The Challenge in Context
It is hard for people in the US and other industrialized countries to imagine the challenges of basic health care in sub-Saharan Africa.
Can you imagine walking 5 miles to the nearest health center?
In Tanzania, most people are within five miles of a health facility. However, since 85% of the population lives in rural areas with rugged roads and little or no transportation, the trip can be taxing. Pregnant women who have started labor may need to walk or bike to the nearest health facility. In such cases, the road be prohibitively far, not to mention dangerous, during the night.
All too often, the journey to health care does not end when the patient arrives at the clinic. A patient may find that the drugs to treat malaria, for example, are not in stock. Or, a patient may have to wait for hours because the clinic does not have enough doctors or nurses to go around. There are fewer health workers and health clinics in rural areas; therefore training more health workers – and ensuring that rural health posts are filled – is critical.
Creative solutions – such as providing bicycles for community health workers and call centers to gain second opinions on complicated cases – are also paramount, especially in rural areas. The Who Cares? Campaign emphasizes the need to bring care “to the last mile.”
Can you imagine a hospital without clean water?
Many health facilities in sub-Saharan Africa have no running water. Every type of health facility – from large, urban hospitals to small, rural clinics – needs a functioning and reliable water supply, electricity and communication equipment to provide adequate care. Health workers require this basic infrastructure to ensure proper hygiene and safety when caring for patients.
Unfortunately, one or more of these elements is often lacking in Tanzanian health facilities, particularly in rural areas. For example, only 50% of Tanzanian public health facilities receive electricity from the grid that makes it impossible to refrigerate sensitive items, like blood used in transfusions, or conduct safe operations.
Health workers also depend on communication tools like cell phones or the Internet to refer patients to facilities with greater specialization, to place orders for drugs and equipment, and to share medical knowledge. The Touch Foundation is working to address these infrastructure and communication challenges so that health workers can do their jobs.
Can you imagine you are the only doctor in Kahama – a district with one million people?
This is the situation that Dr. Leonard Subi faces. As the District Medical Officer, he has heavy administrative and public health responsibilities, leaving little time for direct patient care. The hospital staff is comprised of too few nurses and Assistant Medical Officers, and they are overwhelmed. They must care for two or three patients per bed and they lack basic equipment. For patients, the consequences are dire. Many pregnant women cannot reach the hospital. Of those who do, at least one dies every week giving birth.
The situation in Kahama is not unique. Dr. Subi is one of only 1,300 physicians in a country of 40 million people. One of Tanzania’s greatest health challenges remains the massive shortage of doctors and other healthcare workers.
How does one begin to tackle a problem of this magnitude and complexity? The answer is one step at a time, starting with training more healthcare workers.
For many young Tanzanians the primary obstacle to higher education is a financial one. Students from poor families simply cannot afford to attend medical school. At the Bugando University College of Health Sciences, situated about 150 miles from where Dr. Subi is based, students are training to become doctors, nurses and other health professionals. They can do this because their tuition and living expenses are predominantly funded by the Touch Foundation. The Touch Foundation’s support has enabled Bugando to become the second largest of five medical training institutions in the country.
Bugando is now training over 900 students across eight professional specialties. Upon graduation, nurses will deliver primary care, particularly in the rural areas; Assistant Medical Officers will deliver lifesaving interventions, including Cesarean sections; and pharmacists will be equipped to safely administer critical preventive and curative medications at small dispensaries and clinics. Bugando graduates will increase the number of doctors in Tanzania by 30% in five years.
Can you imagine saving the life of a pregnant woman with malaria?
A pregnant woman has a high risk of suffering miscarriages or fatal consequences if infected with malaria because her immune system is much weaker than when she is not carrying a baby. About 1.7 pregnant women contract malaria while pregnant annually in the world and countless complications result. In order to protect the lives of these women and their children, health workers are needed! A doctor such as Stella, a nurse, or other health worker has many crucial roles. For example, in the case of malaria, health workers prevent malaria by distributing bed-nets and educating the community, diagnose and treat the disease, and provide care during complicated pregnancies caused by malaria or other conditions.
Governments, nonprofits, individuals, and others are working to improve health outcomes in sub-Saharan Africa. The world has rallied behind the Millennium Development Goals (MDGs), a framework established by world leaders that “commits rich and poor countries to end poverty, improve health and education, protect the environment and create a global partnership for development by 2015.” Three of the MDGs relate to health – central to people’s happiness and wellbeing. The Who Cares? Campaign to train healthcare workers and reduce unnecessary deaths in sub-Saharan Africa is part of this groundswell of action.