UHC [universal health coverage] is determined by availability, affordability and quality of basic health services being at facility level or within communities. In a country like Tanzania those 3 elements are exactly the issue. Although there is considerable progress making facilities available closer where people live there is still a long way to go for affordability, quality and community care. Why? , with such clear and evidence based guidance from WHO, from national policies and guidance materials of MOH. The answer lies exactly in the complexities and controversities within global and donor policies, inabilities to translate policies into action through and with civil society and growing disparities between a growing upper middle class but a much faster growing lower middle class and below. The consequence is an increasing reliance on self care through the mushrooming of drug outlets with pharmaceuticals you can dream of available.
A few illustrations: Donor money is readable available in the health sector complementing the Treasury’s contribution for constuctions, training, salary support for a large workforce within MOH and its implementing government arm, the Ministry of Regional Administration and local Government. Donors however in general do not follow the guidance from the Astana Declarion on PHC in 2018 calling for health service delivery integrated and involving communities reflecting equity. Donors follow health security threats to a large extent and can quickly mobilize enormous amounts. COVID-19 is a good example, A threat however needs to be seen in context. A threat in a western country may not have the same weight in a western or eastern African country. In Tanzania for example one has to see Corona threats in the context of maternal deaths, traffic accidents, pneumonia and diarrhoea deaths and increasing NCD fatalities to mention a few.
Health care service delivery with Government and donor support needs to appreciate a systems strengthening approach in which all threats can be addressed in an integrated needs based manner together with a top priority move to ensure a basic health insurance package for low and middle income families based on capitation and not on intervention so that service delivery quality in addition to the type of laboratory or pharmaceutical intervention can be introduced and be seen to generate trust in the system. Only in that way we can move away from non standardizer nor regulated self care through easily available medicine shops which only benefits the drug manufacturers and their franchises.
Dr Eric van Praag
Founding member of the Tanzanian Public Health Association, a 40 yrs old civil society organization and a retired clinician/disease control epidemiologist, currently advising in Health Systems and Community Care to Ministries and NGOs and Institutions.
HIFA profile: Eric van Praag is a medical doctor, public health specialist, retired staff Medical School, Muhimbili, Dar es Salaam, Tanzania as well as WHO Zambia and Geneva, FHI360 and UNICEF Tanzania. He currently lives in Tanzania. Professional interests: Health Systems Strengthening, Community Health Care, Disease control. Email address: eric.vanpraag AT gmail.com
