Habari!

Mambo! This I spent the week in Dar es Salaam, staying with the Sustain Foundation university scholar, Remmy. She attends the Institute of Finance and Management (IFM) and will graduate in November with a degree in computer science. She showed me her registration program that she has developed for one of her classes and it looks so advanced!

Remmy is extremely motivated and was an AMAZING host. She arranged for her friends to drive us around Dar es Salaam for the week so I could meet with different organizations focused on health and education. Every night she tucked in my mosquito net and sometimes carried my bag so I wouldn’t be a target. One of my favorite nights was when we visited her friend Max for dinner and I got a better glimpse into village life on the outskirts of Dar.

University Life
Remmy’s school is surrounded by many countries’ embassies, the National Museum of Tanzania, and the Ministry of Health, so it is located in a very safe neighborhood. She lives with 3 other girls in a girl’s hostel that is located on campus. Sometimes during exam week friends who live farther away will come and stay in their room so they aren’t late to their exams. Their room has a TV, stereo, DVD player, and computer and the girls all seem to get along really well. Remmy said that her roommates were so excited I was coming that they would pretend Remmy was me and would practice what they were going to say.

Ministry of Health
Last Thursday, Remmy took me to the national office of the Ministry of Health and persuaded the guards to let me meet with a Communications Officer, Nsachris. I spent about an hour with him and got a great view into how the health system operates from a national level.

ROLE OF MINISTRY OF HEALTH: Before, the Ministry of Health communicated policies directly to villages and rural areas. Now, they make national policies and leave it to the regional and local leaders to enforce the policies. It is less micromanaging and more looking at the big picture. Nsachris said that this transition is helping empower the villages to deal with their own specific health issues. However, the national Ministry of Health still has people that work with specific district governments to help them understand the policies and how to implement them.

Regarding HEALTH INSURANCE, he said that there is National Health Insurance from the government for government employees and there is private insurance provided by religious groups or NGO’s that cater to private companies. For those without insurance, the cost-sharing program goes into effect.

This is the policy from the Ministry of Health: If someone can’t pay for medicine, the fees are waived and people are still treated. They use certain metrics and guides to find out if someone is too poor to pay, but he admitted that these are sometimes not a great measure of ability to pay. They also use social worker interviews and other people in the villages to determine need. Also, children under 5 and adults over 60 are treated for free.

WEAKNESSES IN SYSTEM: He said the biggest issue is that there is a human resource crisis due to a lack of doctors and nurses. In rural areas, there are plenty of doctors, but they are usually the second hand doctors or non professionally trained. There are simply not enough qualified doctors in the country.

To mitigate this, they are setting up more government training institutions, offering scholarships for diplomas and certificates and creating more part time jobs in clinics.

ACCESS TO HEALTHCARE AND WATER/FOOD: Nsachris said that while access to some sort of healthcare isn’t typically a problem because the infrastructure is there (even in rural areas), access to trained doctors could be an issue. Also, sometimes people are not aware of what prevents certain illnesses or what food they should be eating. Thus, sometimes it’s not access to healthy food and hygienic tools that is the barrier, but rather the lack of basic health nutrition and hygiene education.

COMMUNITY HEALTH WORKER PROGRAM: I probed Nsachris about this program and he said this used to be a nationally funded program. Now there are people trained in a lot of places without programs in place. In certain areas, the program was taken over by an NGO. He said the original intent was for the program to become self sustaining and to empower the villages to eventually take over. However, communities became dependent on the government funding to pay the health workers, so the program fell through. He said if they had to do it again, more thought needed to go into who these workers were: they needed to be real people who care about the community and will stay in the community for a long time. He said that the program wasn’t approached in the right way and the villages were not properly trained or equipped to become independent.

COMMUNITY HEALTH FUND: In some places there is a community health fund, which acts as community insurance. A family pays about 10,000 TSH (about $100) per year into the fund and then the whole family could be treated at the dispensary. Every district is supposed to have this, but it is up to the districts to enforce it.

MY IMPRESSIONS: It seems that the government has a bottom-down approach, making policies which then trickle down into the regional and local governments, who are then responsible for implementing and enforcing the policies. NGO’s have a bottom-up approach, starting at a local level and then making themselves known through regional hospitals and rarely making it up to the national level. In some communities, NGO’s and government work towards a common goal, and NGO’s help achieve what the governments intend with their policies through funding and training. These seem to be more effective because infrastructure is already in place to welcome these NGO programs – it’s usually the implementation and sustainability that is lacking.

I think that Sustain Foundation is approaching the summer the right way: in a way that is inclusive of the community and also works to address the most pressing needs of a community as a whole.

Word of the week:
mbu - mosquito

Stay tuned!

Sustain Foundation is based in Carrboro, NC, and strives to create and implement specific sustainable solutions to health and environmental issues through linking global and local community networks.

One of Sustain Foundation's initiatives is Team Sakina, a women's running club in Carrboro. Sustain Foundation uses the club fees to support programs in both the local community and globally, in Sakina.

Starting mid-June, Sustain Foundation will have an intern working in Sakina, Tanzania to conduct a health needs assessment, teach business skills to two in-country coordinators, and build upon an already existing education program that provides scholarships to secondary school children. Sakina is a community with population of about 500 located right outside Arusha, the second largest city in Tanzania. Arusha is located in northeastern Tanzania about 1 hour away from Mt. Kilimanjaro.

Visit the Sustain Foundation website (http://www.sustainfoundation.org) for more information and remember to check back for updates!