Rural medics lack access to information, study says

Dar es Salaam. Health workers in rural areas lack access to information and interaction with their colleagues and affiliated councils. Yet, they attend to and diagnose complex clinical cases, some of which are beyond their knowledge and skills.

In Tanzania, as in many countries in sub-Saharan Africa, lack of skilled health workers remains a persistent problem, particularly in rural areas.

According to the national Health Sector Strategic Plan IV (HSSP-IV), about 37,000 out of 66,000 medical practitioners, serve 48 million people in the country.

The distribution of health workers is unequal as it is concentrated more in urban areas, leaving only a small number of them serving in rural areas, where the majority of the population resides.

But thanks to availability of a mobile network technology, which has a mobile network penetration rate of over 80 per cent in the country, most health workers can now use mobile phones to communicate and access information and refer patients to referral health facilities.

However, the relatively high cost of mobile communication is a hindrance, particularly to rural health workers, whose income levels are low compared to those living and working in urban areas.

Health National Programme (HNP) manager Auson Kisanga admits that the ministry of Health, Community Development, Gender, Elderly and Children, health professional councils and health professional associations do not have reliable or complete data records of all of their members.

“Each organisation tries to maintain a separate database of health workers’ records. The ministry, councils and associations are not capable of deploying targeted communication to health workers or quickly and instantly mobilising the health workforce in response to disease outbreaks,” he says.

In 2011, a California-based non-profit organisation created a switchboard as a scalable technology solution that creates a mobile phone network of all health workers in the country, giving practitioners access to nationwide community support.

However, the switchboard operates with three main principles in mind, including using free calling networks, collecting mobile numbers in a health workers directory and communicating using nationwide health services.

In Tanzania, IntraHealth is partnering with the ministry of Health, the Medical Association of Tanzania (MAT) and Vodacom Tanzania—the largest national mobile network operator—on the initiative powered by the switchboard, and which has been locally branded as the Health Network Programme (HNP).

Mr Kisanga admits that HNP allows participating health workers to call and send each other up to 50 basic text messages (SMS) per month for free. He urges members to have zero-rated access to five designated websites selected for health workers to pursue continuing medical education.

“The members of closed user group (CUG) are having access to free calls and free text messages to communicate with their fellow health professionals. The ministry and councils also use the platform to communicate new information to health workers on new guidelines, policy updates and diseases outbreaks,” he says.

He notes that the health workers can join the network for free by dialing a special HNP USSD code. The USSD application, which is part of the switchboard platform, delivers a specific workflow of questions via SMS to which the user responds to details used to verify their eligibility before activating the registration.

According to data availed by the switchboard, with 37,000 medical practitioners in the country, at least 4,444 health workers have been registered in the network out of which about 1,343 health workers are active CUG members, while at least 3,101 health workers are not active CUG members.

“In the next first three years (2017-2019), we seek to enrol at least 8,000 of these health workers as we intend to develop an electronic directory of registered health workers to allow practitioners to check, who is in the CUG,” he says.

Mr Kisanga notes that despite the achievements made in reaching a large number of health workers across the country, the company faces some challenges, including limited resources to run operations, manual processes especially during verification of health workers and Vodacom’s change of tariffs.

“We intend to make the switchboard and professional council databases interoperable to speed up a verification process. Again we are forced to operate under limited resources, hence we fail to expand services to a large number of health workers,” he says.

According to the ministry of Health, inadequate communication among health service providers at various levels means that provider skills and facilities are not maximised.

Many health workers working in underserved areas of Tanzania often lack requisite knowledge, competencies and resources to effectively prevent and treat health issues of their clients, such as maternal, neonatal and child morbidity and mortality.

The ministry’s director of human resources for health, Dr Otilia Gowele, says the government is aware of the challenges facing health professionals working in rural health facilities.

She commends the switchboard for its innovative ways to provide communication service to the majority health workers across the country. She notes that the initiative will assist health workers to have access to communication and help improve health care in Tanzania.

“The programme would enable the majority of health workers to have access to communication services. Our government is aware of persistent challenges facing the health sector. I can let you be assured that in a very short time the challenges will become history as our government makes effort to address them,” she says.

She also reveals that the government continues improving its health facility condition from dispensary to referral levels to create a conducive environment for health workers working in rural health facilities and who are low income earners.

According to her, there are somewhat more than 7,000 health facilities throughout the country. However, more health facilities do not necessarily guarantee improved health service delivery.

“I am glad to see our government has been continually increasing human resources for health and providing sponsorship for further studies to encourage more the health staff to upgrade their skills,” she says.