ArticlePLOS mental health2026
Patterns and determinants of formal healthcare utilisation among individuals with and without proxy-identified mental health need in Tanzania: A cross-sectional analysis of the National Panel Survey.
Article in PLOS mental health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Formal healthcare utilisation remains persistently low across sub-Saharan Africa, yet utilisation patterns among individuals with mental health needs are poorly understood in low- and middle-income country contexts. Using data from the fifth wave of the Tanzania National Panel Survey (2020/21), this study examined patterns and determinants of formal healthcare utilisation among individuals aged 15 years and above with and without proxy-identified mental health need. A nationally representative cross-sectional sample of 11,891 individuals with non-missing outcome data was analysed. Proxy-identified mental health need was determined using the Washington Group Short Set item on difficulty remembering or concentrating at the severe threshold, a proxy associated with common mental disorders. The outcome was any formal provider visit in the four weeks prior to the interview, regardless of reason. Survey-weighted logistic regression estimated odds ratios and predicted probabilities within the Andersen Behavioural Model. Missing outcome data affected 505 individuals in a Missing Not At Random pattern; extreme bounds sensitivity analysis assessed implications for subgroup estimates. Overall weighted formal healthcare utilisation was 19.2%. Proxy-identified mental health need was observed in 54 individuals (weighted prevalence 0.45%). Female sex, older age (55 and above), and Southern Highlands zone residence were independently associated with higher utilisation. Household wealth showed a strong dose-response gradient: individuals in the richest quintile had 2.71 times higher adjusted odds than those in the poorest. Proxy-identified mental health need was not significantly associated with utilisation (adjusted odds ratio 1.27; 95% confidence interval: 0.53-3.04; p = 0.588). Extreme bounds analysis indicated that true utilisation could range from 2.0% to 92.7%, confirming subgroup findings are exploratory. Formal healthcare utilisation in Tanzania is strongly patterned by household wealth, sex, age, and geographic zone. Addressing wealth-related barriers and strengthening service availability in lower-utilisation zones should be the priorities for advancing equitable healthcare utilisation in Tanzania.
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