŶƚƐƵƉƉŽƌƚ 186 ϵ͘Ϯ͘ϯKƌŐĂŶŝnjĂƟŽŶĂŶĚƉƌĞƉĂƌĂƟŽŶŽĨŚĞĂůƚŚĐĂƌĞƉƌŽǀŝĚĞƌƐ 187 ϵ͘Ϯ͘ϰ,ĞĂůƚŚŝŶĨŽƌŵĂƟŽŶĂŶĚƐƵƉƉůŝĞƐŵĂŶĂŐĞŵĞŶƚ 188 ϵ͘Ϯ͘ϱdŚĞĐŽŵŵƵŶŝƚLJĂŶĚĐĂƌĞĨŽƌĐŚƌŽŶŝĐĚŝƐĞĂƐĞƐ 189 ϵ͘Ϯ͘ϲ/ŵƉůŝĐĂƟŽŶŽĨƚŚĞĮŶĚŝŶŐƐŽŶƉŽůŝĐŝĞƐ 189 ϵ͘Ϯ͘ϳ/ŵƉůŝĐĂƟŽŶƐĨŽƌĨƵƚƵƌĞƌĞƐĞĂƌĐŚ 190 ϵ͘Ϯ͘ϴ/ŵƉůŝĐĂƟŽŶƐŽĨƚŚĞĮŶĚŝŶŐƐĨŽƌĐĂƌĞĂŶĚƚƌĞĂƚŵĞŶƚĨŽƌŽƚŚĞƌĐŚƌŽŶŝĐEƐ 191 ϵ͘Ϯ͘ϵZĞŇĞĐƟŽŶƐŽŶƚŚĞĐŽŶĐĞƉƚƵĂůĨƌĂŵĞǁŽƌŬ 191 ϵ͘ϯZĞƐĞĂƌĐŚƐƚƌĞŶŐƚŚƐĂŶĚůŝŵŝƚĂƟŽŶƐ 193 References 195 ^ƵŵŵĂƌLJ 201 Acknowledgements 209
