Supply Versus Demand of Health Care Facilities in a Competitive Context: Case of Tuberculosis Care in Douala-Cameroon.

Abstract Background: Identifying the socio-economic factors associated with the supply and demand of health facilities (HF), including their spatial model, can contribute to the decision-making of the creation of the HF. This study aims to contribute to this issue in the competitive context of the tuberculosis diagnosis and treatment centres (DTC) in Douala, Cameroon. Methods: The “observed” number of patients attending the DTCs was compared to the “expected” number, using a bivariate analysis. Multivariate analysis using logistic regression and the analysis of variance were used to identify the factors associated to attendance of DTCs. Spatial analysis was performed to access the spatial-economic model hiding behind the distribution of the DTCs.Results: There is a spatial-economic model hiding behind the distribution of DTCs in Douala, which dictate their solicitation. The decentralization policy advocated by the national program against tuberculosis (NTP) is not always followed by the patients: The “expected” and the “observed” number of patients in DTCs are not correlated. Patients seeking treatment in DTCs closer to their residence are mainly women and patients from relative poor households, while attendance of DTC was associated with the quality of serviceConclusion: Attendance HF is dictate by the spatial-economic model. The policy of creating HF for TB is not followed by patients in competitive context. Attendance of HF by TB patients is associated with some socioeconomics factors;