Tanzania: Scarcity in public hospitals

By Kizito Makoye

DAR ES SALAAM, Tanzania (AA) - A pregnant woman, who gave birth without help on the cold tiled floor at Mawingu Hospital in Tanzania’s south western Rukwa region a year ago, tells a grim story.

“It is hard to imagine how I managed to relieve myself from a stressful situation. I think it was the grace of God,” recalled Maria Msemwa, a mother of two who lives at Kisumba village in Rukwa region.

Msemwa was rushed to the hospital by her husband on a bicycle after she had experienced labour pains. She did not get the help that she deserved because there was no midwife in the hospital.

“I was in a very critical condition and there was no one to help me when we arrived,” she told Anadolu Agency in an interview.

As the pain was getting severe, the 28-year-old farmer had to stand in a squatting position and pushed out the baby who started crying as she landed on the floor.

Msemwa’s husband looked helplessly as he made frantic calls for help for her shocked wife standing over her child with a pool of blood streaming from the ruptured umbilical cord, as the baby fell on the ground.

“It was very scaring, my baby could’ve contracted infections from the dirty floor and die,” she said.

Msemwa’s story is an example of how acute shortage of health workers and scarcity of medical supplies in Tanzania’s public hospitals is a barrier to better health service delivery.

- New born babies at risk

While Tanzania has made remarkable progress in health service delivery, pregnant women and new born babies are still at high risk of untimely deaths, according to Service Delivery Indicators (SDI) survey conducted by the World Bank in 2016.

Tanzania’s maternal mortality rates are very high -- 432 deaths per 100,000 live births -- according to a National Bureau of Statistics data released in 2014.

According to the World Bank survey, serious challenges remain in getting more health workers out to rural areas. According to the report, the rural areas have only 9 percent of the country’s doctors and 28 percent of its health work force.

Although expecting mothers in Rukwa region had become used to receiving free antenatal services from the hospitals, their family members often bear the brunt of what the health facilities are not able to provide due to acute shortage of supplies, local officials said.

“When the midwife arrived, she started complaining that I didn’t bring her disposable gloves,” said Msemwa.

Acute shortage of medical supplies, and ageing physical infrastructures have badly crippled health workers’ ability to provide better healthcare, health officials said.

“We often get less money for buying drugs and other essential supplies than what we have requested,” said Emmanuel Mtika, Acting Rukwa Regional Medical Officer.

According to Mtika, the hospital had requested Tanzanian shillings 286 million ($127,908) from the central government last year but they only got 60 million ($26834), which he said, was not enough to meet the hospital's growing needs.

- ‘Small budget for health sector’

The officer said small budget allocated to the health sector often results in shortage of essential medical supplies, thus patients are forced to stay on the waiting list for long time.

Speaking to Anadolu Agency, many Rukwa residents said pregnant women are sometimes stuck in the maternity ward for days before receiving the first dose of prescribed drugs, forcing some of them to contract infections.

A recent study -- Working in Scarcity: Effects on social interactions and biomedical care in Tanzanian hospitals -- conducted by Washington University, shows shortage of donor funding and corruption have affected health delivery in public hospitals.

From outpatient department to X-Ray and labor room, residents are forced to pay a small amount of money in order to get the service they deserve, local residents said.

“Corruption in our hospital is so glaring that a bribe is taken even when everyone is watching,” said Msemwa, who was repeatedly approached by the nurses demanding bribes in the course of her pregnancy.

“No matter how sick you are, no one will help you unless you pay bribes,” she said.

In February this year, a surgeon with Muhumbili Orthopedic Institute Deodata Matiko (30) was charged along with a nurse Erick Kimwomwe (28) by a Dar es Salaam court for soliciting and receiving Tanzanian shillings 1 million (US$ 500) bribe from a patient’s relative so that they could perform a high-risk surgery.

According to the World Bank study, majority of people who pay bribes in hospitals are poor, and thus the amount of money they pay makes a significant portion of their income.

- Bitter social relations

At Mawingu hospital -- the largest health facility in the southern highlands -- widespread scarcity has led to bitter social relations between health workers and the residents, who accuse the former of selling drugs that are meant to be given for free.

The health workers denied the allegations.

“Most people think that we are stealing medicines. It is not true,” said Rukia Salum, a trained midwife at Mawingu hospital.

According to her, local residents do not know how the government supply chain works and therefore refuse to understand why a big medical facilities may run out of stock of critical supplies.

While most healthcare workers deny selling government drugs, local media reports suggest that many often try to supplement their low incomes by charging patients fees that were inflated or should not have even existed.

“Health workers sometimes win the sympathy of people, who see them as deserving more for what they do,” said Salum.

However, in some situations, the allegations contributed to the nurses’ feeling of being undervalued.

“We live by the accusations, but we cannot refuse to treat those who accuse us,” Said Salum.

Corruption allegations in Tanzania health sector as reinforced by people, who have experienced it, has led to much broader distrust of the healthcare system.

“We have stern disciplinary measures against anyone who is caught taking bribes,” said Mtika.