Why Tanzania should invest more in HRH

Monday September 06 2021
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By Lucy Tomeka

As the years lapse, one into the next, strides on every front continue to be made, some of which are immeasurable.

The health sector has not been immune to these either. Matter of fact, some of the most notable strides of improvement can be found in this sector.

It comes with no surprise that regardless of how much the improvement is made, there are some areas of concern that have led to outcries for more to be done.

The human resource for health being one of these areas, is prevalent, especially in many Tanzanian communities for many reasons.

Global pandemics have been one of the major push factors for the different health goals that have been set by organisations such as the World Health Organization and UNAIDS.

One of the more notable and ambitious is the 95-95-95 strategy which was announced by UNAIDS in 2014 with the aim to end the AIDS epidemic by 2030 by achieving 95percent diagnosed among all people living with HIV (PLHIV), 95percent on antiretroviral therapy (ART) among diagnosed, and 95% virally suppressed (VS) among treated.

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An intermediate goal of 90-90-90 was set for 2020. These targets have been adopted by many countries implying that treatment should be prioritised in resource allocation amongst which human resource should be.

According to Dr Isaac Maro of TMH hospital, a research that was conducted by him and his team showed that of the three, so far the human resource for health is lagging far behind.

His sentiments and research have been backed up by the Benjamin Mkapa Foundation, an organisation in Tanzania that pioneers for human resource for health all over the country.

In a recent sit down with both Maro and the Benjamin Mkapa Foundation, I had a serious “aha!” moment as a lot of my unanswered questions fell in place.

The health workforce is the backbone of any good functioning health system and is critical in accelerating progress towards Sustainable Development Goals and building strong primary health care systems that can be easily accessed by everyone.

Despite its importance, Tanzania faces a chronic shortage of qualified health workers, especially in rural areas which has been a major barrier for accessing health services.

A resident of Makambako, Mr George Nyambo explains the challenges that he and his family faced recently when his grandmother was injured.

“Seeing as I live many kilometres from my grandmother, I had to take a bus and upon arrival, I saw how dire the situation was and my grandmother had been immobile for days by then,” he narrates.

“We then took her to the nearest dispensary which is about ten kilometres from where she stays. However, due to the severity of the injury, they were not able to treat her and so we were referred to Ilembula.”

Unfortunately again, due to the distance and transportation difficulties, they had to wait for dawn and the best that could be done for their grandmother was relieve her pain for the night.

Upon arrival at the hospital, they had to wait for a very long time just to see a doctor. “We were told that the doctor on duty had a lot of patient rounds and he will see us when he finishes but just looking at the number of people in line, I knew we would have been there long,” he says.

Eventually they were able to see the doctor and their grandmother was afforded a bed and treatment but he does say further that for almost every service they needed, the wait time was very long and by the time their grandmother was admitted, it was already dusk.

“In Tanzania, we have invested heavily in the health sector in terms of infrastructure and equipment but we have a limited number of doctors and nurses to care for patient and other medical technicians,” said Dr Maro.

The World Health Organisation standard for doctor-patient service is one doctor for every 1000 population however due to the shortage in Tanzania, one doctor serves a population of about 20,396.

This misdistribution is even worse when comparing rural and urban regions where rural areas could see one doctor serving a much larger population.

Despite the progress made, there is existing regional variations on attaining the third goal, whereby the eight lowest performing regions have an average of 41.3 percent against the national target of 90 percent and these same regions are facing a critical shortage of both skilled and non-skilled health workers.

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Challenges behind the shortage

Social, demographic and economic changes:

Over the last decade, Tanzania has seen a relatively high growth with the World Bank recognising that growth and updating the country’s income from low to lower-middle-income status.

Unfortunately, this economic growth has not translated into increased health expenditure.

An example of this is how the government only allocated 5.53 percent of the 2020/21 national budget towards health.

The economic transitioning and rural-urban migration continues to have a serious impact on the health system and will continue to put strain which creates a wider gap between the high-end health facilities and the underserved facilities, both of which are in the same system which in the long run also widens the gap in the health force


Financial constraints

In the fiscal year 2019/20, the government recruited and deployed about 1,817 health workers to various facilities across the country.

However, while there have been notable increases in the budget allocation for human resource for health, the overall allocation versus the need still remains rather high.


Curbing the challenge

1. Involve key stakeholders:

Both governmental and private stakeholders tend to benefit from investment in human resource for health.

The Ministry of Health, Community Development, Gender, Elderly and Children is the one government body that has the mandate to spearhead this type of investment and lobby for it to help ease the burden they face of finding able bodied and capable health workers.


2. Invest in community health workers:

Community health workers are not medically certified to serve as doctors or at a more technical capacity but they are trained to help ease certain tasks for doctors.

Other government bodies like President’s Office Regional Administration and Local Government which work closely with communities are better positioned to help identify individuals that can work as trained community health workers.

On this aspect, the BMF has made some impressive strides in training and helping CHW serve better.

Out of 5,378 deployed CHWs, 2,914 were facilitated with mobile phone handsets and are using a mobile App known as CHAID (Community Health Assistants Information and Decision-Making Application) designed by BMF.

CHAID was developed to inform decision-making for the community to facility referrals and enable CHWs to provide health education at the household level.

These CHWs provided immense help especially during the Covid-19 outbreak which saw the majority of them being deployed to Tanzania entry points and ports all across the country.


3. Invest and modify learning systems:

Seeing that CHWs are very critical in closing the gap, the BMF intends on making online trainings much more accessible, not just for doctors and certified health workers to continuously hone themselves; but as a platform for other willing candidates to take up as community health workers.

As medical infrastructure continues to grow, the cry to avail bodies to work and operate in these facilities continues to grow.

As it stands, the call to action is to meet that third 95 goal and invest in human resource for health as sit back as we watch the health system in our country strengthen.