• THE ADULT MORBIDITY AND MORTALITY PROJECT

Health:
Hotuba ya Waziri wa Afya Mheshimiwa Anna Margareth Abdallah, Mbunge, kuhusu Makadirio ya Matumizi ya Fedha kwa Mwaka 2002/2003

For a period of almost thirty years, health services delivery has been largely a prerogative of the state, only a limited number of private-for-profit health services were provided in major towns of the country. After independence, health care facilities were re-directed towards rural areas and free medical health services were introduced except for Grade I and II. 

• In 1977 private health services for profit was banned under the Private Hospitals (Regulation) Act and the practice of medicine and dentistry prohibited as a commercial service. This Act had negative implications on health services in the country.
• However, after a series of major economic and social changes, the Government adopted a different approach to the role of private sector. New policies were developed that looked favorably on the role of the private sector. The importance of the private sector in health care delivery was further recognized with an amendment to the Private Hospitals (Regulatory) Act, 1977 which resulted into the establishment of the Private Hospitals (Regulation) (Amendment) Act, 1991. following this act, individual qualified medical practitioners and dentists could now manage private – hospitals, with the approval of the Ministry of Health.

HEALTH FACILITIES 2000:

Source:   Ministry of Health Statistical Abstract          

The distribution of Health Facilities has a heavy rural emphasis because more than 70% of the population live in rural areas. Plans for the establishment of health facilities have in the past taken into consideration the facility/population ratio, but with time this has in some areas been seriously overtaken by the high population growth-rate.

Health Services System (Structure):

The health system and especially the Governments referral system assumes a pyramidal pattern of a referral system recommended by health planners, that is from dispensary to Consultant Hospital (Better Health In Africa, 1993). 

The structure of health services at various levels in the country is as follows: 

1.      Village Health Service:
This is the lowest level of health care delivery in the country. They essentially provide preventive services which can be offered in homes. Usually each village Health post have two village health workers chosen by the village government amongst the villagers and be given a short training before they start providing services. 

2.      Dispensary Services:
This is the second stage of health services. The dispensary cater for between 6,000 to 10,000 people and supervise all the village health posts in its ward.

3.      Health Centre Services:
A health Centre is expected to cater for 50,000 people which is approximately the pop. of one administrative division.

4.      District Hospitals:
The district is a very important level in the provision of health services in the country each district is supposed to have a district hospital. For those districts which donate have Government normally negotiates with religious organizations to designate voluntary hospitals get subventions from the Government to contract terms.

5.      Regional Hospitals:
Every region is supposed to have a hospital. Regional Hospital offer similar services like those agreed at district level, however regional hospitals have specialists in various fields and offer additional services which are not provided at district hospitals.

6.      Referral/Consultant Hospitals:
This is the highest level of hospital services in the country presently there are four referral hospitals namely, the Muhimbili National Hospital which cater the eastern zone; Kilimanjaro Christian Medical Centre (KCMC) which cater for the northern zone, Bugando Hospital which cater for the western zone; and Mbeya Hospital which serves the southern Highlands. 

7.      Treatment Abroad:
Other diseases and cases require special treatment whose facilities and equipment are not available in the country. Depending on the foreign exchange position, some patients have to be sent for treatment abroad. 

Public Education:
Public Health Education mainly is concerned with identifying prevailing health problems and disseminating to the public methods of preventing and controlling them. This is an integral part of community involvement in Primary Health Care (PHC). 

It is assumed that, the health of an individual, the family and community at large is dependent upon factors as environment, social cultural traditions and life styles, hence public health education focuses to strengthen and address issues related to agricultural development, child up-bringing, environmental sanitation and development in general. For instance school children are special target group for health education through the school health programme. Public health education is provided by a variety of methods including mass media, continuous development and dissemination of health education materials and through dialogue with communities. 

Health Professional Training:
There are several medical training schools for various medical cadres. The aim of the government is to train adequate, - qualified and motivated medical personnel at all levels of the health care system.

Reproductive Health:
The National Family Planning Programme is the sum total of all Family Planning activities provided by various agencies – and coordinated by the Reproductive and Child Health Unit of the Ministry of Health.

The Government formally started providing Family Planning Services as one of the MCH components in the mid seventies. The Family Planning Unit (FPU) was operational in 1986, and has been gradually strengthened to its present capacity. This FPU is responsible for initiating and developing Family Planning standards and guideline on service provision, training and other aspects of quality care.

Health Sector Reforms

The Ministry of Health appraised the health sector performance with the intention of raising strategies to improve quality of health services and increase equity in health accessibility and utilization.  This appraisal came up in the report named "Proposals for Health Reforms, Ministry of Health, 1994 (HSR)".  The reforms are in the following dimensions: managerial reforms or decentralization of health services; financial reforms, such as enhancement of user-charges in government hospitals, introduction of health insurance and community health funds and public/private mix reforms such as encouragement of private sector to complement public health services. They also include organisational reforms such as integration of vertical health programmes into the general health services; health research reforms such as establishment of a health research users fund and propagation of demand oriented researches in the health sector.  

The Health Sector Reforms Programme has the following objectives:

• Improve access, quality and efficiency of primary health (district level) services.

• Strengthen and reorient secondary and tertiary service delivery in support of primary health care.

• Improve capacity for policy development and analysis, development of guidelines for national implementation, performance monitoring and evaluation, and legislation and regulation of service delivery and health professionals.

• Implement a human resource development programme to ensure adequate supply of qualified health staff for management of  Primary, secondary and tertiary services.

•  Strengthen the national support systems for personnel management, drugs and supplies, medical equipment and physical infrastructure management, transport management and communication.

•  Increase the financial sources and improve financial management.

• Promote private sector involvement in the delivery of health services.

•  Within the sector-wide approach, develop and implement a system for donor involvement, co-ordination, monitoring and evaluation.

Their inter-linked strategies are:

• The provision of accessible, quality, well-supported cost-effective district health services with clear priorities and essential clinical and public health packages which are organised at the decentralized level.

• Provision of back-up secondary and tertiary level referral hospital services  to support primary health care.

• Redefinition of the role of the central Ministry of Health as facilitator of health services, providing policy leadership and a normative and standard-setting role.

• Addressing of the challenges of human resource development to ensure well-trained and motivated staff deployed at the appropriate health service level.

• Ensuring of the required central support systems such as personnel, accounting and auditing, supplies, equipment, physical infrastructure, transportation and communication.

• Ensuring a sustainable health care financing which involves both public and private funds as well as donor resources, and exploring a broader mix of options such as health insurance, community-cost-sharing as well as user fees.

• Addressing the appropriate mix of public and private health care services.

• Restructuring the relationship between Ministry of Health and the donors.