Solution needed to shortage of medical specialists in TZ

Thursday May 23 2019



Professor Zulfiqarali Premji

Professor Zulfiqarali Premji 

Human resources and specialist doctors are crucial in the provision of quality health care. Without these experts provision of quality care is compromised.

Recently the chairperson of the Society of Anesthesiologist of Tanzania (SATA) Dr Mpoki Ulisubisya indicated the acute shortage of anesthesiologist in the country. According to statistics Tanzania has only 22 per cent coverage and that the shortage is of 157 specialists. Since this was a SATA conference it was appropriate to talk about SATA related challenges but I contest that take any medical specialty and there will be similar or even more acute shortages, this is a fact that cannot be denied.

Unfortunately from the reported news item I did not see any tangible strategy to fill this gap. Every year not only SATA but also other such medical specialty associations will come out loudly about the acute shortage and its impact but solutions and actions will be lacking. I can assure such statements can be made till the cows come home meanwhile Tanzanians will be suffering because shortage of experts undermines quality of care.

Undeniably the scarcity will continue and perhaps become worse because, firstly, our population is both growing and aging and the prevalence of chronic diseases is increasing. Secondly, training takes a long time and the associated cost is high, and the training institutions are not increasing proportionally.

Another problem is the fact that doctors are clustered in cities and affluent areas, leaving rural and poor Tanzanians critically underserved. There is oversupply in urban settings and an undersupply elsewhere. Rural communities are in desperate need of more practitioners.

In a nutshell these are some of the main issues. We need innovative ways to provide care along with physicians (and other medical staff) practicing in efficient systems that offer a wide range of health care delivery. The solution to the problems will require a multi-pronged innovative approach.

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In all the medical schools the postgraduate training is a MMed (Master of Medicine) degree programme, some are three years and in the recent past there has been a push to increase the training to four year thus some new programmes are of four year duration. This is a fairly long duration. It is also expensive and, although needed it is not ideal in the situation where there is acute shortage. With this structure there is no way the shortage problem can be solved.

The reality is that in the three year MMed programme, the last year of the programme is mostly devoted to research and thesis writing. This is important because it instills critical thinking and how to think about a problem (hypothesis development) and scientific ways to prove the hypothesis.

However, the clinical experts working in the regional and district hospitals utilize this skill set rarely and their major interest and work involves managing patients. This is the needed skill set.

Thus the logical question is why train for three or four years when you need only the clinical skills and these can be imparted in two years thus lessening the time and costs.

Those who wish to pursue an academic career need the MMed programme and perhaps latter on a PhD but those who are committed to a career of clinical practice just need a two year post graduate training that merits a Master of Science Degree (MSc instead of MMed). This is innovative thing and at least a solution to fill the shortage gap.

The ministry of Health is a major stakeholder because it sponsors candidates for postgraduate training. Being passive and not actively deciding on how to resolve the problems leads to chronicity, the shortage of medical specialists will be a life long problem.

The new concept of quality care is team-based care, and the specialist leads the team. Other team members include medical officers, clinical officers, nurse practitioners, and other allied health professionals.

This may be a cost-effective option to help alleviate projected shortages and a possible way to lower the number of experts the nation needs to train.

Another option is the new care delivery models. Supporting the development of new care delivery models like an increase use of telemedicine can more efficiently make use of unused time by treating more patients. Additionally, it connects specialists to rural hospitals enabling patient access to a wider pool of physicians.

Of course you’re not going to resolve the mal-distribution obstacle without solving the overall shortage issue. I believe the solution will partially require team-based care and better technology.

The critical shortage of healthcare workers is not only confined to Tanzania but is across sub-Saharan Africa and is one of the most pressing and complex global issues of the modern age.

This multifaceted crisis stems from the interaction of several political, environmental and social forces on the national and international levels and has far-reaching effects, weakening public health systems and reducing people’s quality of life throughout sub-Saharan Africa.

It is high time to have constructive debate on this issue and find innovative solutions, which in turn, will help, promote the social, political and economic advancement of Tanzania.