Cost-Sharing in Urban Primary Healthcare in Tanzania: Determinants of Affordability, Equity Implications, and Policy Lessons for Universal Health Coverage

Cost-sharing can mobilize healthcare resources but may create financial barriers to equitable access, particularly among low-income households. This study examined the affordability determinants and equity implications of cost-sharing in urban primary healthcare in Tanzania. A cross-sectional mixed-methods study was conducted at Buguruni and Chanika Health Centres and Vingunguti and Tabata Dispensaries. Data were collected from 480 survey respondents, supplemented by focus group discussions, key informant interviews, and observations. Quantitative data were analyzed using descriptive statistics, chi-square tests, independent-samples t-tests, and regression analysis. Affordability was highest in Vingunguti (77.14%), followed by Buguruni (62.86%) and Chanika (54.29%). Employment was not significantly associated with affordability in Buguruni (p = .769), whereas education was significant in Chanika (p < .001). Marital status was not significant in Vingunguti dispensary (p = .390). Health insurance expenditure was lower than OOP expenditure at three facilities but not at Tabata. Access to exemptions remains limited. Strengthening risk pooling, exemptions, medicine availability, and equitable public financing is essential for advancing UHC.