Question Lingers Whether the Poor Enjoy Equitable Health Services in Tanzania!

[HKigwangalla]

Tanzania: Question Lingers Whether the Poor Enjoy Health Services in Country

The Citizen (Dar es Salaam)

OPINION
4 December 2007
Posted to the web 4 December 2007

Dr Hamisi Kigwangalla

When it comes to talking about equity, much has been said about the distribution of wealth.

But what about the distribution of health? Consider access to quality healthcare for a poor man who lives in a rural village, where the dispensary is more than 10 km away.

Then compare that with a minister who is sent to England for treatment. Are these two people justly treated? Is there a just or fair process of resource allocation when it comes to health?

Tanzania has seen tremendous changes in recent years. In the drive to boost economic growth, we have shifted from an equitable society to a country which has been looted of resources, with benefits flowing to an elite few.

Instead of ensuring equity, our leaders keep on cutting bigger and bigger pieces of the national cake to benefit themselves and their cronies.

Corruption and embezzlement of public property has become the order of the day. In the meantime, ordinary people are being reduced to victims of poverty, diseases and illiteracy.

How can we address these issues, and develop a framework for achieving health equity?

In the early 70's, the American philosopher John Rawls came out with a theory of political and moral justice. Rawls' theory, also known as "justice as fairness," holds that each person has an equal right to the most extensive basic liberty, so long as it is compatible with the liberty of others.

In addition, he asserted that all the 'primary goods' such as health and education should be equally distributed in society. Disparities can be justified only if they are to the advantage of the worst-off. The capability of a human being to do or to be is dependent on whether he is in good health or not.

Ill health reduces the functioning capability of a human being, restricting him in choosing the life he desires.

Therefore health is a resource that must be equally distributed among citizens if they are to be active participants in society. Access to quality healthcare should be protected as a universal right.

The principles of distributive justice require people in a community to enjoy resources equitably. In today's Tanzania, it seems we are not adhering to these principles, particularly when it comes to health.

Those with higher incomes enjoy much greater access to quality healthcare than those who are worse-off.

In 1993 the government of Tanzania instituted a cost sharing policy in order to face the challenges of healthcare financing, availability and quality improvement. The scheme was also intended to increase demand, ownership and participation. User charges and community health funds were sequentially established. In most cases they were left to be used locally in the facilities to complement the running cost provided by the central government.

As the cost-sharing policy began to be implemented, a dilemma on how to cater for the poor arose, and therefore protection mechanisms were put in place.

The so-called safety nets (exemptions and waivers) were established hand in hand with the implementation of the cost sharing mechanisms.

However, the protection mechanisms seem to be non-protective in many cases: Often, the means to test who is eligible and who is not fails and the health providers are unaware of the regulations and operating modules of the mechanisms.

Is there equity in health service provision if the poor are being charged? Or when the poor have to walk long distances to access services? It seems that the wealthy have more access to even the primary care that is provided in government facilities compared to the poor, though they could easily afford to pay for these services.

Why then can't we change our policies into free primary care to all, as it used to be in the past? Or, why can't we make sure that we have proper mechanisms for ensuring that we correctly identify those people who cannot afford to pay for health services?

The reduction of inequalities in health should become a necessary requirement of justice. Failing to achieve health equity deprives people of their rights to be active, engaged citizens or to do things they desire.

That is, it weakens democracy. Thus, recent efforts to improve governance and accountability should be expanded to address health equity.

The government should honour its political obligations to the people and ensure them proper protection when it comes to healthcare.

http://allafrica.com/stories/200712040672.html

Dr Hamisi Kigwangalla is an independent public health consultant.

 

[Kamundu]

Dr Hamisi Kigwangalla nilitaka kuchangia hoja yako iliyopita lakini niliona reply nyingi sana lakini naomba uchukue mawazo yangu kwa makini kwani mimi ni mtaalamu wa Healthcare Cost hapa USA na niko hapa USA kwa miaka zaidi ya 14 sasa.

Pesa ni tatizo kubwa Tanzania na hivyo hata kwenye Afya ni rahisi tu kwa mtu yeyote kusema tunataka kuongeza budget ya hiki na kile lakini ni lazima tuelewe Tanzania ni masikini na hiyo pesa na budget haitapatikana mpaka uchumi ukuwe na ma Daktari wanataka mishahara zaidi n.k. Sasa cha kujiuliza ni kitu gani tunaweza kufanya kupunguza magonjwa, Gaharama na kuongeza huduma bila kuongeza budget zaidi. Tutatakiwa kufanya hivi hapa chini nitaanza na utangulizi.

1. European System: Tanzania kwasasa ina European System ya Medical Centers hii ni system ya kuwa na huduma zote kwenye sehemu moja na kuwa na ma doctor na wataalamu wote sehemu moja. Hii System inawezekana Europe kwasababu (1) Europe ni ndogo hivyo mtu akiumwa hospitali haiwezi kuwa mbali hivyo badala ya kuwa na hospitali nyingi ni bora kuwa na Medical Center chache (2) Europe haina nafasi hivyo ni lazima wawe na mpangilio mkubwa wa Real Estate ili wapate sehemu za shule, hotel, nyumba n.k. Hii System sio nzuri kwa Tanzania ingawa ndiyo tulio nayo kwasababu (1) Tanzania ni kubwa na watu wanakaa mbalimbali sana (2) Hatuna miundombinu mizuri (3) Hatuna wataalamu wa kutosha kwenda kila mahali Tanzania nzima (4) Hatuna pesa. Sasa ni kitu gani tunaweza kufanya kutatua tatizo hili (1) Mobile Health Services- Hapa tuna Mobile Services ambazo ni magari makubwa yenge ma doctor, X-Rays, hata kuna Mobile CT-Scan na MRI Machine. Hizi ni muhimu kwasababu zinaweza kuzunguka sehemu nyingi za vijijini bila kuongeza madaktari. Hii huduma inaweza kutolewa kwenye Chanjo, Screening kama X-rays etc, Magojwa ya meno, vipimo vya kujua kama watu wana kisukari na blood pressure. Sasa Tanzania tuna tumia pesa nyingi kujenga vitua badala pesa nyingi kuhudumia wagojwa. Nana niishie hapa kwa hiii point lakini naweza kwenda deep zaidi baadae (2) Health Education- Kitu kingine Tanzania inaweza kufanya bila kutumia pesa nyingi ni elimu ya Afya. Magojwa mengi yanatokana na kutokujua kama watu wenye Kisukari chakula ni muhimu kupunguza makali ya ugojwa lakini ni lazima watu kwanza wajue ni wagojwa na pili waambiwe wafanya nini kuthibiti magojwa yao. Kisukari kisikotibika kinaweza kuleta matatizo ya Pressure, kukatwa viongo kama miguu, matatizo ya figo, macho hata kifo. Haya yote ni gharama ambazo zingeweza kuzuiwa kabla hata hazijatokea kwa elimu. Naomba niishie hapa kwa mfano huu kuna mifano mingi sana kama mazoezi, na kupunguza kula vyakula vyenye high calestrol, high salt and high sugar. (3) Clinics- Tanzania inabidi iruhusu na ihamasishe watu binafsi kufungua biashara za clinics pamoja na ma dactor. Mafano mimi nataka nije Tanzania kufungua Screening Ctr yenye X-Rays, Utrasound Machine na CT kama niki pata. Hii huduma sitaweza kuhudumia kila kitu lakini mtu mwingine anaweza kufungua clinics za Dental, Kidney, n.k hivyo tunapunguza msongamano kwenye hospitali za umma na tunaongeza hudumu kwa Watanzania. Vitu vingi hapo juu ukiacha clinics vinaweza kufanya na kusaidia na Foundations kama za Bill Gates, Clinton etc Tanzania ikiomba Mobile X-Ray or CT kwa Bill Gates Foundation wata pewa lakini ni lazima muonyeshe plan. Hivi vitu unaweza kufanya kwa budget yetu ya sasa hivi na idadi ya madoctor ya sasa hivi ni kueka utaratibu tu. Doctor wa macho au Kisukari anaweza kuzunguka sehemu nyingi badala ya kukaa offisini peke. Ni lazima tutafute ufumbuzi kwani serikali pekee haitaweza kuhudumia idara ya Afya na matatizo yote hasa ukizingatia Watu watakuwa wanaishi zaidi miaka ijayo. Nikipata muda nitakueleza jinsi ya kuweka Healthcare Fund, Jinsi ya kuhusisha Makanisa na misikiti n.k. na jinsi ya kutumia hizi Foundations kusaidia kwenye idara ya Afya.

 

[FJM]

Dr Kingwangala, nimekusoma. Nadhani una point nzuri. Lakini kama hutojali naomba nitoe rai kwako. Next time tafuta jicho la pili ili u-edit article unazoandika kwa kiingereza. English sio lugha yetu hivyo usione tabu kutafuta mtu aangalie article zako kabla hujaweka kwenye public domain.

Other than that umeweka mambo ya msingi sana especially kwa nchi ambayo some 37% are living below the poverty line.

 

[HKigwangalla]

Dr Kingwangala, nimekusoma. Nadhani una point nzuri. Lakini kama hutojali naomba nitoe rai kwako. Next time tafuta jicho la pili ili u-edit article unazoandika kwa kiingereza. English sio lugha yetu hivyo usione tabu kutafuta mtu aangalie article zako kabla hujaweka kwenye public domain.

Other than that umeweka mambo ya msingi sana especially kwa nchi ambayo some 37% are living below the poverty line.

mh! Nashukuru, lakini article hii ilipitia edit room ya gazeti moja la maana sana hapa nchini na ikachapishwa...