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Cycles of powerlessness: How can we improve the health system?

Discussion in 'Jukwaa la Siasa' started by HKigwangalla, Mar 14, 2012.

  1. HKigwangalla

    HKigwangalla Verified User

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    By Dr. Hamisi Kigwangalla

    I woke up today reeling from nightmares of what is happening to poor people in Tanzania. I was recently in Tabora conducting research on reproductive health, where I had an opportunity to interview a man who consented to participate in our research. He willingly agreed to share his experiences on the barriers to accessing reproductive health services. His distressing story illustrates the experience of many people across the country.

    The whole story starts with this beautiful young lady who got married to this fine young man. The woman got pregnant after some time. She went to the nearby antenatal clinic for care and was advised by the health workers there to go to Kitete general hospital for delivery. But due to lack of finances the family decided not to go to Kitete and rather to go to a traditional birth attendant.

    Unfortunately, when the day came the woman didn't immediately notice that she was in labour. When she finally realized and told her mother-in-law, she was told to just wait and be strong, because she is a woman. So she waited. At night, the pain became aggravating and grew stronger and stronger. She woke her husband, who was fast asleep and drunk, but he assured her everything was alright and that she should wait as his mother had earlier said, because she knows better.

    Finally, he noticed his wife groaning and struggling. They quickly awoke the whole family and took her in a cow-pulled cart to the traditional birth attendant, where they were confident that they will receive delivery services. When the traditional birth attendant came and examined the lady in the cart, she quickly noticed that the head of the baby could easily be seen. Upon further examination, she noticed that the woman had twins and that she had lost a lot of blood. Realizing she could not help, the birth attendant told them to rush to the nearby dispensary. It was very late at night and not even a single car passed that way. Suddenly the woman became too tired even to cry. Her movement decreased. The situation was desperate. The husband was sobbing and his cheeks were full of tears. Everyone was quiet, perhaps begging mercy from God. When the midwife was awakened, she quickly jumped off her bed and went to examine the woman. She noticed the woman had twins, had lost a lot of blood and that both the mother and babies were distressed. She opted to call the ambulance from Kitete and at the same time to infuse the patient. She knew she could not be of any further assistance.The poor woman struggled to wait for the ambulance to no avail. The husband sat beside his wife, weeping calmly, his heart full of guilt. As minutes passed, he became aware of the reality that his wife was dying. No sooner than the ambulance arrived, the woman passed away. This is a testimony from the husband.

    To this moment, he still cries for his dead wife and twin children. He lost the three most important people in his life in one day. I listened to the story with a chill, as I became aware of the multiple barriers that so many people in this country have to face. These barriers contribute to "cycles of powerlessness."

    The first cycle is within the individual; he or she has to be liberated and enabled to demand for his or her rights. This entails a person who is confident and can make decisions about his or her life and his or her children. Unfortunately many people – especially women – remain trapped in this cycle by a lack of information and autonomy.

    Second, a person must overcome barriers imposed by people who have the most direct influence over their lives; i.e. their in-laws and their own families.

    Third, there are barriers imposed by the social environment (community) and fourth by the health system. All these barriers create a cycle that is difficult to break – particularly for poor women.

    These barriers reflect the obstacles to achieving health equity for women and children in Tanzania. The fact that about 80 percent of Tanzanians live in rural areas, and that more than half of all births occur outside health facilities, compels a strong case towards reforming the health system. We must target improvements in primary health care in order to improve the security of the poor majority living in rural areas. The Government should direct more resources to strengthening primary health care services bringing them closer to the people. Will the budget that is going to be tabled next month in Parliament reflect this?


    Dr. Hamisi Kigwangalla is an independent public health consultant and social justice activist. Call 0715636963 or Email [​IMG]
     
  2. Ndjabu Da Dude

    Ndjabu Da Dude JF-Expert Member

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    Well, for starters, how does the value of your illicit, tax-payer paid, luxurious Range Rover Vogue square up to a "cow-pulled cart", Hon M.P.?
     
  3. Kiranga

    Kiranga JF-Expert Member

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    Hii habari walengwa ni kina nani? na asilimia ngapi yao wanaelewa hii lugha?

    Maana kutetea masikini wa Tanzania kusije kutumiwa kama nyenzo tu ya kuandika vizuri kwa minajili ya kutafuta misaada ya kutoka kwa wazungu na ndiyo maana hata habari zenyewe zinaandikwa kwa lugha ambayo hao masikini hawaielewi.
     
  4. Mwali

    Mwali JF-Expert Member

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    Hatuwezi kuongelea swala la power bila kugusia swala la representation.
    Hatuwezi ku-exercise power yetu wote kwa pamoja,
    ndio maana tunachagua watu wa kutuwakilisha katika decision making process.
    Kinacho tuponda ni accountability mechanism.

    Tunahakikishaje kua hao watu wanao tu-represent (direclty au indirectly)
    wanasaidia kuunda policies ambazo zina-promote interest za wale masikini zaidi
    (ambao ndio wengi Tanzania)? Ikiwa policies ziko sawa
    hata bila mtu kuamsha hiyo power within ataweza kufaidi health services.
    Yunaona mfano katika nchi zingine nyingi tu (so called developed and developing)

    Pia swali la Mkuu Kiranga linahusika sana.
    Kama Social Justice Activist, bwana Kigwangala angeandika article inayo onesha wazi
    ni namna gani Public health services zinaweza kuboreshwa na kuwafaidi raia,
    wala sio kuleta sad anecdotes ili tuonewe huruma na donors.
     
  5. Kiranga

    Kiranga JF-Expert Member

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    Tukizungumzia swala la representation, mtu aliyeshindwa kura za maoni za chama chake vibaya, na akaishia kubebwa kiajabu ajabu hawezi kutufanya tuamini kwamba anatoa representation ya kweli wananchi walioitaka.

    Anaonekana fraud tu. Ndiyo maana hata hizi habari anazileta hapa ki fraud fraud tu, kama anatetea masikini, kumbe anaangalia magharibi na wapi kuna misaada ambayo hatujui hata kama itasaidia hao masikini.
     
  6. Ndjabu Da Dude

    Ndjabu Da Dude JF-Expert Member

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    Siku zote watu wa aina yake wana-qualify kuitwa "psychopaths" kwa lugha ya kitaalamu. Wako very intelligent, highly learned professionals and intellectual elites at local and even international levels, while at the same time are extremely manipulating na wanachukua kila nafasi ku-exploit the corrupt system in place ambayo wanaifahau inside-out, kwa maslahi yao na familia zao tu and in order to maintain their privileged social, political and economic status.
     
  7. Radhia Sweety

    Radhia Sweety JF-Expert Member

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    Utterly inappropriate response! Swala lililopo mbele yetu ni jinsi gani ya kuboresha huduma ya afya. Wewe badala ya kujadili mada ya msingi unaanza kuleta 'personal attacks' which are apparently triggered by your own vendetta against the man. Kama una ushahidi kuwa alibebwa kwenye uchaguzi kwanini hujachukua hatua ya kumpeleka mahakamani? Unasubiri kumvizia JF ili uanze kumwaga matusi kama mwanaume aliyenyang'anywa mke na baunsa.
     
  8. Mwali

    Mwali JF-Expert Member

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    Kweli kabisa mkuu.
    Ila representation yenyewe nimesema inaweza kua direct (kupitia wagombea)
    au indirect (kupitia civil society, NGO na activist wanao tetea haki za binadam).
    Ndio maana nimeuliza huyu mwandishi wa hii habari, kama 'representative' amechukua hatua gani
    kuhakikisha health policies (his field of professionalization) zinawafaidi masikini wa nchi hii.

    Hii tabia ya kuandika kwa nia na dhumuni ya kufedheesha raia wa nchi masikini
    ili kupata fundings za miradi mbali mbali, ambazo hata hazina accountability mechanism
    zinachangia sana katika kukuza inequalities. Ile paper inahusu exactly this.
     
  9. Nyani Ngabu

    Nyani Ngabu Platinum Member

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    Daaah! Watu kweli ni mahodari wa kuponda!
     
  10. Kiranga

    Kiranga JF-Expert Member

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    Hasa kama mtu ni phoney na fraud unataka ku-usurp championing some noble causes.
     
  11. Mwali

    Mwali JF-Expert Member

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    Mimi (Mwali) sijamponda, najaribu tu kumwelewesha
    anaweza kuchukua hatua kadhaa zaidi (on top of wuat he already does)
    na kazi yake ikaleta matokeo chanya. Kwa sasa it is just descriptive.
    Aongeze ka analysis na alete recomendations that would be more in line
    with what a health practitioner and social justice activist is expected to do.
     
  12. Roulette

    Roulette JF-Expert Member

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    We need concrete actions from inside, not from donors. please read this thread :)
     
  13. Kiranga

    Kiranga JF-Expert Member

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    Nimeanza mwanzo kwa kuonyesha mtoa mada hana nia ya kuwakilisha ujumbe kwa hao masikini anaojifaragua kusikia uchungu sana kwa ajili yao.

    Ukiwa unaangalia "swala lililo mbele yetu" tu utaishia kuangalia juu ya pua yako tu na kugongwa na gari barabarani kwa sababu huangalii mambo kwa upeo.

    I don't know this man, had he not run for public office - or had he merely ran for public office but not try to usurp some noble causes which he doesn't have the right track record to champion- I wouldn't give a rat's behind about him. But he took the office, he should conduct himself as a public servant, and not some opportunist with no vision.

    It will remain to be a fact that this fraud - also known as Kigwangalla, although there is controversy even over the name suggestive of further fraudulent tricks- was not the first choice of the people he claims to represent, this is a matter of record and if you dispute this you will only show that you are not interested in the truth.

    Mie sina muda mchafu wa kupoteza mahakamani, lakini hilo halifuti ukweli kwamba huyu fraud si chaguo la kwanza la wananchi na kafika hapo kwa sababu ya kubebana kwa rulers na machination za state sponsored terrorism that is carried by CCM.

    Matusi hujayaona bado. Labda wewe ndiye unataka kuleta matusi. Tatizo when one calls a spade a spade, a fraud a fraud, usurper usurper, one is accused of "matusi".

    Ajibu maswali tu. kama kawaandikia masikini wa Tanzania, kwa nini kaandika katika lugha ya kigeni ambayo wengi wao hawaielewi?

    Au gia tu hizi?
     
  14. Radhia Sweety

    Radhia Sweety JF-Expert Member

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    Kweli nyani huwa haoni mgongo wake! Hivi kati ya Kigwangala na wewe, nani anayeongoza kwa kuandika kwa kiingereza humu? Jitahidi kutawaliwa na kweli badala ya hisia ili uwe huru kaka! Vinginevyo na wewe utaonekana kama mnafiki fulani tu.
     
  15. Kiranga

    Kiranga JF-Expert Member

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    Comprehension ndogo,

    Mimi sina constituency, sijajidai ku champion causes za masikini wa Tanzania na wala sijajitutumua kugombea nafasi ya umma.Situmii senti tano nyekundu ya mlipa kodi wa Tanzania. Sanasana naweza kuwa nachangia tu katika GDP ya Tanzania.

    Hata nikiamua kuandika Kireno, Esperanto au Klingon na machizi wangu wawili hapa poa tu.

    Huyu mbunge anayejidai kuona uchungu sana kwa niaba ya masikini wa Tanzania, anapowaandikia ujumbe kwa Kiingereza, wengine tukisema anawakejeli na kuwakoga tutakuwa tunakosea?

    Au tukisema anataka kutumia tu chambo cha kutetea masikini lakini lengo lake ni kukinga mkono ili apate misaada kwa kupitia jina la masikini, misaada ambayo hatujui kama itawafikia walengwa na wala hatuna sababu ya kuamini hivyo, utakuwa na haki ya kutukatalia?
     
  16. Rufiji

    Rufiji JF-Expert Member

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    Kingwangala,

    What about the barriers imposed by the corrupt CCM's government.
     
  17. Avanti

    Avanti JF-Expert Member

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    Mhhh Ung'eng'e, naona wengi hawatakuelewa, na hata uchangiaji unaweza ukawa low ingawa wangependa wachangie. Anyway kama unaweza nipe mi kazi ya kutafsiri. Kama we ni consultant basi ukinipa consultancy sio mbaya. Naamini kama hutaibadili katika Kiswahili inatapeperukia machoni tu.
     
  18. Ndahani

    Ndahani JF-Expert Member

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    Mheshimiwa, ukiwa miongoni mwa wachache waliomo kwenye vyombo ambavyo vinaweza kuleta mabadiliko tunayofikiria kama watu waliomo wakitaka, upi mchango wako katika kuboresha huduma za afya ndani ya nchi yetu leo. Tumekuwa wapiga hadithi sana...tungependa kusikia vitendo zaidi ya maneno.
     
  19. HKigwangalla

    HKigwangalla Verified User

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    Kiranga,

    You display yourself as a very intelligent guy. And too you have a wide and diverse knowledge and experience. Ila inasikitisha sana kukuona ukijishusha kiasi hiki na kutoa hoja, kwa maksudi kabisa, zisizo na mashiko ya kimantiki hata kidogo.

    Hapa tunaongelea hoja ya Health systems wewe unaleta hoja za uteuzi wangu, inahusika vipi hapa?

    Sipendi kukujibu lakini naomba nikueleweshe kidogo tu kwamba mchakato ulionipelekea mimi kuwa MB leo hii hauna hila wa dhulma kwa mtu yeyote na binafsi sina mashaka kwa hilo na hata waliokatwa na vikao vya chama wanajua kwa nini walikatwa. Hili halina shaka hata kidogo. Mimi nimechaguliwa na wananchi tena kwa kura nyingi sana, zaidi ya 20,000, na ndiyo maana ninasimama hadharani kifua mbele kwa kuwa najua kuna watu wengi nyuma yangu. Ukiongelea uhalali wa uwakilishi wangu, kama una nia nzuri, hautokuwa na shaka na hilo, maana mimi ndiye chaguo la watu wa Nzega (kwa kura halali kabisa). Ila kwa macho ya ushabiki na chuki kwa Kigwangalla, ungeweza kusema 'Kigwangalla siyo chaguo la wana CCM wa Nzega' maana nilishika nafasi ya tatu kwenye matokeo ya 'kughushi' ya kura za maoni ndani ya CCM, hata hivyo ungetakiwa ujue kuna utaratibu gani wa kupata wagombea kutoka CCM. Utaratibu wa kupata wagombea uko katika hatua mbili, kura za maoni na vikao vya maamuzi, na kushinda kura za maoni siku zote si tiketi ya kukufanya uteuliwe na chama kuwa mgombea bali ni mojawapo ya vigezo vitakavyosaidia wajumbe wa vikao wafanye maamuzi.

    Nakushauri ujifunze ku-critique na siyo kutoa criticism kwa kila kitu. Ni mtazamo wangu tu juu yako.
     
  20. Mwali

    Mwali JF-Expert Member

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    Mkuu, nimeona unasema ulikua uki-conduct research.
    As a researcher, unaweza kutupa scientific articles ulizo wahi kutoa
    zenye kuhusiana na changamoto hizo? written for a scientific audience?

    Pia, kila mtu hapa JF anaweza kukupa true story itakayo kusikitisha
    Wewe kama representative wa watu, na Social Justice Acticivist
    Doctor, MD, MPH, MBA, na mengine yote, unafanya nini kubadili hali yetu?
    Actions for the poor? Any concrete initiative to date?
     
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