This paper explores the changing institutional context of health service
delivery in rural Tanzania through an anthropological analysis of the kinds of healing
strategies pursued by men and women when they are ill. In some rural districts popular
dissatisfaction with state medical provision is not manifested in a rejection of the allopathic
medicine with which it is associated, but in increased reliance on an emerging informal
sector of private medical provision. Although this sector provides a valued and accessible
service to certain categories of clients it delivers poor quality treatment, serving to reinforce
the cyclical relationship between poverty and ill health. Despite the best intentions of
major public sector reforms neither government nor other agencies are able to meet rural
demand for health services. Reliance on the parallel market for medical provision is likely
to continue, at least in the short term, with negative consequences for health.