Health check: How do Tanzania’s health services rate?

My colleagues on Twaweza’s Sauti za Wananchi mobile phone-based surveys are scaling up their output this year, in a big way. After the fascinating briefs they launched in last month on water supplies and the new constitution, they have a new one out today, on health services.

Tanzania has been making great strides on some health-related measures (notably malaria and child mortality), but has a long way to go in other areas. Sikika recently found, for example, that over 90% of public hospitals lacked essential medicines (pdf), and that there is a real problem in retaining doctors, with one survey reporting that 40% of graduate medical doctors were no long practising clinical medicine (pdf).

Back the Sauti brief, there are some very interesting findings:

• 63% say the government is handling the improvement of health services badly or very badly
• Of those who visited a health facility in the past 6 months, over three quarters (77%) visited a government facility.
• Both health centres and dispensaries are desperately short of staff. The average health centre is supposed to have 9 nurses, but actually has only 4.
• Staffing levels are further undermined by absenteeism rates. A third of health workers were found to be absent at the time of an unannounced visit.

But most interesting of all was the clear finding that government policies on free outpatient treatment in government facilities for children under five years and people over 60 years are not being followed. Only 18% of consultations for children under 5 incurred no charge, and only 6% for adults aged over 60 – see chart:

It’s another useful reminder that it’s a lot easier to put a policy in place than it is to implement it.

Irenei Kiria of Sikika commented on the brief:

“Surveys such as Sauti za Wananchi provide important feedback to the government on how they are performing on provision of various services to citizens. This report on on how citizens experience healthcare delivery in Tanzania add to numerous others which have reported same challenges and more in the past. How else should citizens communicate for the government to act? Is the government doing enough to address these challenges?”

“It is unacceptable for a country so blessed with abundant natural resources like Tanzania to run health facilities with inadequate health workers, medicine and medical supplies, diagnostic equipment, and necessarily amenities such as water and electricity. The on-going budget session in the Parliament in Dodoma must consider allocations sufficient to address theses perennial challenges of healthcare provision in Tanzania.”

Let’s hope they’re listening.

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Further reading: Another one from Sikika: I’m a big fan of this thoughtful position paper (pdf) on the “Right to Health” in Tanzania.