Routes to Government TB Treatment: Private Providers, Family Support, and the Process of TB Treatment Seeking among Ugandan Women

Abstract

Tuberculosis (TB) remains a major source of morbidity and mortality in Uganda. This cross-sectional study explores Ugandan women’s TB treatment-seeking processes to determine the routes to effective government TB treatment among a sample of urban, semirural, and rural women. This research focuses on women in particular as Ugandan women with tuberculosis must negotiate their treatment paths in a context where women tend to be politically and economically marginalized, with limited control of household resources and senior family members’ health care decisions. The results examine the structural, social, and economic forces similarly guiding treatment seeking across the three research sites and then the specific differences among the settings. The findings suggest that the modest number of nongovernmental health care providers’ diagnoses and referrals, particularly for urban and semirural participants, represents a critical barrier to biomedical TB treatment. Private providers’ diagnosis delays also carry financial and physical costs, which undermine the resources available for subsequent TB treatment and participants’ social and economic well-being. This study indicates that conceptualizations of the political economy of treatment seeking need to more fully acknowledge the dynamic nature of the microlevel political economic context of treatment seeking, including the domino social, economic, and health effects of structurally problematic health care systems.