Tanzania: Adequate health care services vital in fighting HIV,AIDS

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 non governmental 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?

The writers of this article, Tusekile Mwambetania is the Head of Department of HIV & AIDS while Nora Muchaki is an Intern at Sikika