Tanzanian Minister of Health Ummy Mwalimu leads charge to expand first-line health services in "Health for All" approach
By: Godfrey Philimon, Community Health & Right To Health Advocate, People's Health Movement Tanzania
We have seen that there have been various efforts from various stakeholders, global leaders, governments, politicians, citizens and the WHO in general on how to combat the COVID-19 Pandemic, while also increasing efforts to ensure that the world achieves Universal Health Coverage (UHC) by 2030 and by ''Leaving No One Behind''. Tanzania is one of the countries that has not lagged behind in these efforts through the establishment of bylaws, policies, and reforms that will lay the foundation to ensuring Tanzania meets the Sustainable Development Goals (SDGs) by 2030. One of the strategies to achieve these goals included strengthening ''Political Will'' by electing strong and resilient leaders who will oversee various socio-economic sectors including the ''health sector''. It should be noted that Tanzania is also a country that has experienced challenges after the death of the former fifth term President John Pombe Magufuli where according to the country's constitution we have seen his former Vice-President Samia Suluhu Hassan taking on the responsibility of continuing to lead as the Sixth-Term President of Tanzania.
It should also be noted that due to this challenge, there has been an exchange of powers in the cabinet that assist the current President to bring development to Tanzanians. The Health Sector in Tanzania is one of the sectors that also underwent these changes. From 2015 to 2020 it was led by Minister Ummy Mwalimu, who according to statistics shows she was able to lead it well. Looking at the minority and the general health sector, she was able to improve access to medicines in hospitals, improve the environment for better access to health care, strengthen and manage access to health insurance (Single National Health Insurance Fund) by conducting a process that will lead to the foundation of Health Insurance Law for all Tanzanians by Leaving No One Behind. These are just a few of the many things that Minister Ummy Mwalimu implemented before being removed and transferred to another Ministry immediately after the 2020 political elections.
However, in January 2022, many Tanzanians expressed their happiness after President Samia Suluhu Hassan reshuffled his cabinet and eventually appointed Minister Ummy Mwalimu to return to lead the Ministry of Health (MoH). Many Tanzanians were pleased with her expertise, tenacity, and leadership in overseeing the Tanzanian MoH, as well as her commitment to comply and implement laws and regulations set by the government and guidelines set by the WHO and international organizations.
Soon after the appointment Minister Ummy Mwalimu mentioned the task and gaps in front of her in leading the MoH by which she stressed that she will start and continue where she left when leaving the MoH. She described her leadership priorities as (1) Strengthening Primary Health Care; (2) Formulation of Universal Health Coverage Law Act (NHIF Law Act); and (3) Supply and Access to Medicine for all Tanzanians.
We would like to take this opportunity to congratulate Minister Ummy, first and foremost on her appointment to oversee the MoH in Tanzania, to highlight the priorities that are directly aimed at implementing the SDGs most specifically UHC and in particular its responsiveness to listening from citizens and various stakeholders that are commenting and giving opinions on the health sector challenges in Tanzania. We have been following her good start this week where she ran a good social media discussion that focused on the concerns that cause the lack and shortage of medicine in government hospitals as well mentioning a website that any citizen can submit comments or feedback termed as e-Feedback (www.emrejesho.gov.go.tz). This is what good leadership and governance of the health sector should look like.
However, we take this opportunity to offer advice and suggestions in Minister Ummy's number one priority which is Strengthening Primary Health Care (PHC). Following the Alma Ata declaration in 1978, Tanzania was among the first few countries to embark on the development and implementation of the PHC. Tanzania spearheaded the ‘Health for All’ approach by massively expanding first-line health services. As per Primary Health Services Development Programme (2007-2017), the goal was to expand health services by adding at least one health center to every ward and at least one dispensary to every village by 2017 (PHSDP, 2007), something which is progressing well. Access and equity in health care have, therefore, been a driving principle in the implementation of the national health policy, with an emphasis on self-reliance through community mobilization.
It should also be noted that we cannot reach UHC without strengthening PHC. And to strengthen PHC without involving Community Health Workers (CHWs) who are the mainstay of delivering health services to the community but also a link between the community and these public health facilities.
CHWs who are properly trained, EQUIPPED, SUPPORTED, and PAID can take on a range of tasks that otherwise depend on mid level health workers. CHWs extend care to underserved communities, especially women and children, where they enhance access to health services and promote trust, demand and use of such services. CHWs who speak the local language (Swahili and vernacular) and are identified by the local community convey health messages more effectively. CHWs, community capacity training and services contribute to capacity for community leadership especially women and youth particularly at these times when the country targets vaccinating all populations without leaving anyone behind. The majority of CHWs recruited from the communities they serve are less likely to go elsewhere because they are used to community context. Women and youth tend to trust community actors such as CHWs, as the majority of CHWs are popular and influential. Generally, CHWs can help service users avoid trips to health facilities, which translates into saved transportation costs and time. CHWs can meet some of the needs of homebound patients.
The government has put in place the National Policy for Community Health Cadre to support Human Resource for Health (HRH). The aim must be to optimize a health team approach at the front line of the health system, fit for the local context, with facility-based and community-based health workers working together. This approach may result in slower progress at the outset but will ensure long-term results and sustainability. However, these CHWs have not been supervised within the government structures and supported at the level of programme implementation. This has made district and sub-district health committees missing lessons learnt on women and adolescent girls’ health needs captured by CHWs for policy feedback and reviews and hence ensuring synergy among multiple stakeholders and initiatives be captured. This could also enhance the accountability of CHWs programmes to district and community governance structures for health and development. One of the major benefits of a general CHWs cadre would be the institutionalization and integration of this cadre into the health system in order to standardize practice throughout the country and strengthen policies for remuneration of services. To date, most CHWs working throughout the country have been engaged in multiple community programs with less knowledge on Rights to Health and Social Determinants of Health (SDH). However, their distribution, training background and capacity (i.e., education level) and motivation to provide a broader range of services is unknown
Research studies show that there are at least one or two CHWs per village as per a study conducted by MOHU. The government is aiming to recruit at least 2 CHWs per village so the study tried to analyze the percentage of villages having 2 or more CHWs under existing programs. More than three fourths of the CHWS have received training on MNCH, HIV/AIDS, Malaria, Nutrition and Family Planning. There were significant gaps in the standardized module in regards to basic rights to health, food and nutrition even though the majority of existing CHWs are working as health educators and providing information to the community on their thematic area of work. CHWs are involved in service provisions like Family Planning and malaria which is not enough. The majority of CHWs do not have networks or associations in place that could be a coherent and sustainable platform for the scale-up of CHWs programmes towards achieving PHC and hence UHC in Tanzania.
In recent years, and particularly in the face of the COVID-19 pandemic, there has been growing recognition that CHWs are effective in delivering preventive, promotive and curative health services while reducing inequities in access to care and contributing to global progress toward UHC.
In light of this, the MoH under Minister Ummy Mwalimu should intend to Count CHW, Pay Them and improve the knowledge of CHWs on rights to health and SDH by promoting PHC. The Government should enhance the performance of community health workers teams with Technology. As we continue fighting the Pandemic, digital solutions have the potential to strengthen support and supervision of CHWs working on the front lines of community health which is the cornerstone for achieving PHC and UHC.