Ministry of Health

Today Remmy took me to the national office of the Ministry of Health and persuaded the guards to let me meet with a Communications Officer, Nsachris. I spent about an hour with him and got a great view into how the health system operates from a national level.

ROLE OF MINISTRY OF HEALTH: Before, the Ministry of Health communicated policies directly to villages and rural areas. Now, they make national policies and leave it to the regional and local leaders to enforce the policies. It is less micromanaging and more looking at the big picture. Nsachris said that this transition is helping empower the villages to deal with their own specific health issues. However, the national Ministry of Health still has people that work with specific district governments to help them understand the policies and how to implement them.

Regarding HEALTH INSURANCE, he said that there is National Health Insurance from the government for government employees and there is private insurance provided by religious groups or NGO’s that cater to private companies. For those without insurance, the cost-sharing program goes into effect.

This is the policy from the Ministry of Health: If someone can’t pay for medicine, the fees are waived and people are still treated. They use certain metrics and guides to find out if someone is too poor to pay, but he admitted that these are sometimes not a great measure of ability to pay. They also use social worker interviews and other people in the villages to determine need. Also, children under 5 and adults over 60 are treated for free.

WEAKNESSES IN SYSTEM: He said the biggest issue is that there is a human resource crisis due to a lack of doctors and nurses. In rural areas, there are plenty of doctors, but they are usually the second hand doctors or non professionally trained. There are simply not enough qualified doctors in the country.

To mitigate this, they are setting up more government training institutions, offering scholarships for diplomas and certificates and creating more part time jobs in clinics.

ACCESS TO HEALTHCARE AND WATER/FOOD: Nsachris said that while access to some sort of healthcare isn’t typically a problem because the infrastructure is there (even in rural areas), access to trained doctors could be an issue. Also, sometimes people are not aware of what prevents certain illnesses or what food they should be eating. Thus, sometimes it’s not access to healthy food and hygienic tools that is the barrier, but rather the lack of basic health nutrition and hygiene education.

COMMUNITY HEALTH WORKER PROGRAM: I probed Nsachris about this program and he said this used to be a nationally funded program. Now there are people trained in a lot of places without programs in place. In certain areas, the program was taken over by an NGO. He said the original intent was for the program to become self sustaining and to empower the villages to eventually take over. However, communities became dependent on the government funding to pay the health workers, so the program fell through. He said if they had to do it again, more thought needed to go into who these workers were: they needed to be real people who care about the community and will stay in the community for a long time. He said that the program wasn’t approached in the right way and the villages were not properly trained or equipped to become independent.

COMMUNITY HEALTH FUND: In some places there is a community health fund, which acts as community insurance. A family pays about 10,000 TSH (about $100) per year into the fund and then the whole family could be treated at the dispensary. Every district is supposed to have this, but it is up to the districts to enforce it.

MY IMPRESSIONS: It seems that the government has a bottom-down approach, making policies which then trickle down into the regional and local governments, who are then responsible for implementing and enforcing the policies. NGO’s have a bottom-up approach, starting at a local level and then making themselves known through regional hospitals and rarely making it up to the national level. In some communities, NGO’s and government work towards a common goal, and NGO’s help achieve what the governments intend with their policies through funding and training. These seem to be more effective because infrastructure is already in place to welcome these NGO programs – it’s usually the implementation and sustainability that is lacking. There are other NGO’s that do their own thing, never meeting the government’s objectives. In a village that already meets the government’s basic objectives, this may work fine. But in a place where an NGO is trying to reinvent the wheel, it sometimes falls flat.

Word of the day:
Mbu – mosquito