History of the German Technical Cooperation in the health sector - Tanzania
German Tanzanian Co-operation in Health can be followed back to the 19th century and is linked to the names of famous medical researchers like Robert Koch. After independence and up to the late 1970s the Tanzanian Health System was renowned for its achievements in terms of geographic coverage and quality of care. Unfortunately, the fiscal crisis combined with rapid population growth, led to a rapid deterioration of the system.
The present status of health in Tanzania, including reproductive health, is inadequate for sustainable development and for the reduction of poverty of the Tanzanian population. Principal causes are the presently insufficient national budget funds to ensure acceptable levels of health care, the inefficient use of the available resources, as well as the lack of technical and managerial human capacity to effectively deliver quality health care.
Developments in the Health Sector- Tanzania
Since 1994 the Government of Tanzania has been striving to bring about in-depth reforms of the health sector seeking improvement of the quality and accessibility of services throughout the country. The Health Sector Reform was approved by parliament in 1997 and is widely supported by the donor community. From 1998 a Memorandum of Understanding (MoU) has been signed formalising a Sector-wide Approach (SWAp) for Health Development. It forms part of a comprehensive reform process which comprises also the Civil Service Reform and the Local Government Reform.
A new Health Sector Strategic Plan (HSSP III) 2009 - 2015 is in place. This can be seen as Phase II of the reforms under SWAp, the aim of which is to improve service provision and client satisfaction. The new HSSP has increased the pro-poor key strategies to 9, adding HIV/AIDS and these have now been integrated into 3 components:
- The role of the central level,
- secondary and tertiary hospital services and
- district health services.
The planned results of the shared Tanzanian-German co-operation strategy in the health sector correspond to the objectives of the previous Health Sector Reform Programme of Work (HSR PoW) and are consistent with the new Health Sector Strategic Plan (HSSP III); they will mainly concentrate on capacity building for district health services, sustainable rehabilitation and maintenance of existing health facilities, support for co-operation between public, private for-profit and non-profit providers of health care (notably CSSC), development, dissemination and financing of decentralized models to fight HIV/AIDS; as well as assistance to develop cost sharing systems.
Tanzania and Germany have come a long way together in their co-operation regarding health. Bilateral Government co-operation over the last 30 years began in the areas of Primary Health Care, disease control, health infrastructure rehabilitation, operational research and later in the development of District Health Services, support of the Health Sector Reform and for cross-sectoral approaches to Reproductive Health / Family Planning and in combating HIV/AIDS.
Furthermore, policy advice and advice on implementing strategies within a Sector Wide Approach (SWAp) at national, regional and district levels are accompanied by financial contributions to the so-called "health basked fund".
Major Achievements of the Cooperation to date include;
- Technical support to the Tanzanian Health Reform Process
- Contribution to the Tanzanian health sector basket fund since 2001. This basket fund serves to finance a range of prioritized health interventions at national, regional and district levels that have previously been identified and agreed upon by both, the Ministry of Health (MoH) and donors.
- Support in the development of national guidelines for the Comprehensive Council Health Plans
- Support to the field of reproductive health developing a series of booklets compiled from the most frequently asked questions of adolescents on reproductive health topics together with answers from different experts. Topics include, "Growing up", "Healthy Relationships", "Sexual Relationships", "Pregnancy", "HIV/AIDS and the New Generation", "Drugs and Drug abuse". To date close to one million sets have been distributed.
- Technical support to the districts on how to incorporate reproductive health into their planning and on training of health facility staff in the diagnosis and treatment of sexually transmitted infections (STIs). The latter led to a great improvement in the offer of services available.
- Financial support for procurement of contraceptive supplies, in particular of hormonal injectibles in order to respond to the increasing demand of low-income users.
- Financial support to improve health infrastructure and equipment in both public and church-run hospitals and health facilities, particularly rehabilitation and extension of primary health care (PHC) facilities and district hospitals in Mtwara, Tanga, Mwanza, and Dodoma Regions. It can be assumed that about one third of Tanzanian hospitals have been supported in one way or the other by financial cooperation (including the Joint Social Services Programme Health & Education). Concepts for rehabilitation and preventive maintenance have been developed and are increasingly applied in church-run and public health services. In four districts public-private partnership in health care delivery has been tested successfully and could serve as an example of best practice for other districts as well. Drug revolving funds have been introduced in church-run hospitals and have contributed to the managerial and financial sustainability of these facilities.
- Technical suppot to the council health management teams (CHMTs).