Mid-level providersTANZANIA

Godfrey Mbaruku

              Date : 20 Sep 1996

Source : UN Office for the Coordination of Humanitarian

Affairs (OCHA)

                 

                                                                                

                    

Some facts about Tanzania

• Largest country in E.A-330,000sqkm

• Population-38M

• MMR-578/100,000(DHS);1,200(WHO)

• IMR-112/1000

• Dr:Population-1:20,000

• NMW:Population-1:10,000

Reasons for MLP

• At independence,1961,only 3 local physicians

• No medical school(UEA)

• Projection for self sufficiency-

• Demanding geography

• 80%population-rural

Skilled-care in Africa

• Is it needed?

• Is it available?

• Magnitude?

• Is it cost effective?

• What are the gaps?

• Do solutions exist?

IMPORTANCEIn Africa

• Obstetrics:5% of women die in childbirth

• Perinatal death-5% of all pregnancies

• Injuries:5% of all deaths

• Increase with economy

For every 1 death,1disabled

(acute abdom,hernia,cataract,cong)

Surgicallytreatable:25MilDALYs

(10% of all African DALYs)• Injuries- 10 million• Obstetrical complications- 4 million• Perinatal conditions- 2 million• Malignancies- 2 million• Congenital anomalies- 2 million• Cataracts & glaucoma- 1 million• Others- 4 million

Do we meet the need?

Emergency Obstetric care as a measure

Met need for EmOC in 3 countries

(assume 15%deliveries complicated)

Met Need Drs/mil

• Mozambique 25% 30

• Tanzania 30% 20

• Uganda 5% 80

• Kenya 10% 60

APPENDICITIS DEATHS, USA 1920 - 1960

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4

6

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12

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16

1925

1940

1955

YEAR

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Series1

WHAT HAPPENED,U.S.A?

• Safe blood: availability

• Antibiotics:discovery

• Trained anaesthetists(mostly nurses)

• Trained surgeons(mostly GPs)

• NOT:ICUs,monitoring,US,CT scans,respirators

DOES IT COST TOO MUCH?

Annual cost per bed-5 hospitals

cost/bed(USD) GDP/capita

• Seattle USA 606,000 25,000

• Montry Mexico 68,000 3,900

• Kumasi Ghana 4,100 330

Bangladesh 3,600 350

TANZANIA 2,800 400

However,genuine constraints

• Infrastructure-worn out buildings/equip

• Supplies-drugs,blood

• Inadequate budget-3-18USD per capita

• Transport-ambulances,roads,delays

• Staff-lack,skills,motivation

Innovative solutions

A 7yr intervention program in Mmortality

(1987-1991)• Adressed issues:-• Staff-delegation,availability,skills(OJT)• Equipment-local repairs• Supplies-infusions,blood,drugs• Infrastructure-local fund raising,rehab• Management-regular audit

Results

• MMR reduced by 50%(844-300)/100,000

• CFR reduced 40%(9-3.5)

• Increased attendances by 70%

• Increased patient´s satsfaction

MMR-TRENDS

Conclusions

• Mat mortality can be reduced but following essential

• Staff-training,motivation,presence(24hrs)

• Facilities-conducive

• Supplies-readily available

• Management-problem solving,audit