By Tusekile Mwambetania and Nora Muchaki, Dar es Salaam:
Accessibility and availability of adequate health care and HIV & AIDS
services is vital not only for People Living with HIV (PLHIV) but also
health service users whose lives are endangered once they lack these
key services. It is, however, unfortunate that these important
services are difficult to access for many in this country due to
various reasons, many of them avoidable.
A recent visit by Sikika, a health advocacy nongovernmental
organisation, to Kondoa and Mpwapwa districts in Dodoma revealed a
sorry state of affairs as people there face challenges when it come to
accessing health services. The situation there showed the sad reality
of many challenges, in accessing quality health services, for
Tanzanians especially in rural areas.
This is so despite the government\’s effort to try and curb the problem
of inadequate health facilities. The government intends to construct
and make sure that there is a health care facility in each village, as
the Primary Health Development Programme instructs, but it is common
to find a newly constructed facility, not operating because of lack of
health workers.
The shortage of health workers is a problem that has been affecting
this country for a long time and it is now a tired story. The
situation is worse in rural areas which trained professionals shun
because of unconducive working and living environment.
Kondoa District is one such example where in Makorongo Ward; there are
two clinics in Khubunko and Maziwa that were built and remained closed
because there are no health workers. In Chase Ward, a dispensary was
forced to close down because the only health worker who was in charge
had died.
For the few facilities that are operational, some are manned by very
few staff members who can be as few as four per facility. These attend
to between 20 – 70 patients a day, including PLHIV. During month end,
these workers have to travel to town to collect their salaries and
either leave one staff who will endure all the workload or they close
the clinic all of of them go.
Why can’t easy ways of receiving salaries for health workers in rural
areas be sought without them leave their duty stations? Tanzania
already has a Human Resource crisis in the health sector and
deliberate efforts should be sought to provide incentives in order to
retain the available health workers. This will reduce stress on the
part of available few health workers and ensure continuity of the
health services throughout the year.
Some clinics only offer Voluntary Counseling and Testing (VCT), which
only provides counseling and testing services. It will then require
patients to travel far for Care and Treatment Centres (CTCs) mostly in
town for treatment and for CD4 count. This has its challenges because
transport cost is not affordable to most villagers. As if that is not
enough, most health facilities in rural areas have CTCs but do not
have a CD4 count machine, which again requires patients to travel far
to have the CD4 check or not go at all because they can’t afford; they
continue taking their ARVs for years without checking the status of
CD4. This is not right because treatment is effective if it considers
patient’s CD4 count for the purpose of monitoring patients.
A clinic in Kisese Ward, Kisese Health Center has a CTC but does not
have a CD4 count machine. Other centers are Hamai in Songolo Ward,
Busi Ward, and Kwamtoro ward to mention just a few. Patients are
required to travel to either Kondoa or Dodoma town for CD4 count
services. Other wards that have health centers in Mpwapwa without CD4
count machines are Kibakwe, Rudi, Mima and Pwaga, and the list
continues.
Some health facilities for instance, in Mpwapwa (Mpwapwa District
Hospital), do not have not only the CD4 count machine but also a
malaria test kit. Malaria is one of the major opportunistic
infections, which goes hand in hand with HIV & AIDS treatment.
According to service users, for Mpwapwa District Hospital this problem
has existed for more than a year now. With situations like this, the
number of PLHIV who undergo CD4 count will continuously decrease
instead of increasing despite its importance.
Priorities and needs of PLHIV are not included into national plans and
hence aren’t budgeted for. The channel through which citizens can be
involved in plans and monitor the implementation of plans is HIV &
AIDS committees. It is a pity that these committees that were
government initiative are not functional. Like in most parts of the
country, Kondoa and Mpwapwa are not exceptional;
The committees have been formed; the procedures to select the
representatives were not always followed because the composition is
not as it is stated in the guideline for forming committees that came
from the Presidents Office. In Kondoa and Mpwapwa most committee
representatives that Sikika spoke to were not aware of their
responsibilities. According to these representatives, government
promised to conduct capacity building sessions to all committees on
their roles and responsibilities after they were just formed but it is
more than five years now, they are still waiting for them to come. The
committees also do not receive any financial or other basic support
from the government. Most committees do not even conduct regular
meetings as it is stated in the guideline.
In order to fight the HIV & AIDS epidemic effectively at the local
level, the AIDS Control Committees were formed at the village, mtaa,
ward, district and city municipality levels. Some of the roles of AIDS
committees are to collect views and ideas of all stakeholders in order
to assist in the management, documentation and implementation of HIV &
AIDS programmes. The committees should also work closely with citizens
in order to evaluate and give recommendation based on the AIDS
situation in the areas such as infection rate, number of those
infected and contributing factors to the disease. If the committees
are not empowered, HIV & AIDS will remain a national catastrophe and
will continue to affect many people.
The health policy of Tanzania clearly states its aim of improving
health status of all Tanzanians especially the marginalized by having
good health systems that will benefit citizens and prolong their
lives. The vision is to have a healthy society that will contribute
productively in the development of the country. With the health trend
in the country currently, can we really say we are on the right track?
*Tusekile Mwambetania is the Head of HIV & AIDS Department and Norah
Mchaki is an Intern in the same department at Sikika