Determinants of Pregnant Mothers to Bypass Primary Health Facilities and Directly Seek Health Care in Hospitals in Dar es Salaam Region-A Cross Sectional Study

Introduction: Dar es Salaam is the region with a large number of healthcare facilities than any other region in Tanzania. Primary health care facilities (dispensaries and health centers) outnumber the available hospitals. However, hospitals are overwhelmed with patients as compared to primary health care facilities (PHCF) because people tend to skip the primary health care facilities, leading to poor quality of the health care services in secondary facilities due to congestion. Objective: The aim was to identify determinants that influence mothers to bypass primary health care facilities. Setting: The study was conducted in healthcare facilities in Dar es Salaam region. It targeted all postnatal women who attended hospitals during data collection. Methodology: A cross-sectional study carried out in December 2018 to assess the determinants associated with pregnant mothers to bypass primary healthcare facilities in their healthcare needs. The sample included all women who attended public hospitals for delivery and consented to the study. A consecutive sampling procedure was used and a total of 544 of respondents were involved. A structured questionnaire was used. Data were analyzed in levels of univariate, bivariate and multivariate using SPSS statistical package number 20. Results: A total of 544 respondents were interviewed. Out of those respondents, 536(99%) were above the age of 18. The majority, were married (398, 73%), and had daily incomes of more than one USD (298, 92.5%). The bypass by the respondents of the PHCFs was higher 402(74%) and only 27(26%) had referral to the higher facilities hospitals at Council [Level one Hospital] and Regional Level [Level 2 Hospital] than primary facilities. Conclusion: This study has found that seven of every ten pregnant women surveyed had bypassed the primary health care facilities. Findings from this study reveal a strong and urgent need to 1. Strengthen primary healthcare facilities to make them more attractive to people and 2. To better implement the referral guidelines to reduce this bypass.