Health facility revisit and its associated factors among clients utilizing public health facilities in Zanzibar: a retrospective cohort study.

backgroundSince 1964, healthcare in Zanzibar has been tax-funded and provided free at all public facilities. However, this model has become financially unsustainable. Inadequate funding allocation and weak adherence to the referral system have led to inefficiencies, including unnecessary revisits to healthcare facilities. Despite ongoing reforms, there is limited evidence on how inefficient healthcare utilization occurs in Zanzibar's system. The purpose of this study was to utilize a new digital healthcare reporting system using patient-level information to measure the magnitude of patient revisits and identify factors associated with them, as well as the time to revisit.

methodsThis retrospective cohort study included individual-level data from clients enrolled in Zanzibar's digital healthcare utilization system, which records all inpatient and outpatient visits to public health facilities. We included clients with at least one health facility visit between January 2021 and June 2022. Revisit was defined as revisiting any public health facility within the study period. The time taken to revisit a health facility was calculated as the difference in days between the consecutive multiple visit dates. We applied logistic and linear regression models to assess the factors associated with revisits to health facilities.

resultsOf the 554,264 enrolled clients, 45,675 (8.2%) visited a health facility during the 18-month study period, of which 28.3% had revisited. Of these, 86.8% revisited the same facility, whereas the rest visited multiple different facilities. Over 10% of the revisit patients had a revisit within ten days. Children under five years of age, females, individuals with higher socio-economic status, those insured, and those diagnosed with non-communicable diseases (NCDs) were more likely to revisit. In addition, patients diagnosed with NCDs, non-residents, children under five years of age, and individuals with a low socioeconomic status were most likely to revisit a health facility within a short time window. Undiagnosed conditions were common at lower-level facilities.

conclusionThe findings suggest a need to enhance the efficiency of health service delivery, especially at lower levels, to reduce avoidable revisits and consequently reduce the cost per patient. The findings can also be used as a resource to inform ongoing healthcare reform in Zanzibar.