Saturday, July 14, 2012

Health sector in Tanzania strangled

By Elias Mhegera
Amid the doctors’ strike in Tanzania policy analysts met in Dar es Salaam recently, and they said that the on-going crises at the major hospitals are due to poor budgetary allocation, and to mismanagement of funds by some leaders in various Government circles.
The analysts say the low budget allocated to the health sector is against the Abuja Declaration on Health Equity. They warned that the health sector is deteriorating fast, and it needed financial intervention.
This assessment came in the wake of a Policy Forum debate on 29 June 2012, at the British Council, where contributions from members of the floor and presentations that were made diagnosed a lot of issues to be taken into serious consideration.
Presenting her paper entitled “Health sector expenditure trends from 2006.07 to 2011/12,” Dr Flora Kessy, a poverty analyst at the Mzumbe University, said that there was a serious problem between nominal and real budgetary allocations.
She said that she has conducted several pieces of research, just to discover that whatever is being allocated in the health sector does not necessarily reach the targeted people.
“At this juncture let me praise the private sector, particularly religious institutions, which have contributed a lot in the provision of health services, otherwise the situation would have been chaotic,” she remarked.
The title of the debate was:“Health Sector Budget Allocations: is the state of the health sector improving?” Coincidently this debate was organized while the doctors in all major hospitals are discussing the fate of their colleagues, particularly the interns who have been suspended following a go-slow.
Moreover, the debate could have been a good forum for representatives of the Government to come and collect views from various circles, in its bid to improve the working conditions of many employees from the sector who are dissatisfied.
Dr Kessy added that so far only 15 percent of Tanzanians are covered by reliable health insurance, be it in the Government or the private sector and due to this discrepancy many institutions have been trying to cover the gap.
She acknowledged the fact that in some areas religious institutions have chosen to take over the health service distribution altogether, by depending on direct foreign sources, after realizing that the Government alone cannot meet the demands.
“If there is money allocated in the budget but it does not reach the people, it is a bad picture which then necessitates others filling the gap,” she commented. 
Dr Flora charged that although it was not healthy for a nation to depend on foreign sources, yet the urgency of saving the lives of poor people, who are the majority in Tanzania, outweighs the pride of not receiving health support from abroad.
She was reacting to a comment from one attendant who said he queried her statistics. On the contrary, she admitted that different people and various institutions use different statistics for different purposes, but this does not eliminate the fact that there are serious problems in the provision of health services in Tanzania.
She recommended that in order to change the situation there was a need to increase the budget to 15 percent, as by the Abuja commitment.
Dr Kessy commented further that 15 percent was an ideal share, but this must be compared with the similar developments in other areas like water, education and agriculture.
She sustained that health insurance should be made to function more effectively. “There must be universal coverage, strategies must be formulated in order to bring the rural communities on board, since only eight percent of this population is covered,” she concluded.
From Sikika, an NGO which strives to bring equity in the provision of services was its programme officer Simon Moshy who dwelt on “10 years of the Abuja Declaration and Health Equity”.
He criticized the Government for not taking health seriously, to the extent that there are many other areas which are given priority over health, one of those areas being the setting-up of infrastructure.
Highlighting surveys that have been conducted by his organization, he asserted that from August 2011, it was found by these studies that in 100 enquiries, 29 categories of medicines were out of stock.
But while Moshy was seeing this as a serious problem Dr Rufaro Chatora, World Health Organization country representative to Tanzania, who was a discussant, said it was not proper to think that the Government must concentrate on certain areas only, and take others as a second priority.
To this extent he said that infrastructure was very important in the provision of health services, since good roads will improve accessibility to health services, including dispensaries and hospitals that are located in vulnerable areas.
He said that although there are many complaints from various circles in this country that there is embezzlement of public funds yet Tanzania has continued to attract a lot of grants from foreign agencies, a sign that there was good accountability and financial discipline.
But Dr Dunstan Bishanga from Jhpiego, an institution which is affiliated to the John Hopkins University, said that infrastructure and hospital buildings without medicines are serious problems in Tanzania.
Implicitly he was responding to Dr Chatora, whom some noted to be ‘too diplomatic’ to discuss the subject objectively.
1.    Medical Association of Tanzania President Dr Namala Mkopi (right) addressing a press briefing
2.    It is claimed by doctors that there is a serious shortage of working equipment
3.    A patient being taken away from the Muhimbili National Hospital following the doctor’s strike recently.