Achievements of Benjamin Mkapa Foundation in 12 years

Transforming rural healthcare has been on the agenda of major health stakeholders on the African continent. In Tanzania, the BENJAMIN MKAPA FOUNDATION (BMF) has for the past 12 years been at the forefront of bridging gaps in healthcare at the rural level. But: has the Foundation been able to transform rural healthcare for the better?In the following exclusive interview with THE CITIZEN’S Health Reporter, SYRIACUS BUGUZI, the Foundation’s chief executive officer, DR ELLEN MKONDYA-SENKORO, explains what it takes to invest in rural health in Tanzania. Excerpts…

It’s now 12 years since your operations began, and most of your work has been in rural Tanzania. Tell us to what extent your organisation has been able to improve rural healthcare?

As per our vision and mission, we have focused our programme on underserved areas of the country which are mainly rural. When reviewing many health indicators in the country as per national and programme surveys, rural communities are more disadvantaged in comparison to urban settings. So, I do believe we have achieved much.

Exactly what have you done…?

Among the aspects which BMF has transformed in rural health care is on ensuring there are health care workers in place from the district hospitals level to the lower dispensary level. Yet, we know that this is a complementary intervention to what the government has been undertaking. To date, we have contributed to increasing the density of skilled health professionals by deploying 1,100 health professionals in rural settings; provision of scholarships at diploma and certificate levels to 881 students; construction of 482 low-cost houses in 268 rural primary health care facilities – thus ensuring that services are available at least 24hrs a day.

Furthermore, in enhancing access to, and availability of, quality maternal, TB, HIV and other poor health conditions in rural settings, BMF constructed 11 operating theatre-buildings in the past 12 years, with some being fully equipped. We trained staff to undertake Caesarean section; strengthened supportive supervision by specialists to the facilities, and provided comprehensive emergency obstetric care services, and re-initiated functional quality improvement teams to the beneficiary facilities.

We do realise the importance of community engagement in disease prevention and enhancing access to quality health services so as to improve the wellbeing of the communities.

Now that Tanzania is striving to bridge the gaps in healthcare provision through promoting Universal Health Coverage (UHC), what is BMF’s role in making this possible?

BMF believes that Tanzania needs to embark comprehensively upon UHC, and we are committed to being part and parcel of attaining the set national goals. One area in which BMF is playing a role – and would like to add more value to – is the need to balance the investment to be made on supply and demand.

While we mobilise the community to be covered with health insurance, we need to ensure our supply-end is client-oriented and well-equipped with basic resources, including qualified health staff; functional diagnostic services with reliable quality results; availability of medications; suitable infrastructures and effective referral systems.

Likewise, on mobilisation of community, BMF has been working with local government authorities and related institutions, including Civil Society Organisations (CSOs). We feel that the role of CSOs in the UHC programme has not been fully optimisded, as it could be an effective medium to reach different communities for mobilisation on the UHC agenda countrywide. BMF sees the need for making use of local CSOs’ strong networks that are in place countrywide. This possibility should be further explored.

Health insurance should be made an integral pillar in community-based initiatives of CSOs. Likewise, our vast experience in human resource management (HRM) is being rolled out since last year to strengthen the community-based health programme through community health workers.

Trends in healthcare are changing, as well as disease patterns. Currently, there is a major outcry against Non-Communicable diseases (NCDs). How is BMF reacting to these trends? Any investments in this…?

NCDs have been gradually increasing globally, and Tanzania is no exception. Notwithstanding that the NCDs are now on the rise, we further note that same individuals have dual health conditions, thus further constraining families, and health systems.

Since year-2006, BMF investments in NCDs have been done indirectly, whereas the direct placement of 1,100 health professionals (including 554 medical doctors) in health facilities has ensured availability of quality care for those suffering from NCDs as well.

BMF initiatives in the community through outreach services and combination prevention campaigns have enabled us to give screening services on cancer of the cervix to almost 3,200 women.

BMF is keen to further explore the integration of NCDs prevention aspects into its existing programmes that would address communicable diseases. Through this integration, our foundation will ensure a wider reach of the Tanzanian population – and would also be more cost-effective.

There is a shortage of basic diagnostic services in rural hospitals. How much of BMF’s investments go into solving this problem?

BMF has supported improved diagnosis within the country through strengthening diagnosis services by placement of skilled health professionals. For example: at the Muhimbili National Hospital (MNH), BMF recruited and deployed 15 laboratory technicians, six (6) ICT Officers and six records management assistants as a way of strengthening lab services at the hospital.

In addition, 22 regional hospitals have benefited from 60 BMF-recruited laboratory technologists and technicians, as well as 23 data clerks to ensure full operationalisation of the fully-rehabilitated laboratory (a collaborative initiative of Abbott Fund and the government of Tanzania).

Through BMF, 13 administrative regions in Tanzania have also benefited from the refurbishment and renovation of the Multi-Drug Resistant-Tuberculosis Ward (MDR-TB) in each of the regions in order to support decentralization of MDR-TB treatment, as well as one TB diagnostic centre per region with the aim of supporting availability of TB diagnostic services.

We are aware of your successes in improving the rural healthcare workforce by training more doctors, nurses and other medical staff. But, there is this cadre known as ‘Community Health Workers’ (CHW). Have you tapped their potential – and, if yes: to what extent?

So far, the BMF is supporting the ministry of Health, Community Development, Gender, the Elderly and Children to roll-out CHWs. The project is financed by UK Comic Relief – “a major UK charity with a vision of a just world, free from poverty” – and focuses on building capacity of the National level, Lake Zone Health Training Institutions, Regions and Councils to effectively implement the Community-Based Health Programme Strategic Plan (CBHSP) of 2015 to 2020.

So far, we have managed to harmonize CHWs teaching materials and teaching aides to ten (10) Health Training Institutions which the project is supporting. As of today, a total of 989 students have graduated from these Institutions.

Apart from the training aspect, BMF also supports the orientation of four (4) Regional Health Management Teams and 34 Council Health Management Teams – all of them are from the Lake Zone.

Apart from setting up vital training and management structures, BMF also expects to recruit 273 CHW with the support of Irish Aid and place them at the village level. Through this recruitment, we expect to reach 273 villages, including villages in Chemba District (Dodoma), Itilima (Simiyu) and Misungwi (Mwanza).

Now that you have completed 12 years of service, what is it that you have on tap for the coming years? What should people now expect from you in the next phase of your operations?

We plan, from May 2018 onwards, to kick off three (3) new projects which focus on HRH, HIV/Aids, Maternal New-born health and other health systems strengthening interventions.

Thus, we aim to continue being active in the Human Resource for Health (HRH), which is our main niche. We understand that this is still a grey area which requires innovative approaches to address the situation.

We are in advanced discussions with the government of Tanzania and other partners to jointly pilot innovative strategies on HRH to strengthen both the public and private segments of the health sector.

In this regard, we shall be more engaged in advancing the CHWs through pilot-testing, documentation and knowledge-sharing nationally and internationally.

We further aim at scaling up the HIV/Aids programmes in the rural areas to ensure that we reach the ‘90-90-90,’ the ambitious treatment target to help end the AIDS epidemic. Hence, multi-pronged approaches will apply at the facility, community and policy levels.

In rolling out our noble initiative – the Mkapa Fellows Programme, Phase-III – some of the interventions will focus on reinforcing the Maternal and New-born health in underserved areas.

BMF will be exploring in two (2) other areas which include supporting the government in implementing the UHC agenda.

What seems to be the biggest obstacle to BMF’s efforts to achieve the goals of transforming people’s healthcare and improving lives?

Given the good track record – especially on the tangible outputs noted by beneficiaries – expectations from the public have increased with time. Thus, more demands are raised for BMF to consider in providing technical and financial support.

When BMF designs projects – which at most times is done in close consultation with the Tanzania government – usually there are commitments made by all the parties involved. At times, we have experienced delays and/or failure by our counterparts to meet the commitments as per signed agreements – thus hampering the intended results on health care delivery.

How do you surmount the barriers ahead of you, as BMF?

Challenges and barriers are healthy, as they make the Foundation grow stronger and sustainable, as they create space for being more innovative, learning from failures, and becoming more strategic.

The set policies, systems and structures within the Foundation – plus the team of staff with commitment and eagerness to be part of the success story – have all facilitated overcoming the barriers that BMF encounters.

The resilient BMF leadership and governance body have been the main pillars which motivate the entire BMF team in being more aggressive and responsive to arising challenges/barriers – and, in fact taking them as opportunities for further development!

BMF believes in win-win partnerships. Hence, with time, more consortium partnerships have been developed to design and implement projects – thus enabling us to overcome the barriers that include gradual shrinking of the donor financing envelope to the health sector within the country.

How much investment – in terms of money – do you expect to pump into BMF activities in the next financial year as you embark on your planned activities? How much support do you expect from the government and other stakeholders in achieving these plans?

The Foundation’s current Strategic Plan is coming to an end in June 2018, and we’ll have a transitional period before we put in place our 3rd Strategic Plan (2019-2024). It is this new strategic direction which will guide us in core areas of programs concentration and Institutional development.

However, the Foundation will continue to rely on different sources of financing, including donors/development partners; private sector sources; in-kind individual donations/philanthropists, and ‘other’ investments.

As approved by the BMF Board during the beginning of our financial year, the budget for FY-2017/18 was Sh7.2 billion which arose from confirmed and committed projects. We anticipate that the FY-2018/19 budget may increase – all depending on the success rates of the outcomes of the different proposals submitted to our prospective financiers.