Who's Raising the Bar? A Comparative Analysis of Healthcare Quality in Rural and Urban Primary Care Settings in Tanzania

Background Rural-urban disparities in quality of care and healthcare services utilization is a significant issue in both developed and developing countries. This leads to inequitable access to quality healthcare, poorer health outcomes and poor performance of a health system. Objective This study is dedicated to unveiling the prevailing variation in quality of healthcare across rural and urban Primary Healthcare (PHC) settings in Tanzania. Methods This is a quantitative secondary data analysis using the Star Rating Assessment (SRA) data collected in the fiscal year 2017/2018. Compliance with HCQS was measured by considering service delivery areas of SRA Tool. With the aid of Stata 18, we used Chi Square and Proportion Z tests for comparative analyses in regard to facility level and facility ownership. Spatial variation by region were visualized with the aid of QGIS 3.8 Firenze. Results This study involved 5,933 PHCs, majority of which were rural located (78.3%), public owned (77.2%) and dispensaries (87.7%). On average, 46.9% (95% C.I 32.9% − 35.6%) of Urban health facilities, complied with HCQS compared to 34.3% (95% C.I 32.9% − 35.6%) of rural health facilities. This difference is statistically significant, indicating that urban health facilities are significantly more likely to comply with quality indicators compared to their rural counterparts (z=-8.3, p < 0.001). A disaggregated analysis by facility level and ownership showed higher variation in compliance with HCQS among rural compared to urban health facilities. Conclusions This study demonstrates prevailing disparities in compliance with HCQS between Urban and Rural health facilities. To ensure equitable accessibility to quality healthcare services, this significant gap should be worked on including equitable allocation of HRH, improving infrastructure and the availability of health commodities in rural settings.