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The market shaping of charges, trust and abuse: health care transactions in Tanzania

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  • Tibandebage, Paula
  • Mackintosh, Maureen

Abstract

Effective health care is a relational activity, that is, it requires social relationships of trust and mutual understanding between providers and those needing and seeking care. The breakdown of these relationships is therefore impoverishing, cutting people off from a basic human capability, that of accessing of decent health care in time of need. In Tanzania as in much of Africa, health care relationships are generally also market transactions requiring out-of-pocket payment. This paper analyses the active constitution and destruction of trust within Tanzanian health care transactions, demonstrating systematic patterns both of exclusion and abuse and also of inclusion and merited trust. We triangulate evidence on charges paid and payment methods with perceptions of the trustworthiness of providers and with the socio-economic status of patients and household interviewees, distinguishing calculative, value based and personalised forms of trust. We draw on this interpretative analysis to argue that policy can support the construction of decent inclusive health care by constraining perverse market incentives that users understand to be a source of merited distrust; by assisting reputation-building and enlarging professional, managerial and public scrutiny; and by reinforcing value-based sources of trust.

Suggested Citation

  • Tibandebage, Paula & Mackintosh, Maureen, 2005. "The market shaping of charges, trust and abuse: health care transactions in Tanzania," Social Science & Medicine, Elsevier, vol. 61(7), pages 1385-1395, October.
  • Handle: RePEc:eee:socmed:v:61:y:2005:i:7:p:1385-1395
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    Cited by:

    1. Maureen Mackintosh, 2006. "Commercialisation, inequality and the limits to transition in health care: a Polanyian framework for policy analysis," Journal of International Development, John Wiley & Sons, Ltd., vol. 18(3), pages 393-406.
    2. Leonard, David K. & Bloom, Gerald & Hanson, Kara & O’Farrell, Juan & Spicer, Neil, 2013. "Institutional Solutions to the Asymmetric Information Problem in Health and Development Services for the Poor," World Development, Elsevier, vol. 48(C), pages 71-87.
    3. Trani, Jean-Francois & Bakhshi, Parul & Noor, Ayan A. & Lopez, Dominique & Mashkoor, Ashraf, 2010. "Poverty, vulnerability, and provision of healthcare in Afghanistan," Social Science & Medicine, Elsevier, vol. 70(11), pages 1745-1755, June.
    4. Bloom, Gerald & Standing, Hilary & Lloyd, Robert, 2008. "Markets, information asymmetry and health care: Towards new social contracts," Social Science & Medicine, Elsevier, vol. 66(10), pages 2076-2087, May.
    5. Kamat, Vinay R., 2006. ""I thought it was only ordinary fever!" cultural knowledge and the micropolitics of therapy seeking for childhood febrile illness in Tanzania," Social Science & Medicine, Elsevier, vol. 62(12), pages 2945-2959, June.
    6. Mohseni, Mohabbat & Lindstrom, Martin, 2007. "Social capital, trust in the health-care system and self-rated health: The role of access to health care in a population-based study," Social Science & Medicine, Elsevier, vol. 64(7), pages 1373-1383, April.
    7. Thomas Porter & Jane Chuma & Catherine Molyneux, 2009. "Barriers to managing chronic illness among urban households in coastal Kenya," Journal of International Development, John Wiley & Sons, Ltd., vol. 21(2), pages 271-290.
    8. Ruth MEENA, 2010. "Nurses and home-based caregivers in the United Republic of Tanzania: A dis-continuum of care," International Labour Review, International Labour Organization, vol. 149(4), pages 529-542, December.
    9. Hampshire, Kate & Hamill, Heather & Mariwah, Simon & Mwanga, Joseph & Amoako-Sakyi, Daniel, 2017. "The application of Signalling Theory to health-related trust problems: The example of herbal clinics in Ghana and Tanzania," Social Science & Medicine, Elsevier, vol. 188(C), pages 109-118.
    10. Bloom, Gerald, 2011. "Building institutions for an effective health system: Lessons from China's experience with rural health reform," Social Science & Medicine, Elsevier, vol. 72(8), pages 1302-1309, April.
    11. Megan M McLaughlin & Louis Simonson & Xia Zou & Li Ling & Joseph D Tucker, 2015. "African Migrant Patients’ Trust in Chinese Physicians: A Social Ecological Approach to Understanding Patient-Physician Trust," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-13, May.
    12. Hamill, Heather & Hampshire, Kate & Mariwah, Simon & Amoako-Sakyi, Daniel & Kyei, Abigail & Castelli, Michele, 2019. "Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context," Social Science & Medicine, Elsevier, vol. 234(C), pages 1-1.
    13. Leonard, Kenneth L. & Adelman, Sarah W. & Essam, Timothy, 2009. "Idle chatter or learning? Evidence of social learning about clinicians and the health system from rural Tanzania," Social Science & Medicine, Elsevier, vol. 69(2), pages 183-190, July.
    14. Kruk, Margaret E. & Freedman, Lynn P. & Anglin, Grace A. & Waldman, Ronald J., 2010. "Rebuilding health systems to improve health and promote statebuilding in post-conflict countries: A theoretical framework and research agenda," Social Science & Medicine, Elsevier, vol. 70(1), pages 89-97, January.

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