Tanzania's healthcare breakthrough
It is 2002. Parents and babies wait patiently to see the community health worker in Mvomero, Tanzania. “People have faith in the services. They are treated well and diagnosed properly,” says Samuel Hassain, here with his sick grandson. Health worker Y.E. Kapito marvels that “it has been six to eight months since I heard of a child dying.”
This scene is one small part of a remarkable healthcare renaissance — one that has put Tanzania on course to achieving the Millennium Development Goal of cutting under-five deaths by two-thirds ahead of the 2015 target date.
Dramatic drop in child deaths
Tanzania reduced child mortality by an astonishing 40% over five years in two test districts in the late 1990s with a simple top-up of 80 cents per capita to health budgets.
That such gains could be made with such a small investment “was a huge surprise to everyone. Nobody believed this could actually happen,” recalls Hassan Mshinda, a former health researcher and now director general of the Tanzania Commission for Science and Technology.
Since then, Tanzania has rolled out these health reforms nationwide. The result: dramatic improvements in health for children and adults throughout the entire country.
Poor facilities and planning
Tanzania’s health system was in dire straits just a few years earlier. In the early 1990s, “there was a shortage of drugs and of the tools needed to deliver services. Facilities were dilapidated and health care was not properly planned,” Mshinda says. Clinics were understaffed, and staff were undertrained.
With epidemics (HIV/AIDS, malaria, and others) ravaging the country, the death rate soared. In 1990, for example, UNICEF estimated that more than 160 of every 1,000 Tanzanian children died before their fifth birthday. Many Tanzanians stopped seeking medical care for themselves or their children.
That changed, thanks to the Tanzania Essential Health Interventions Project (TEHIP), a collaboration between IDRC, the Tanzanian health ministry, and the Canadian International Development Agency. The project proposed that small but strategic investments in health infrastructure could save lives.
Tanzanian and Canadian researchers began work on several fronts. An easy-to-use computer tool was developed to collect information on the major causes of death and disease. This simple program enabled health workers in both districts to direct more money toward combating the diseases that killed the most people.
Fixing the system
And that’s not all. Radio communications were improved so that vital drugs and supplies could reach clinics. Staff at the clinics received training. The distribution of anti-malarial bed nets was ramped up. A comprehensive approach to treating childhood diseases was introduced. And communities pitched in to rebuild clinics.
The idea: ensure all parts of the health system work effectively together. “Fixing a few big bottlenecks can have a dramatic effect on people’s health,” says epidemiology professor Don de Savigny, formerly TEHIP research manager for IDRC.
A model for success
The effects have been dramatic. According to Honorati Masanja of Tanzania’s Ifakara Health Research and Development Centre, as many as 280,000 fewer Tanzanian children died between 1999 and 2005 than would have been expected to die in the early 1990s.
TEHIP’s success has had a profound influence on African and global thinking about the importance of strong health systems. Burkina Faso, Ghana, Nigeria, and other African countries are following the TEHIP model in reforming their health systems. Globally, there is a growing acceptance of the TEHIP lessons.
Says Nairobi-based IDRC program officer and former TEHIP project manager Graham Reid: “What often matters immediately is not the discovery of new drugs and vaccines, but getting existing, successful treatments down to the people who need them most.”
"The impact of TEHIP continues to be seen more than eight years after TEHIP itself has ended."
— Hassan Mshinda, Director General, Tanzania Commission for Science and Technology