Country Spotlight Series, Health Systems Strengthening
Faith-based Organization Role in Health Systems in Tanzania
Health in Tanzania
Tanzania is a country faced with a significant burden of disease, poverty, and disparities in health outcomes. According to the World Bank, 26% of Tanzanians live below the poverty line, causing a significant barrier to access and affordability of healthcare in the country.
FBOs are the largest providers of hospital services in Tanzania, owning 41.1% of hospitals, and the second largest provider of health services, owning 23.3% of total health infrastructure.
Health services in the country are very limited due to lack of funding, health professionals, and disproportionate allocation of services. In 1992, the government of Tanzania recognized the value and potential impact of developing partnerships with faith-based and non-government organizations to improve the health sector, specifically in rural areas of the country. As a result of government financial support and contracts, faith-based organizations (FBOs) now serve as the largest providers of hospital services in the country, owning 41.1% of hospitals, and the second-largest provider of health services, owning 23.3% of total health infrastructure.
TANZANIA COUNTRY PROFILE
- Country Population (2019): 58,005,463
- Life expectancy at birth (2018): 65
Maternal Mortality Rate
Under 5 Child Survival Rate
- Mortality rate (under 5, per 1,000 live births) is 50.3 (2019)
- Infant mortality rate (between birth and 1 year, per 1,000 live births) is 36 (2019)
- Ranked 37th among countries: (2019 data)
Skilled attendance at birth
64% of births had a skilled attendant present (2016)
Child Stunting and Nutrition See Report
- In 2018, approximately 3 million Tanzanian children under 5 years old were estimated to be stunted
- 3.5% of children aged 0-59 months were found to have Global Acute Malnutrition
- Approximately 440,000 children were moderately malnourished and 90,000 children were severely malnourished in Tanzania in 2018
Gross Domestic Product
$63.177 U.S. Billion
FBOs and the Health Care Landscape
Tanzanian government policymakers aim to reform health care by increasing funding and contracts with FBOs and NGOs to make health care and services more affordable. However, while FBO and government partnerships are effective in bringing services to more individuals in need of care, FBOs often have significant shortages of funds in relation to increasing demand for health services.
With FBOs providing such a significant portion of health services in the country, it is, therefore, necessary that collaboration between policymakers, government officials, and FBOs continue to improve in order to further strengthen Tanzania’s health system. Three FBOs that have a significant impact in the country are the Mennonite Central Committee (MCC), Friends of Shirati, and the Christian Social Services Commission (CSSC). All three of these organizations aim to strengthen the health system of the country and to strengthen community sustainability, education, agriculture, and address health disparities.
Example 1: Mennonite Central Committee
Mennonite Central Committee (MCC) Tanzania has worked primarily in the areas of agriculture, health, and education since the 1960s. MCCTZ supports local Tanzanian NGOs to effectively implement development projects within their own communities as well as provide financial grants to partner organizations, technical advisers, and capacity-building through MCCTZ project coordinators.
MCCTZ partner organizations also collaborate closely with their local government offices to supplement or fill gaps of care within their communities. Three examples of partner organizations’ connection to government activities are as follows:
- The Arusha Mental Health Trust (AMHT) – MCCTZ supports this government facility by raising awareness about mental health issues over the radio and procurement of approved psycho-therapeutic medications.
- Naboishu Development Initiative (NDI) – This partnership complements the government supply of antenatal supplements and offers nutritious food to women who come to government clinics for prenatal visits. This has led to a significant increase in the number of people accessing health care at government clinics.
- Dodoma School for the Deaf (DSD) – MCCTZ supports the DSD by contributing to its supply of textbooks for students, student nutrition, and health care costs for students.
While FBO and government partnerships are effective in bringing services to more individuals in need of care, FBOs have significant shortages of funds in relation to increasing demand for health services.
MCC also strengthens community involvement and health through a care group model. Traditional midwives are trained as care group volunteers to educate neighborhood women on the importance of antenatal care visits and having a facility delivery. The project promotes proper infant and young child feeding to mothers after exclusive breastfeeding for six months.
MCC Tanzania Project Participant Counts and Impact
- 20,000 individuals served annually
- 7,071 served through health programs
- 8,700 served through education programs
- 3,100 served through food security programs
- 14,600 catchment area for health projects
- Catchment area of 20 million people for projects in Northern Tanzania
(Data is approximate counts. All information on MCCTZ from P. Mosley, personal communication, August 14, 2020)
Example 2: Friends of Shirati
Friends of Shirati works to provide medical, educational, and developmental support to the Shirati Hospital, located on the shores of Lake Victoria in Northeastern Tanzania, and surrounding communities. Friends of Shirati is the largest source of external support to the Shirati Hospital, raising more than $1.6 million USD and spending more than $1.2 million USD for projects and services. Many of these projects include improving cancer screening, HIV/AIDs prevention and treatment, disability services, and building improvements and development.
One of its current projects involves raising funds for the purchase of necessary medical equipment to more effectively deliver health services to the community.
While Friends of Shirati does not work with the government, the Shirati Hospital and surrounding communities have experienced a great improvement in health care access, services, community development, and education thanks to the hospital.
Friends of Shirati projects include improving cancer screening, HIV/AIDs prevention and treatment, disability services, and building improvements and development.
For example, the disability program has provided prosthetics to adults and children; the HIV/AIDs program hosts monthly educational training for youth to learn about prevention, diagnosis, and treatment, and individuals have received high-quality care at the leprosy hospital and palliative care units.
Friends of Shirati funded a significant sustainable development project to provide two solar electric plants that power approximately 90% of Shirati Hospital and pump water across two miles. As a result, there are four additional locations around the hospital where individuals can buy clean water.
Shirati Hospital Annual Impact in 2017
- 3,500 outpatients under 5 years old
- 10,500 outpatients 6 and older
- 2,650 maternity inpatients
- 1,750 children inpatients
- 650 major inpatient surgeries
- 300 minor inpatient surgeries
- At least 50,000 total patients annually(Approximate counts. All information on Friends of Shirati from D. Ressler, personal communication, July 13, 2020)
Example 3: Christian Social Services Commission
Christian Social Services Commission (CSSC) is the largest ecumenical organization in Tanzania, serving in over 87 dioceses and provinces. CSSC facilitates educational, social, and health services in Tanzania through their member churches, primarily contributing to physical, mental, social, and spiritual development. CSSC and member churches aim to strengthen community health knowledge and resources to build self-sufficiency, community sustainability, and health equity – regardless of color, race, and creed.
CSSC owned and managed services in Tanzania
• 42% of hospital health services (103 hospitals)
• 56% of health facilities in rural areas
• 10% of education services
• 102 health centers
• 696 dispensaries
• Church owns 7% of all basic educational facilities in Tanzania
• 370 pre-primary schools
• 172 primary schools
• 370 secondary schools (52 seminaries)
• 12 teacher colleges
• 126 vocational education and training centers
• 26 universities and colleges
• 143 laboratories
CSSC initiated a task force with members from the Christian Council of Tanzania (CCT), the Tanzania Episcopal Conference (TEC), Government of Tanzania, overseas international partner churches, and the German Government to discuss methods of collaboration in addressing social services, education, and health.
As a result, CSSC has strengthened the relationship between national, regional, and council government officials to improve policy and legal frameworks as well as increase cooperation in the delivery of education and health services.
CSSC and member churches aim to strengthen community health knowledge and resources to build self-sufficiency, community sustainability, and health equity – regardless of color, race, and creed.
CSSC’s education projects include promoting e-learning in secondary schools, learner-centered teaching, and strengthening community engagement in education service provision. CSSC led and participated in numerous health projects including initiatives to address HIV/AIDS (FASTER Project and ART Project), Tuberculosis (TUWAFIKIE TB Project), health systems strengthening projects, and more.
In addition, CSSC has supporting units like The Competence Centre (CC) that addresses management needs for social service activities, the Knowledge and Information Managements (KIM) unit assists in performance-based planning, monitoring and evaluation (PME), reporting, quality assurance, lobbying and advocacy work, and networking and partnerships.
Other unit services include information and communication technology, human resources and administration, finance and accounting, and a Tanzania Ecumenical dialogue group. Through policy dialogue, CSSC has advocated for the development of a national pre-primary educational framework, changes to taxation laws that negatively impact faith-based educational institutions, and advocacy to increase female science and mathematics enrollment.
CSSC has led and participated in numerous health projects including initiatives to address HIV/AIDS, Tuberculosis (TUWAFIKIE TB Project), health systems strengthening projects, and more.
Areas for Continued Improvement
According to the World Bank, the population of Tanzania is rising faster than the supply of social services necessary to address education, health, and water access. For example, there exists a lack of essential drugs, skilled providers, and transportation services.
The Tanzania Development Research Group (TADREG) also reported that 75% of villagers are still concerned about the affordability of healthcare, but 71% of villagers would rather pay more for the quality of their health care or travel further than receive poor services.
Additional challenges to the health system in Tanzania include addressing social injustice and inequality. Tanzania’s religious setting is vast, with 30% of the population adhering to Christianity, 35% to Islam, and 35% to indigenous beliefs.
According to a study by Wilk-Mhagama in 2016, individuals in Tanzania with religious convictions face increased challenges of poverty, social injustice, and inequality.
Therefore, faith-based organizations are vital to the health of Tanzanians who are faced with increased difficulty in accessing health care due to religious convictions. FBOs have strengthened the health care infrastructure of Tanzania by bridging gaps in care, addressing disparities of health, and improving and innovating current health care services offered by the government.
FBOs now serve as the largest providers of hospital services in Tanzania, owning 41.1% of hospitals, and the second largest provider of health services, owning 23.3% of total health infrastructure. –International Journal for Health in Equity
Conclusion
In Tanzania, faith-based organizations are essential to providing health care for the 28% of Tanzanians living under the poverty line. Because of the strong connection between the Tanzanian government and FBOs, faith-based organizations now represent a significant share of hospitals and health services. FBOs have been active in strengthening health systems, health education, and addressing health disparities.
In addition to providing direct resources and services, FBOs in Tanzania have been actively involved with advocacy of policies that support their missions. Though there is still a widening gap between the supply of services and the health care needs of the Tanzanian population, FBOs continue to strengthen the health care system and help bridge gaps in care.
The CCIH Country Spotlight Series features Christian health services, including those provided through facilities, communities and churches. The aim of these pieces is to help identify influential Christian health organizations and highlight key partnerships and initiatives that improve health for those in need. These pieces are illustrative and will not represent or reflect the entirety of important Christian contributions to the design and delivery of health services. CCIH is a non profit association based in the United States with members across the globe.
CCIH Intern Marie Jankowski, MPH conducted research and writing for this report.