Patient-health provider relationships in the context of health care reforms in Tanzania: the case of health facilities in Muleba and Chato districts

Previous studies on health care reforms in Tanzania reported that structural aspects of health care have improved significantly since the implementation of the ongoing health care reforms that started in 1990s. However, the nature of patient-health provider relationships during these reforms has remained unclear. This study was conducted to reveal the nature of the relationships and their determinants, using a case study of two districts of Kagera Region. Surveys (390) were administered to health care users selected by systematic random sampling. Focus group discussions (FGDs) were conducted with health care users and nurses, whereas in-depth interviews (IDIs) were used for other cadres of health providers and health care users with different modes of access to health care. The study findings indicate that patient-health provider relationships in the study areas are largely paternalistic in both public and private health facilities, although the level of paternalism is significantly higher in the former. Patients with exemptions and waivers significantly face more paternalism than their counterparts under user fees and health care insurance. Due to this paternalism in health care encounters, patients’ trust on health providers has largely decreased due to the fact that patients’ trust increases with improvement in clinical relationships. A patient experiences mutual or paternalistic patient-health provider relationship depending on one’s mode of access to health care, level of education, and the type of health facility one attends. Health providers use the existing structural constraints at health facilities to justify the perpetuation of paternalistic patient-health provider relationships, which are in their favour. Mechanisms need to be devised within the framework of the current healthcare reforms to improve patient-health provider relationships as the improvement of structural aspects of health care alone will not automatically lead to improved clinical relationships.