Strong partnerships answer to government’s healthcare agenda

A doctor tends to an infant at the maternity ward at Aga Khan Hospital, Dar es Salaam. The hospitals sees over half a million patients through its outpatient care services. PHOTO | AKHS 

In Summary

• Tanzania, like most developing countries does not have an elaborate health financing system and the majority of its citizens pay for their own medical expenses.

By SISAWO KONTEH
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Health systems in Tanzania have been improving over the past decade as the country aims to establish acceptable and universal health provisions for its citizens.

The country has made some progress in improving local health facilities through modernisation of its infrastructure, acquisition of leading-edge technologies, development of sound policies to support the healthcare system, as well as the growth and expertise of the human resources pool that supports the country’s health infrastructure. However, additional work is required to ensure consistency across the country.

Tanzania’s health system is a referral pyramid, which includes interventions at the village and ward level where there are community dispensaries; divisional level where there are rural health centres; district level where there are district or district designated hospitals; regional level where there are regional hospitals; zonal level where there are referral/consultant hospitals and the national level where there are national and specialised hospitals.

At the national level, the Ministry of Health administers and supervises national hospitals, consultant referral hospitals, special hospitals, training institutions, executive agencies and regulatory authorities.

At the regional level, provision of health services is vested to the Regional Administrative Secretary with technical guidance of the Regional Health Management Team.

At the district level, management and administration of health services has been devolved through the respective district’s Council Authorities, Health Service Boards, Facility Committees and Health Management Teams.

Understanding the tiers in Tanzania’s health system is key to understanding the scope and depth of the government’s measures to achieve universal health coverage (UHC). The government has worked closely with local and international players to ensure a vibrant system that not only provides curative but also preventive healthcare.

Tanzania dedicates 5.6 per cent of its GDP towards the growth and development of its health sector, which is higher than the amount invested by other countries in Africa. In addition, 35 per cent of government expenditure on health programmes comes from external sources. (Source: World Bank 2016).

Tanzania, like most developing countries does not have an elaborate health financing system and the majority of its citizens pay for own medical expenses, which, according to the World Bank, stands at 23 per cent compared with 34 per cent for the sub-Saharan region. (Source: World Bank 2016).

This has led to the government developing a mechanism to increase the number of people with health insurance coverage.

A bill developed through consultation with health system stakeholders and the National Health Insurance Fund (NHIF) will soon seek to consolidate existing schemes and change the manner in which people pay for health services. Health insurance through pooling of risk protects individuals and families from catastrophic health expenditure.

Meaningful partnerships are crucial in order for the government to achieve this ambitious agenda and collaboration with institutions such as Aga Khan Health Service, Tanzania (AKHS,T) are an example of how this vision is being realised.

As an agency of the global Aga Khan Development Network (AKDN), AKHS,T has been committed to providing quality healthcare in Tanzania for over nine decades. The vision is to create a truly integrated system that provides access to quality and affordable healthcare.

Today, its contributions align with the government's National Development Plan 2025, particularly as this relates to the following areas: Access to primary healthcare for all; gender equality and the empowerment of women in all socio-economic and political relations and cultures; access to quality reproductive health services; reduction in infant and maternal mortality; addressing the increasing burden of non-communicable diseases including mental health issues; effective treatment of injuries; and increased life expectancy.

The Aga Khan Hospital in Dar es Salaam sees over half a million patients through its outpatient care services, and conducts 1.3 million lab tests, 75,000 radiology investigations, and over 7,000 surgeries annually across its facilities.

Five primary medical centres, located in Dodoma, Iringa, Mbeya, Morogoro, and Mwanza, serve an additional population of approximately 10.9 million (source: Tanzania Bureau of Statistics population projection 2017).

Through its partnership with the Aga Khan University’s Institute for Education Development (AKU-IED), the Aga Khan Hospital is committed to being the premier teaching hospital in the country, offering health sciences education in both the medical and nursing fields an integral part of its vision.

Together with AKU, the Aga Khan Hospital offers postgraduate medical education in family medicine, internal medicine and surgery. Since 2004, AKU has graduated over 600 nurses and midwives in Tanzania and continues to expand its post graduate residency programmes to help train more qualified nursing professionals.

Over the past few years, 23 AKHS outreach health centers have opened throughout the country, making affordable and quality healthcare accessible to even more Tanzanians.

These expansion plans are part of a much larger integrated health network that AKDN is developing in East Africa, which uses a hub and spoke model that pairs the Aga Khan Hospital with a series of community health programmes, health centres, as well as local clinics and hospitals.

The Phase 2 expansion of the Aga Khan Hospital this week is yet another reminder of the importance of partnerships to achieve Tanzania’s critical healthcare goals. Together with Agence Française de Development (AFD), AKHS,T will expand its facilities to provide specialised care to fight non-communicable diseases in the areas of oncology, cardiology and neurosciences.

Drawing from the strength of its global network and lessons learnt from around the world, it will provide excellence in every sphere, in full commitment with the government’s development agenda.

Tanzania’s healthcare system is continuously evolving to fulfill its government’s vision of delivering an integrated, full service offering to its citizens. And while this commitment is noteworthy, there is recognition that no one stakeholder can go the distance alone.

At AKHS, we believe that everyone has the right to quality healthcare and the ability to pursue their dreams, to build their lives, their communities and their nation together. And we are proud to be a partner to the government of Tanzania in realising the full potential of this vision.

Sisawo Konteh is the chief operating officer, The Aga Khan Health Service, Tanzania.