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Tanzania faces new health challenges

 

As we struggle with unfinished agenda of infectious diseases, malnutrition and complications from childbirth, we are faced with a growing epidemic of non-communicable diseases like hypertension (high blood pressure), diabetes mellitus (kisukari), mental health disorders, cancer, lung diseases (asthma and chronic pulmonary obstructive diseases), injuries from traffic accidents, cattle rustling and violence. The epidemic is already unfolding in both developed and developing countries.

As our retiring age has gone to 60 years we anticipate more strokes (kiharusi), more diabetes mellitus and may be more urinary retention cases among male adults and cancer of the breast and cervix among female adults, as there are no routine health checks in our health systems. 

In 1998, nearly 60 per cent of the global burden of disease was due to non-communicable diseases and injuries, both intentional and unintentional. In the developing world, non-communicable diseases such as depression and heart disease are fast becoming the leading causes of disability and disease. Depression alone will be the second most important cause of disease burden worldwide by 2020. 

By 2020, over 70 per cent of the global burden disease will be caused by non-communicable diseases, mental health disorders and injuries.  Where will the Ministry of Health and Social Welfare in Tanzania  put its money, in infectious disease control or non-communicable disease? Innovative ways will have to be found to meet this resource crunch. Our health system will have to adapt to this bewildering variety of diseases and injuries, even as we struggle with old problems.

Non-traditional partners will have to be found to extend care to all sections of society especially the poor.  In hospitals all over the country there are hospital beds occupied by patients suffering from HIV/AIDS related cases. Among the 65,000 plus patients  suffering from Tuberculosis, 30-40% of them are HIV infected. Surprisingly enough 25% of all Tuberculosis cases are in Dar es Salaam.

There are patients attending physiotherapy (services, which may not be available in all hospitals in the country), due to different disabilities like strokes and post traffic road accidents victims.  There is need to design mechanism of filtering some of the cases to be taken care of in our community. Alternative ways of health care delivery in the community should be home-based care for all chronically ill patients, but with back up system e.g. hospitals, health centres and dispensaries. 

At the end of the day, the whole community knows “prevention is better than cure”. Preventive interventions exist, but they are undervalued and under used. Policy decisions to deal with this shifting burden of diseases are required now than ever before.  In Tanzania, the prevalence of Non-Communicable Diseases (NCD), like diabetes mellitus is 0.6 – 12 per cent, accidents 4- 8.8  per cent (40 per cent of traffic road accidents occur in Dar es Salaam alone), high blood pressure 2.6 – eleven per cent, epilepsy 5-37/1000 and asthma three per cent. 

Projections for the future indicate that without action the problem will get worse. There are powerful forces of change sweeping the world necessitating global economic and health system restructuring, countries need to re-evaluate the issues and priorities for action with respect to health.  

The World Health Organisation (WHO) recognizes Non Communicable Disease prevention and control as a major global health issue that needs to be comprehensively addressed under the framework of Health for All (HFA) in the 21st century.  There is a remarkable commonality to the risk factors for NCD, which have their root in unhealthy lifestyles and environment where people live and work.

For example, the risk factors for cardiovascular diseases (heart and blood vessels) are found in lifestyles characterized by unhealthy diets (chicken and chips, chips and eggs) rich in energy intake, particularly saturated fats, use of tobacco, excessive use of alcohol and lack of physical activity.  Tanzania needs to deal with NCDs within the context of the health sector reform which is part of the global process characterized by increasing demands for democratisation, economic reform, equity, rationalization of public services and the alleviation of poverty. 

With specific reference to NCDs, health sector reform needs to address a number of fundamental problems namely: The significant variations in the burden of NCDs leading to inequity to access health services among disadvantaged groups. There are the significant demographic shifts, together with the ageing of the population and the need to respond to them -- Great technological change (CT scans, Ultra sounds and other sophisticated equipment e.g. MRI etc), inefficiencies in both the allocation of resources and the management of services.

Inadequate provision of quality services for NCD,  the need for sustainability in the resources for health systems and addressing issues on competent and skilled manpower (human resources deployment).  Integrated approaches to Non Communicable Disease control are a major vehicle that Tanzania can employ to respond to those changes.

Change of life style and building the culture and habit to undergo medical and physical check up at least once in a year will assist in the control of diabetes mellitus and high blood pressure. Once diagnosed it means treatment for life.  There is no way to identify non-communicable diseases without undergoing regular medical checks. The importance of these checks cannot be over emphasized. Be alive to your health, and live a healthier life devoid of the pains of diabetes and hypertension.  

HER Excellency, President Samia Suluhu Hassan has ...

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Author: Dr Ali A. Mzige

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