Thanks for the post, David. My experience is more anecdotal, from mainland Tanzania and Kenya. Running an orphanage, it was evident that most people do not go to a clinic for most health issues, for themselves or for their children.
They go to dispensaries (zahanati) and private vendors of drugs (duka la dawa), which are often staffed by people who know nothing about medicine. Although I took children to a hospital and encouraged staff to take their family health problems to a hospital they tended not to. Anyone can go to any vendor and purchase antibiotics, including very large quantities of generic antibiotics, often without question. Again anecdotal, but one of the US pediatric doctors told me that UTIs are extremely frequently misdiagnosed, with antibiotics being prescribed regardless of test results. Zahanatis take this a step further, regularly diagnosing UTIs and prescribing three days of IV antibiotics.
HIFA profile: Simon Collery is an Independent Consultant working in Tanzania and is currently director of The Toa Nafasi Project, training young women to provide special needs education to children in their first and second year at Tanzanian state schools.