Abstract
BACKGROUND: Healthcare accessibility remains a critical challenge in many low-and middle-income countries, where disparities between rural and urban areas persist. This study, conducted in Dodoma region, Tanzania, models the determinants of healthcare accessibility, aiming to generate evidence that informs policy interventions for equitable healthcare service delivery in underserved populations. METHODS: A cross-sectional survey design was adopted. Data were collected from 1,009 households (urban 556; rural 453) across four selected districts withing Dodoma region, Tanzania, using a structured questionnaire digitized and implemented through KoboToolbox. The bivariate analysis and binary logistics regression were used to assess the determinants of healthcare accessibility. Fairlie decomposition was also used to assess and explain the healthcare accessibility disparity between urban and rural areas. RESULTS: Among the 1,009 households surveyed, 45% had access to healthcare services, with urban households having higher access compared to rural households. Significant determinants of healthcare accessibility included healthcare insurance cover [(AOR = 72.006 p < 0.001), CI:19.573 - 264.895], household size [(AOR = 0.713, p < 0.05), CI: 0.536 - 0.947], age of the head of household [(AOR = 0.830 p < 0.001), CI:0.785 - 0.878], and Out-of-pocket costs used for the last illness episodes [(AOR = 0.404 p < 0.01), CI:0.139 -1.167]. Additionally, decision-making authority within households, payment methods, and the presence of chronic illness showed significant or partial influence on accessibility. Fairlie's decomposition revealed that health insurance and the age of the head of household account for the largest (93.4%) share of the disparity in healthcare accessibility between urban and rural households. These findings underscore the complexity of healthcare access, providing actionable insights for policy interventions to address rural-urban disparities. CONCLUSION: The study highlights the importance of health insurance coverage in improving healthcare access, emphasizing the need for targeted policy interventions to address rural-urban disparities and improve health outcomes, considering unique rural household needs.