Universal health care: Tanzania makes progress as key challenges remain

Dar es Salaam. The health docket is one of the sectors of the Tanzanian Economy that have shown huge potential – and which have shown considerable progress in 2018. This makes Tanzania one of the world’s developing countries that are making tangible progress towards achieving the Universal Health Coverage (UHC) by 2030.

Also known as ‘Universal Health Care,’ and ‘Socialised Health Care,’ UHC is a system that provides health care and financial protection to all citizens of a country.

Following are the key highlights of the efforts made by the government of President John Magufuli this year, working in collaboration with the country’s development partners and other stakeholders. The underlying objective is to transform for the better the health sector with a view to ensuring that all citizens can sustainably access quality medical products and services.

Surge in health budget allocation

The government sought to strengthen health care services by raising the medical supplies budget to enable payment for essential medicines, immunisation, medical equipment and reagents to over Sh300 billion in the 2018/19 financial year, compared with just over Sh35 billion in FY-2015/16.

“Essential medicines are now available in public hospitals by 90 per cent – and at least Sh100.5 billion has been set aside to finance the construction of at least 67 district hospitals countrywide,” Health deputy minister Faustine Ndugulile told The Citizen over the phone on November 28, 2018.

He added that “the government has also allocated at least Sh30 billion to facilitate rehabilitation of regional hospitals countrywide”.

Revealing that the government will next year continue to improve healthcare systems and programmes, the minister said this was with a view to ensuring sustainable provision of quality medical products and services in public health facilities at all levels: national, regional and district dispensaries.

“The main focus is on enhancing universal health insurance (UHI) coverage among citizens by establishing health insurance schemes with affordable packages to cater for all the citizens,” Dr Ndugulile said.

He added: “Another focus is on improving reproductive health with a view to addressing issues such as maternal deaths, reproductive tract infections – including sexually transmitted diseases and HIV/Aids – gender-based violence, infertility, malnutrition, anaemia and reproductive tract cancers.”

Despite the promising progress that has so far been made by the government and other stakeholders to fully tap the potential in the health sector, the docket still faces many challenges that need to be addressed accordingly.

In this regard, the government has been struggling over the years to surmount maternal and infant mortality among Tanzanians, as well as non-communicable diseases (NCDs) which claim the lives of thousands of people yearly.

NCDs include – but are by no means limited to – cancers, cardiovascular diseases, diabetes and hypertension.

According to the Tanzania Demographic Health Survey and Malaria Indicator Survey (2015/16), the infant mortality rate in Tanzania was at about 25 deaths per 1,000 live births, while the rate of maternal deaths was 556 per 100,000 among women aged 15-49.

This means that at least 11,000 pregnant women die yearly from delivery complications.

It was on these grounds that the government came up with a strategic initiative dubbed ‘Jiongeze Tuwavushe Salama’ that aims at enhancing countrywide interventions to tangibly reduce the maternal and infant mortality rates.

To combat the NCDs malady, the government established the ‘NCD Strategic and Action Plan 2016-2020’ for the prevention and control of non-communicable diseases.

Independent stakeholders impressed, call for more efforts

“As a nation, we have made tremendous efforts to reduce the child mortality burden for children aged 5 and above. It is high time now that more efforts were made to prevent deaths in under-5 children – particularly during and after delivery.

“This is because when they reach 5 years of age, the possibility of them surviving is greater,” Dr Samwel Ogillo, the chief executive officer (CEO) of the Association of Private Health Facilities in Tanzania (APHFTA) said when he spoke to The Citizen on November 30, 2018.

He added: “Doubling of efforts is necessary to educate pregnant women on the importance of visiting clinic during pregnancy with a view to avoiding sufferings from health problems during delivery that can result in the death of the baby or the mother – or both!”

Dr Ogillo further stated that birth control is vital in combating maternal and infant mortality among women and the newborn. In the event, he called upon the government to enhance comprehensive medical interventions in educating women and girls on reproductive health methodologies.

“I also urge the government to improve infrastructure in hospitals at all levels, to ensure that pregnant women and their newborns do have reliable access to quality medical care during and after pregnancy. This can be achieved by providing healthcare-takers and medical supplies in all the public hospitals countrywide,” he said.

Commenting on the NCDs and communicable diseases, Dr Ogillo stated: “We are still hit by both infectious diseases like HIV/Aids and malaria, as well as NCDs. More efforts should be put in seeking to achieve sustainable prevention rather than treatment of NCDs.”

For his part, the executive director of the health advocacy organisation, Sikika, Mr Irenei Kiria, called on the government to increase Health budget allocations and ensure sustainable disbursement of the funds to facilitate implementation of various health outreach programmes designed to create public awareness about NCDs and infectious diseases, among others.

He raised concern on the urgent need to improving both diagnostic and surgical services – particularly in rural areas – with a view to reducing maternal deaths among women and children.

“I also commend the recent government decision to disburse development funds directly to hospitals – unlike in the recent past when the funds were disbursed to District Councils, hopefully for onward transmission to the hospitals,” he said.

“As the result,” Mr Kiria added, “the availability of medicines and other medical supplies in hospitals is now higher than before because the hospitals are able to purchase medicines directly from the manufacturers instead of relying on MSD,” the government medical stores department.

Historic kidney transplants and cochlea implants

The Muhimbili National Hospital (MNH) this year recorded a phenomenal achievement in kidney transplanting as local surgeons are now able to perform such intricate medical operations with minimal guidance from outside.

The local medical experts, particularly kidney transplant surgeons, have enhanced their capacity in performing medical operations by 75 per cent, while being guided by foreign experts by only about 25 per cent.

The national hospital has already recorded successful kidney transplants on 19 patients, who were all doing well together with the donors of the kidneys.

Meanwhile, Muhimbili National Hospital has this year already saved the nation about Sh1.3 billion after carrying out cochlear implant procedures on 21 children.

A ‘cochlear implant’ is a device that can be surgically implanted into the cochlea of a person with severe-to-profound hearing loss. Consisting of a tiny receiver which is placed under the skin in the bony part behind the ear, the implant stimulates the cochlea to cause hearing.

“We are committed to continue offering both quality surgical and diagnostic medical services as per international standards –particularly the tertiary services related to complex health conditions which were previously not available in the country,” said the executive director of MNH, Prof Lawrence Museru, speaking to The Citizen via the phone on November 28, 2018.

Following the establishment of the subject-specialized medical treatments in Tanzanian hospitals, the government has managed to cut costs by 90 per cent of what it was previously incurring by sending local patients with complex health conditions abroad for specialised treatment, deputy Health minister Ndugulile said.

Rare heart surgeries and cardiovascular diseases screening

More heart patients are now being treated within the country, compliments of the official inauguration of the state-of-the-art Jakaya Kikwete Cardiac Institute (JKCI) at the MNH in Dar es Salaam.

The Institute has been saving people’s lives as a matter of course – thus reducing costs for treatment abroad in otherwise scarce foreign exchange.

This year alone, JKCI – working in close collaboration with foreign cardiac surgeons – successfully performed at least 1,100 open heart and small incision heart surgeries, and offered heart screening free-of-charge to thousands of persons, thereby turning the Institute into a regional paediatric centre of excellence and paediatric cardiac care centre.

Open-heart surgery is any type of surgery whereby the chest is cut open and surgery is performed on the muscles, valves or arteries of the heart.

The achievements were made possible through training provided to the Institute’s heart specialists and other hospital personnel with no mean support of foreign governments and other development partners.

“At least 1,400 heart patients were supposed to be sent abroad for treatment this year, and for whom the government would have incurred enormous costs to facilitate their transfers and specialised services. But they were all successfully treated in Tanzania,” said the executive director of JKCI, Prof Mohamed Janabi, when he spoke to The Citizen via telephone on November 28, 2018.

“Our target is to perform at least 1,800 heart surgeries next year – and perform more free heart screenings on adults and children,” Dr Janabi added.

Revealing that the Heart Institute has signed an agreement with the China government to add another 32 state-of-the-art beds for heart treatment, Prof Janabi stated that these would be located at Mloganzila Hospital in the Ubungo District on the outskirts of Dar es Salaam City. According to the executive director, the Mloganzila facility will specifically be offering heart treatment for children – and that, for good measure, it will be officially named after Dr John Pombe Joseph Magufuli, the sitting President of the fifth-phase government of Tanzania, in office since November 5, 2015.

“Construction of the new heart institute at Mloganzila will start early in 2019 if everything goes as planned,” Prof Janabi said – thoughtfully adding that the Banjamin William Mkapa Hospital in the nation’s capital, Dodoma, will also start providing similar heart services next January. This is part of the government’s efforts to expand cardiovascular diseases treatment across the country.

“For the first time ever, cardiovascular diseases treatment will be offered outside the JKCI next year (2019),” he said.

Historic separation of conjoined twins

Doctors at the Muhimbili National Hospital (MNH) in September this year successfully separated conjoined twins, marking a first since such operations began at the nation’s premier medical facility in 1994. The two-months old male twins were separated by a team of 10 specialist doctors: nine Tanzanians and an Irish medic.

The twins were conjoined, sharing part of the gastrointestinal system and abdominal wall, a condition medically known as ‘omphalopagus.’

The first conjoined twins separation was conducted in Tanzania in 1994, but was unsuccessful because one of the two babies died after 63 days, and had never been removed from Intensive Care Unit (ICU).

MSD sole distributor of medicines, medical supplies in SADC

The government Medical Stores Department (MSD) signed an agreement with the Southern African Development Community (SADC) this year to formally become the sole distributor of medicines, medical supplies and laboratory equipment in the 16 SADC member states.

These are Angola, Botswana, Comoros, Democratic Republic of Congo (DRC), Eswatini (formally Swaziland), Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa (RSA), Tanzania (URT), Zambia and Zimbabwe – named here strictly in alphabetical order.

Under the contract, MSD is tasked with taking orders from the SADC members; administering statistics and information as needed; controlling the database, as well as monitoring procurement and supply process, among other responsibilities.

“We are working with the member states to get their ICT platforms after which they will send in their orders through the e-procurement system. The member states were requested at the SADC Health Ministers meeting held in Windhoek to ensure that pooled procurement is implemented,” the MSD director general, Mr Laurean Bwanakunu, told The Citizen via telephone on November 28, 2018.

He added: “We will not provide them with items from our stores; we will direct manufacturers to deliver to their state capitals for distribution as they see fit.”

The MSD chief took the opportunity to call upon prospective local and foreign investors to establish pharmaceutical industries in Tanzania, expressing optimism that doing so would grow the country’s economy by creating jobs for Tanzanians and generating foreign currency by exporting their medical products.

Fresh breath as MNH inpatients moved to Mloganzila

The Muhimbili National Hospital in January this year began moving some of its inpatients to the new teaching hospital the Mloganzila Campus of Health and Allied Services on the outskirts of Dar es Salaam. This was with a view to easing congestion of patients admitted at the national hospital in the commercial capital.

This came about after President Magufuli directed the Muhimbili top management on November 25, 2017 to explore ways and means of shifting more than 500 inpatients to the Muhas-Mloganzila medical centre that was launched about the same time.

Construction of the facility at Kibamba along the Dar-Morogoro Highway started in 2014 at a cost of Sh206 billion. The facility was designed to accommodate more than 500 persons at a time.