HEALTH

by Ben Taylor

Dr Elsa, the mobile app for health workers
A mobile app to assist health workers in rural areas, known as Dr Elsa, is currently working across 20 health facilities across Tanzania. The app, which uses Artificial Intelligence (AI) and machine learning, is designed to support health workers to make more accurate diagnosis and make better decisions about a patient’s next steps.

Dr Elsa is a project of Inspired Ideas, an Arusha based organisation, working in partnership with the Ifakara Health Institute (IHI), the Tanzania Data Lab (dlab) and others.

Megan Allen, the Head of Operations for Inspired Ideas, explained that they are targeting rural areas in particular. “Initially, we wanted to use technology as a way to get people healthier and focus on the prevention side of things, but then we realised we can make a lot of impact at the point where people come into the healthcare centre to get services. The health infrastructure isn’t the same in rural areas as it is in urban areas, and similarly there are not as many doctors and specialists in rural parts of the country. This means that communities in these areas are not getting access to expertise.”

The app runs on a tablet operated by the healthcare worker. On meeting the patient, they input information about the patient, what symptoms they have, and their history. Dr Elsa will then generate further questions relevant to the specific case.

At the end, they get an assessment which shares the diseases that the patient is likely to have and the recommendations for the next steps. Dr Elsa is able to generate these questions and assessments thanks to the medical expertise and data that has been input into her, with a machine learning model. Megan says that this tool “puts the knowledge of specialist healthcare providers in the hands of a dispensary worker, so they can then use this to make better decisions.”

There are, of course, challenging with adopting such innovative tech­nology. Megan notes that while internet use is growing, it is still a chal­lenge in rural areas, and most technology will require a strong internet connection. She also notes that changing people’s attitude to technology and training medical staff on AI and new systems can be difficult.

Despite this, the new innovations in healthcare systems are proving to make services more accessible to those who would usually struggle to get quality care. The opportunities are significant. “Technology is making us all more connected than ever,” said Megan. “And in relation to healthcare that means we can bridge the gap between those who have the healthcare knowledge and those who need the services. We are moving in the right direction.”

Higher charges for Covid-19 tests
The Minister for Health, Dr Dorothy Gwajima, announced in January that everyone testing for Covid-19 will now have to pay TSh 230,000 or USD $100 irrespective of whether they are nationals or foreigners. This replaces the previous arrangement where Tanzanians were required to pay TSh 40,000, residents were charged TSh 70,000 and foreigners paid USD $100.

The Minister said results of the test would be obtained within 48 hours for travellers who are upcountry, whereas those in Dar es Salaam will get their results in 24 hours. In Dar es Salaam travellers can visit Muhimbili National Hospital, Amana Hospital in Ilala, Temeke Hospital, IST Clinic, or the Aga Khan Hospital, among other sites, for tests.

According to the ministry the rise of new Covid-19 variant across the world and technological changes in testing has forced the cost of testing for the disease to rise. “Some countries have requested an increase in IgM Antibody testing in conjunction with PCR and an increase in demand for sampling facilities,” said the Minister.

“Tanzania is one of the countries that has taken strong measures to control Covid-19 infections,” explained Dr Gwajima.

CORONAVIRUS

By Ben Taylor

Prayers answered?
In the four months that have passed since the last issue of Tanzanian Affairs, Tanzania has defeated the Coronavirus. There have been no new infections and no deaths reported since early May – the only country in the world for which this is the case. President Magufuli has declared victory.

The President had previously called for the country to use the power of prayer against the virus, saying that the virus “could not survive in the body of Jesus”. He called for three days of national prayer and said God would protect Tanzanians against the virus.

So, did it work? Is this why Tanzania has reported no new cases?
It would be easier to answer the question – and indeed to report on the state of the outbreak in Tanzania more generally – if the government had released any new data since early May. It has not done so. On the website of the African Centres for Disease Control and the reports of the World Health Organisation, the number of positive cases in Tanzania has remained firmly stuck at 510 since May.

In a speech on May 3rd the President accused unnamed “imperialist foreign powers” of sabotaging the national response by providing ineffective testing kits or buying off laboratory employees. He said he had sent dummy samples from a pawpaw and goat for testing, with some producing positive results. Heads rolled at the national health laboratory. In the same speech, the president also suggested international media organisations – the BBC was not named, but the implication was clear – have been deliberately spreading scare stories to undermine Tanzania while ignoring the extent of the outbreak in their home countries. He called this “another form of warfare”. Reforms were instituted at the national laboratory, together with a promise that once testing facilities were working properly, regular reports on case numbers would resume. This has not happened.

Nor, however, has there been any compelling evidence to disprove the government’s claims. Hospitals have not been overwhelmed with huge numbers of patients – whether of COVID-19 or indeed of “pneumonia”. It could be possible to cover up or disguise a few hundred – or even a few thousand – COVID-19 cases, but not the 150,000-200,000 deaths suggested by the London School of Hygiene and Tropical Medicine’s epidemiological modelling for Tanzania, assuming an uncontrolled outbreak. That model projected that most of the fatalities would occur in July and August. It has clearly – and thankfully – not come to pass.

The result is two narratives on the state of the outbreak in Tanzania that exist entirely independently of each other. On the one hand, there are no new cases and victory has been declared. The absence of undeniable evidence to the contrary means that the national media has almost entirely bought in to this view, or lacks the basis on which to question it. Life has returned, for most, to something a lot like normal, and the public has largely moved on.

At the same time, it has been very easy for the international media to paint the President as dangerously naïve and misguided, and to foretell devastating consequences for the country.

The true situation may bear little relation to either picture. Indeed, looking beyond Tanzania, scientists are intrigued by the limited impact of the virus across much of Africa. In an article in early August, the journal Science looked at the numbers and found evidence of infection rates in several countries well above official case counts, but with very few people reporting symptoms.

For example, a study by the Kenya Medical Research Institute (KMRI) Wellcome Trust Research Programme in June and July found that one in twenty Kenyans had COVID-19 antibodies – an indication of past infection. This would put the outbreak in Kenya on the scale of anything seen in Europe. And yet, at the time of the research, Kenyan hospitals were not reporting large numbers of patients and the official death toll stood at 100.

Similar studies in Mozambique and Malawi have reached similar conclusions. In the Malawian case, comparing findings with mortality ratios for COVID-19 elsewhere, researchers estimated that the reported number of deaths in Blantyre at the time, 17, was eight times lower than expected.

The discrepancy is unlikely to be solely due to lower testing numbers, otherwise overall mortality rates would be increasing, which does not appear to have happened. It could have more to do with the very low age profiles of African populations – the median age in Kenya is 20, in Spain it is 45. It could be that Africans have some form of genetic advantage, though higher fatality rates among ethnic minorities in western countries suggest otherwise. Or it could be that regular exposure to parasites like Malaria and to a range of COVID-like viruses has helped prime people’s immune system to respond effectively.

This all raises the question of whether the continent should try for “herd immunity” – letting the virus run its course to allow the population to become immune, perhaps while shielding the most vulnerable. But Glenda Gray, president of the South African Medical Research Council, says it could be dangerous to base COVID-19 policies on antibodies. It’s not clear whether antibodies actually confer immunity, and if so, how long it lasts, she notes.

The herd immunity strategy arguably (and charitably) reflects the path that Tanzania has effectively taken. It may yet work. And yet, with no data being released, we have no way of knowing.

COVID-19 HITS TANZANIA

by Ben Taylor

First cases of Covid-19 in Tanzania
[Editor’s note: As this is a fast-changing situation, the details provided here are likely to be somewhat out of date by the time this issue reaches readers. Nevertheless, every effort has been made to ensure the details were correct at the time of writing (April 24).]

The first recognised case of Covid-19 in Tanzania was recorded on March 16 in Arusha, a Tanzanian woman who had recently returned from Belgium. Two further cases were recorded two days later, one in Dar and the other in Zanzibar, both foreign nationals. Three more followed the day after that.

The government acted swiftly, closing all schools with immediate effect on March 17 and universities from the following day. Major sporting events were also suspended. A contact-tracing and testing system – designed with a potential Ebola outbreak in mind – was put in place.

Nevertheless, the number of cases crept upwards over the following days and weeks. The first death was recorded on March 31.

Initially, cases were limited to those having recently arrived in the country from countries where the outbreak was already more widespread. However, on April 9, the Minister of Health, Ummy Mwalimu announced that the first recorded case of local transmission had been detected around the start of the month.

At the time of writing, the number of recorded cases has begun to rise more quickly, reaching 284 cases and ten deaths as announced by the government on April 22, up from 32 cases ten days earlier.

As has been the case across much of the world, the government has struggled to find the right response to an unprecedented and overwhelmingly difficult situation.

Even before the first cases were recorded in Tanzania, the President and the Minister of Health had both begun urging Tanzanians to take precautions – handwashing with soap, social distancing where possible and refraining from handshakes.

Maalim Seif Sharif Hamad (left) and President Magufuli tap feet in greeting on March 3rd – photo State House


President Magufuli himself set a public example when meeting with opposition leader Maalim Seif Sharif Hamad (of ACT Wazalendo) on March 3: rather than shake hands, they tapped feet. The photo featured prominently in news coverage, and did much to raise public awareness of the virus.

On March 13, the President urged the media to dedicate time alongside their news coverage to educate the public about the virus.

More substantive policy measures, however, have been more piecemeal. After the closure of schools and universities, the next major policy response came on March 23, when it was announced that all international arrivals into Tanzania from Covid-19-affected countries would have to undergo 14 days quarantine in designated hotels (at their own cost). This prompted distress from many returning Tanzanian citizens, who complained that the designated hotels were tourist-class hotels at prices beyond anything they would usually pay.

Three weeks later, the Tanzania Civil Aviation Authority suspended all international commercial passenger flights to and from Tanzania until further notice, though in reality almost all such flights had already ceased operating due to restriction in other countries and measures taken by airlines for commercial reasons.

A faith-based response
The government also urged people to remain at home as much as possible, travel less on public transport and refrain from socialising. The message was somewhat undermined, however, by repeated public statements by the President and other national figures encouraging people to continue to attend their churches and mosques as normal, as the country needed their prayers.

The President, speaking while attending a Sunday service on March 22, said the virus was “satanic” and “it cannot survive in the body of Jesus. It will burn.”

This approach drew criticism both within and outside the country. Opposition leader, Zitto Kabwe, accused the government of “a lack of seriousness” and the President of being in “a state of denial.”

Nevertheless, the President doubled down on the message. Shortly before Easter he stated that “this is the time to build our faith and continue praying to God and not depending on facemasks. Don’t stop going to churches and mosques for prayers. I’m sure this is just a change of wind and it will go like others have gone.” And on April 16, the President called for three days of national prayer, saying God would protect Tanzanians from the virus.

Social distancing not in evidence at Palm Sunday mass in Full Gospel Bible Fellowship Church in Dar es Salaam

This earned the President a spot in a list of the “Notorious Nine” world leaders who “responded to the coronavirus with denial, duplicity and ineptitude,” compiled by a Canadian newspaper, the Globe and Mail. “Tanzania today remains the only country where the government has recommended church attendance as a way of combatting the virus,” the paper reported.

The Prime Minister, Kassim Majaliwa, has differed only a little in his stance. “Prayers in houses of worship are desirable,” he said, “but we also need to take necessary precautions.” He added, however, that as even wealthy countries have not been spared the pandemic, “it is time we sought divine intervention”.

On April 22, the President extended his advice a little beyond prayer
– to incorporate tradition medicine using steam inhalation. This, he said, was “scientifically very clear, because vapour is above 100 degrees centigrade and the virus will disintegrate,” before suggesting that concoctions made of Neem trees, onions and other ingredients could be beneficial, though without specifying whether as prevention or as treatment.

Scientists have concluded that this would have no positive effect, could cause burns and might make people more vulnerable to infection or to infections causing more severe problems. A Reuters fact check (not responding to President Magufuli, but to earlier online posts claiming steam inhalation as a cure), concluded that the idea was false, and indeed dangerous. Similarly, a BBC factcheck concluded that “any attempt to inhale steam at this temperature, would be extremely dangerous … and your lungs would certainly be irreparably damaged before reaching a temperature high enough to deactivate the virus.” Scientifically, it is very clear.

After making this suggestion, the president concluded that “we will beat Corona by working together, by putting an end to fear, by putting God first, and will beat Corona as we have been able to win other wars.”

No lockdown, “never”
The President has also shunned all calls for a lockdown. “Let us continue working hard to build our nation,” he said in mid-April. “Coronavirus is not and should not be a reason for us not working. Farmers should utilise the ongoing rains effectively, industrial owners should continue producing and I don’t expect any development project to stop.”

Some minimal social distancing measures were put in place. In addition to the closure of schools, universities and sporting events, this includes attempts to prevent overcrowding on public transport – no more passengers permitted than the number of seats – and some restrictions (later relaxed) on travel between Dar es Salaam and up-country locations. Many rural communities have put in place their own measures to fine or quarantine anyone arriving from Dar es Salaam – as many have done, recognising the lower risk associated with lower population densities and the possibility of growing your own food. The April 26 Union Day public celebrations have been cancelled, as has the Uhuru Torch race.

Opposition leaders say the country needs to take more urgent action to avoid potential disaster. Freeman Mbowe, the chairman of the largest opposition party, Chadema, posted on Twitter: “No lockdown because he (President Magufuli) wants to save the economy and his flagship infrastructure projects. The lives of our people cannot be repaired but the economy can! Lockdown or get locked out!”

The President has repeatedly resisted all such calls. On April 22, speaking in his hometown of Chato to security force leaders, he addressed the issue again: “There are those who have suggested that we lockdown Dar es Salaam. This is not possible,” he said. “Dar es Salaam is where we collect almost 80 per cent of the country’s revenue, we can continue taking measures to curb the virus but not by locking down Dar es Salaam. Never!”

At the time of writing, the truth is that social distancing has not become part of life for many in Dar es Salaam or other urban areas of Tanzania. Markets, public transport and bars remain crowded, as well as places of worship.

And the government faces some impossible choices in this regard. While a small number of Dar es Salaam residents – primarily those in middle class jobs – are able to work from home, the reality for many is that this would spell rapid and severe economic distress. Tanzania lacks the economic capacity to provide either direct financial assistance or food aid to the millions who would need it.

There is considerable debate about whether a lockdown might not be the best response in many African countries, where populations are both extremely young and financially vulnerable. Melissa Leach, the Director of the Institute for Development Studies (IDS) and James Fairhead, an environmental and medical anthropologist, both at the University of Sussex, have written that “the best policies for countries with young populations may not be lockdowns.”

Around 3% of Tanzania’s population is aged 65 or above, compared to around 18% in the UK and 20% in Italy.

“There may be better ways to save lives such as physically shielding and supporting the most vulnerable while allowing the wider population to gain immunity, whether through a vaccine when it arrives or by virtue of enough people catching and recovering from the virus itself,” they wrote. “Poor countries are much less able to cushion the potentially devastating economic impacts produced by lockdowns. This is if they are feasible in the first place. Effective lockdowns are near impossible in crowded low-income settlements that lack taps and sewers.”

“Today, some version of the lockdown has become most countries’ response to the Covid-19 pandemic. In years to come, we may look back on this moment as one in which an ideological practice emanating from older and wealthier countries was misguidedly “copy and pasted” by elites in younger and poorer societies, leading to marginal benefits in tackling the coronavirus but with the effect of increasing poverty and mortality among the poor.”

Nevertheless, most of Tanzania’s neighbours have opted for forms of lockdown that go well beyond anything being done in Tanzania. In Uganda, the country has been in strict lockdown since March 30. Movement is restricted, public gatherings are suspended and all but a small number of essential businesses are closed. This is enforced in Kampala and other urban centres by a heavy police presence on the streets. In Kenya, the government has not gone quite so far, though did introduce a nationwide 7pm-5am curfew and the closure of all bars and restaurants in late March, followed by a ban on movement in and out of Nairobi and other major urban centres in early April.

Health services
Much of Tanzania’s epidemic preparations have been with Ebola in mind, with contact tracing and testing and isolation of patients of a relatively small number of patients. It is not designed to cope with the large numbers of patients the current pandemic has seen around the world, nor with asymptomatic carriers.

The number of ventilators available is low (the precise number is unknown), stocks of protective equipment for health workers are minimal, even supplies of running water and electricity are unreliable in many hospitals. Five hundred ventilators were donated by Chinese entrepreneur, Jack Ma, on April 8, and several local business figures have donated masks, gowns and other equipment. Doctors have complained about a shortage of protective equipment.

Initially, all positive Covid-19 cases in Tanzania were being isolated in selected hospitals, including those with few or no symptoms. Since April 19, this is primarily the Amana Hospital in Ilala, Dar es Salaam. All other patients at the hospital were transferred elsewhere. Muhimbili National Hospital has been directed to refer all Covid-19 patients to Amana, and to focus exclusively on other medical needs. There have been some efforts to increase capacity at Amana and supply it with new equipment.

There have also been reports of unrest among patients in isolation at Amana. On April 24, it was reported that some patients had staged a breakout. Different reports stated this was either due to dissatisfaction at the poor standard of care being provided to more serious cases or due to frustration among patients with no symptoms that they were being kept for an unnecessarily long time against their will. Similar events were seen the same day in Nairobi, Kenya.

International support, and concern
Various donor agencies have pledged additional financial assistance to Tanzania to cope with the pandemic, though details in most cases are scarce. The government of Ireland responded very quickly, providing €1.5 million to support the national response seven days after the first case was announced. Tanzania has been promised part of a €1.2 billion package set up by the French government to support Covid-19-responses across Africa. The British government has pledged some direct support to Tanzania (“an initial” £2.7 million), but has put large amounts toward international efforts towards vaccine development (£544 million) and the work of international agencies (£200 million) including the World Health Organisation (WHO), UNICEF and the World Food Programme in combatting the pandemic. The EU has raised over €15 billion to support the global response, though this is likely to focus most on supporting economic mitigation and recovery. The US government has committed around $1.5m towards the Tanzanian response.

On April 22, President Magufuli thanked the World Bank for making loans available for financing the response, but suggested that the Bank should instead cancel debts owed by Tanzania and other developing countries. “Now is the right time for the World Bank, which has been touched by the crisis and has good intentions to assist us, to forgive part of the debts we owe, so that the money we are paying each month, and the interest, can be put towards responding to the Coronavirus crisis. This is my request, and I request also that other African countries should join in this call.

WHO Regional Director for Africa Matshidiso Moeti who also urged countries not to let Covid-19 eclipse other health issues.


On April 24, the WHO Regional Director for Africa Matshidiso Moeti said there were concerns about the rise of cases reported in Tanzania in the previous few days. “Certainly in Tanzania we have observed that physical distancing, including the prohibition of mass gatherings, took some time to happen and we believe that these might have been probable factors that led to a rapid increase in cases there.”

Uncertainty and trepidation
The coming months hold a high level of risk and uncertainty for the whole world, with every country facing its own unique challenges according to the local context – and a degree of luck. For Tanzania, it now seems unlikely that the outbreak will be contained, and therefore probable that the virus will spread rapidly in low income neighbourhoods of Dar es Salaam, as well as other towns and cities. It seems unlikely that health services will be able to respond effectively. And it seems likely that the economic consequences – lockdown or no lockdown – will be severe for many, with urban areas again likely to be hardest hit.

Lower population densities in rural areas may offer some protection – both reducing the chance of infections reaching rural communities and slowing the spread within such areas. In rural areas, households are also more likely to be able to produce a greater proportion of the food they need. The young age of the population may offer some protection, if fewer of those who contract the virus suffer severe symptoms, though this may also contribute to faster spread among asymptomatic carriers.

The truth is, however, that this situation is unprecedented in modern times. Nobody truly knows how it will play out, nor what the cost in lives will be, nor the impact on food security and the wider economy.

HEALTH

by Ben Taylor

Debate on Health Insurance scheme
The government has launched new health insurance schemes, aimed at those not in formal employment, prompting discussion of such a scheme should operate in order to serve citizens best. Known as Najali Afya (I care about health), Wekeza Afya (Invest in health) and Timiza Afya (Achieve health), the new schemes are run by the National Health Insurance Fund (NHIF).

At the launch, the director general of NHIF, Dr Bernard Konga, said the newly introduced packages will enable more people to access healthcare products and services. Previously, he said, health insurance scheme mainly covered workers in the formal economy. Under the new packages, membership fees are pegged at between TSh 192,000 and TSh 516,000 for Tanzanians aged from 18 to 39 years.

Earlier, Mr Konga had appealed to the government to make health insurance enrolment mandatory, so the country would achieve Universal Health Coverage (UHC). According to him, under the current system most people remain uncovered because it is optional to join the health insurance schemes.

“At least 65% of the population doesn’t have access to the quality health services in the country because they have not enrolled on health insurance schemes,” said Dr Konga. “This can be eliminated only if the health insurance enrolment is made mandatory just like it is in some countries.”

The Parliamentary Committee on Social Services and Community Development noted that it was “no walk in the park” for low-income families to afford the annual fees. The committee’s chairman, Mr Peter Serukamba, suggested that the fees be paid on monthly basis during the year. Other committee members pointed to the fact that many health problems are not covered by the schemes, including cancer, hypertension and diabetes.

Further, opposition party ACT-Wazalendo criticised the government over the new schemes, arguing that it sought to exploit people through turning provision of basic services into a business, and that it would create social classes in accessing health care services. They argued that nobody ever chooses to fell sick or suffer from one kind or other of disease.

The Minister for Health, Ms Ummy Mwalimu, responded in a tweet, saying “the packages are entirely voluntary. No one is forced to enrol in one form or the other. Besides, they have not replaced the Community Health Insurance (CHF) arrangement, where the annual contribution rate remains TSh 30,000 for a household consisting of up to six members.”

The NHIF itself was quick to defend the fees for the schemes, arguing that they were reasonable and reflect the high healthcare costs.

Health Insurance has expanded considerably in recent years, with coverage rising to around 30% of citizens in 2018 from 20% just four years earlier. Expansion has been led by two government initiatives, namely NHIF and the CHF. This progress, and the new schemes, will not achieve the government’s previous target of universal insurance coverage by 2020. However, household surveys suggest that those with health insurance are more likely to seek professional help when they fall ill, and that they pay considerably less for their health services when the do so.

Ebola scare flares briefly
Ebola-related panic arose in Dar es Salaam and Mwanza in early September, when two patients showed Ebola-like symptoms. One of the patients, a 34 year old Tanzania doctor studying for a post-graduate course in Kampala, Uganda, died in Dar es Salaam on September 8. She was undergoing treatment at the Temeke Hospital Ebola Treatment Unit and her burial was supervised by the authorities, according to a leaked report by the World Health Organisation (WHO).

In response, some foreign embassies – including both the UK and the US – issued alerts to their citizens resident or travelling in Tanzania. The UK notice stated that “it appears probable that this is an Ebola-related death.”

The government moved quickly to allay fears. “We took samples of those two cases and I can confirm that the patients were not infected with the Ebola virus,’’ said Health Minister, Ms Ummy Mwalimu at a press conference. She added that she was the only authority mandated to announce an outbreak of diseases such as Ebola and other life-threatening epidemics, and termed reports which say six other people had developed Ebola-like symptoms as rumours.

However, several commentators reacted with some scepticism, pointing to a later WHO report that itself expressed caution: “to date [late September], clinical data, results of the investigations, possible contacts and potential laboratory tests performed for differential diagnosis of those patients have not been communicated to WHO. This information is required for WHO to be able to fully assess of the potential risk posed by this event.”

As no further cases were reported, it seems probably that these cases were not in fact Ebola. However, the government’s defensiveness and lack of transparency led to one observer of global health matters to state that “Tanzania has lost a great deal of credibility” over the matter.

There is heightened vigilance across East Africa over Ebola due to an outbreak of the viral disease in Democratic Republic of Congo (DRC) and a reported case in Western Uganda at the border with the DRC (see TA 124).

DRC is grappling with the world’s second largest Ebola epidemic on record, with more than 2500 lives lost and 3000 confirmed infections since the outbreak was announced on August 1, 2018.

“I urge the public to take precautions. We have enhanced screening for suspected cases at key border areas with Uganda and DRC and ports,” said Ms Mwalimu.

HEALTH

by Ben Taylor

Precautions in place as Ebola outbreak spread in eastern DRC

DRC affected health zones and ebola cases as of July 31, 2019; Uganda cases as of June 21, 2019 – Information from Reuters

Dr Faustine Ndugulile, the Deputy Minister of Health, Community Development, Gender, Elderly and Children, said the government has taken measures to install scanners in all entry points including airports and borders to prevent Ebola from entering the country.

More than 1,800 people have died and more than 2,700 have been infected in the latest outbreak of Ebola in central Africa, which began in August 2018. The World Health Organization (WHO) has declared the crisis a public health emergency of international concern.

The outbreak is the second-largest in the history of the virus. It follows the 2013-16 epidemic in West Africa that killed more than 11,300 people. It took 224 days for the number of cases to reach 1,000, but just a further 71 days to reach 2,000. About 12 new cases are being reported every day.

“The government has embarked on training to health personnel to pro­vide them expertise on how to attend such patients,” said the Minister. “Surveillance systems have been set at the borders and airports. Motor vehicles from outside the country will be tracked, and isolation centres, laboratory systems and tourist monitoring systems have been put in place to ensure the country is ready for the fight against the disease,” he added.

The current 12-month epidemic began in the eastern region of Kivu in the DR Congo and cases have since been reported in neighbouring Ituri.

A case in late July in the border transport hub of Goma is of particular concern to authorities, as it is the first case in the city to be confirmed as transmission within the city. The two previous cases were patients who travelled to Goma after contracting the disease elsewhere. It is far harder to isolate patients and trace contacts in major cities, where large populations live in close proximity. Goma also adjoins the city of Gisenyi in Rwanda, and people travel between the two places every day.

Rwanda has stepped up border monitoring and has urged its citizens to avoid “unnecessary” travel to DR Congo, while some 2,600 health workers had also been vaccinated. Ugandan health officials are also screening travellers at the border to check their temperature and dis­infect their hands, and some mass gatherings including market days and prayers have been cancelled. Three people died in Uganda in June, though the country has since been declared Ebola-free.

The WHO, however, stressed that no country should close its borders or place any restrictions on travel or trade, adding that the risk of the disease spreading outside the region was not high. WHO chief, Tedros Adhanom Ghebreyesus, said “we need to work together in solidarity with the DRC to end this outbreak and build a better health system.”

The fatality rate from Ebola is high – up to 90%, according to the WHO, and there is no proven cure as yet. However, rehydration with oral or intravenous fluids and the treatment of specific symptoms can improve survival – especially if the virus is caught early.

A multiple drug trial is currently under way in DR Congo to fully evaluate effectiveness, according to the WHO. An experimental vaccine, which proved highly protective in a major trial in Guinea in 2015, has now been given to more than 130,000 people in DR Congo, and thou­sands of health workers across the region have also been vaccinated.
(BBC, Al Jazeera, The Citizen)


Dengue fever outbreak

An outbreak of dengue fever, centred on Dar es Salaam, has caused widespread concerns and prompted a concerted government response.

“Dengue fever is here,” confirmed the Deputy Minister, Dr Faustine Ndugulile, in April. “We have started diagnosing some people, who suffered from the disease in Dar and Tanga regions. So I would like to advise health service providers to test patients, who, if diagnosed with the disease, should be provided with proper treatment,” he added.
By mid-May, the Ministry had confirmed 1,901 people had been diag­nosed with the fever since it was first reported in January this year, 95% of whom are in Dar es Salaam.

Chief Medical Officer Prof Muhammad Kambi said the government has also increased surveillance in other regions, which have not been hit by the viral disease. He further said the government has ordered more test kits with capable of diagnosing 30,000 patients.

Dar es Salaam Regional Medical Officer Dr Yudas Ndungile said the regional authorities have taken various measures to fight the disease, citing destruction of mosquito breeding sites and public awareness about the disease particularly in the hardest-hit wards.

By July, the number of cases had dropped significantly, aided by end of the rainy season: 2,759 cases were recorded in May, which fell to 790 in June. Four cases were reported to have resulted in fatalities.

The disease is caused by Aedes Egypt mosquito that bites in daylight and harboured in stagnant water. (The Citizen)

Unsafe abortion: A silent killer of young women
Abortion in Tanzania is illegal. This makes it harder for girls and women to get access to safe abortion. Despite this, women still find their own ways to terminate unwanted pregnancies. Women use various methods including herbs and sharp instruments.

The problem of unsafe induced abortion is reflected in hospital statis­tics, which show significant numbers of alleged miscarriage. Given the legal restrictions associated with abortion, it is difficult to obtain reliable information on its prevalence and to assess the magnitude of the mor­bidity and mortality associated with it.

Nevertheless, according to the Ministry of Health and Social Welfare, 16 percent of maternal deaths are due to complications from abortion.

Further, in a nationally representative study of the incidence of abor­tion and the provision of post-abortion care in Tanzania, researchers found that clandestine abortion is common and is a major contributor to maternal death and injury. Tanzania’s national abortion rate—36 per 1,000 women of reproductive age—is similar to that in other East African countries.

The Penal code provisions on termination of pregnancy are frequently misunderstood as a total prohibition on abortion. Under section 230, it is stated that termination of pregnancy is lawful where it is done to preserve the life or health of the pregnant woman. Nevertheless, any person who assists in an illegal abortion breaks the law, including the pregnant woman herself, anyone who assists her to procure an illegal abortion, and the supplier who provides drugs or equipment used to induce an illegal abortion.

HEALTH

by Ben Taylor

Staff at North KCMC Regional Hospital pictured during a visit by Dr Faustine Ndugulile on Nov 22 (uptymes.com)

Disagreements over family planning
President John Magufuli spoke in September against birth control and family planning. In doing so, he reignited a debate that had largely died down after a similar flare-up early in his presidency.

Speaking at a rally in Meatu, the President advised people to ignore those advocating birth control, some of it coming from foreigners, “because it has sinister motives”. “Those going for family planning are lazy, because they are afraid they will not be able to feed their children. They do not want to work hard to feed a large family. And that is why they opt for birth control and end up with one or two children only,” he said. “You people of Meatu keep livestock. You are good farmers. You can then feed your children. Why would you opt for birth con­trol? These are my views, but I do not see any need for birth control in Tanzania,” he said.

He added: “I have travelled to Europe and elsewhere and I have seen the side effects of birth control. In some countries they are now strug­gling with declining population growth. They have no labour force,” President Magufuli, who was on a tour of Lake Zone regions said.

He urged Tanzanians to keep reproducing because the government was increasing investment in maternal health specifically and the health sec­tor in general. This echoes he previous argument, back in 2016, that his government’s decision to end school fees meant people could give birth to as many children as possible because education was no longer expen­sive. “Women can now throw away their contraceptives. Education is now free,” President Magufuli had said.

On this more recent occasion, President Magufuli was speaking in the presence of the United Nations Population Fund (UNFPA) representa­tive in Tanzania Jacqueline Mahon and the minister for Health Ummy Mwalimu.

The main opposition party, Chadema, criticised the President’s state­ments, and pledged to mobilise the public to safeguard family planning initiatives. “We expected the President to be at the forefront of sup­porting family planning initiatives amid challenges the country faces, especially in planning our highly populated cities and dealing with the job crisis. We want to mobilise the public to safeguard birth control initiatives to better our country and enhance maternal health,” said the party’s Secretary General, Dr Vincent Mashinji.

“All children have the right to education. In facilitating this, family plan­ning education has played a great role in protecting young girls from dropping out of school due to early pregnancies,” he said. The party also called upon all men to always accompany their wives to clinics so that they could get to learn more about family planning as an important thing in the current challenging times.

Less than two weeks later, the government sent a letter to organisations carrying out family planning activities in Tanzania to stop them from broadcasting family-planning adverts in local media.

In the letter, which leaked and then spread rapidly on social media, the permanent secretary for the Ministry of Health, Community Development, Gender, Elderly and Children, Dr Mpoki Ulisubisya, ordered organisations including Family Health International (FHI 360) and the United States Agency for International Development (USAID) to stop airing all content on family planning until it is revised by the government. “The ministry intends to revise the contents of all your ongoing Radio and TV spots for family planning, thus I request you to stop with immediate effect airing and publishing any family planning contents in any media channels until further notice,” reads the letter in part.

Contacted by The Guardian for further clarification, Dr Ulisubisya stated: “We (ministry) want to come up with a standard message for the public on the matter of family planning.”

In a sign of how media and politics are tightly intertwined and indeed highly polarised, reporting of the issue varied greatly between gov­ernment-owned and privately-owned media outlets. The government-owned Daily News ran the headline “JPM touches on family planning”. This was followed by a statement in the article’s opening line that the President had “emphatically stated that Tanzanian parents have the freedom to have whatever number of children they wish provided they are capable of meeting their basic demands.”

In contrast, The Citizen newspaper focussed on the more contentious elements of the President’s speech, citing his reference to foreigners with sinister motives as well as the link he drew between family plan­ning and laziness.

Amnesty International called on the government to remove laws and other barriers to women and girl’s access to information and services they need to live healthier lives. “The Tanzanian authorities must imme­diately stop obstructing access to sexual and reproductive health ser­vices and end the intimidation of anyone providing information about such services, be they health workers, journalists or activists,” said Seif Magango, Amnesty International’s Deputy Director for East Africa, the Horn and the Great Lakes.

Tanzania has ratified the Maputo Protocol, which states that women have the right to control their fertility and chose any method of contra­ception, but in practice access to services is limited. A third of women in Tanzania use family planning, according to the UN population fund (UNFPA), with access most limited in rural areas. On average, women give birth to five children.

The United Nations Population Fund, which supports and advocates for improved access to family planning services in many African coun­tries, said its programs were guided by the International Conference on Population and Development agreement, which Tanzania has signed. “A core part of this agreement is to ensure that women have the power and means to access information and services to enable them to decide on the timing, spacing, and number of children,” UNFPA said.

In a fact-sheet published two weeks prior to the President’s rally in Meatu, USAID described their commitment to family planning in Tanzania:

“Family planning is key to Tanzania’s broad-based development, saves lives by helping reduce maternal morbidity and mortality, and increases newborn and child survival rates. USAID began supporting family planning in Tanzania in the late 1980s with a focus on increasing the prevalence rate of modern contraceptives, proving instrumental in building Tanzania’s national program.”

“USAID’s family planning programs are integrated with other health services and non-health programs which contribute to the U.S. Government and Tanzania Government goals of reducing maternal mortality and improving child survival.”

Minister sets ambitious health insurance target: universal coverage by 2020
The government aims to achieve universal coverage of health insur­ance by 2020, according to the Deputy Minister for Health, Community Development, Gender, Elderly and Children, Dr Faustine Ndugulile. Dr Ndugulile was responding to a question in Parliament.

Dr Ndugulile said NHIF was now serving over 17 million people (32% of the population), with efforts to expand to all areas of the country. “So far NHIF is serving millions of Tanzanians, efforts are underway to ensure that all the people are reached by its service,” he said. He added that the Fund continued to implement its strategy to expand its services and enrol members from both formal and informal sectors, including social service for entrepreneurs and children under 18 years.

Dr Ndugulile had already announced a new government strategy to start providing bundles of health insurance – which he described as being similar to packages of mobile phone airtime and other services – to ensure every Tanzanian could afford the service.

He pointed out that a good number of people in lower income brackets were currently left out of the national health insurance service, thus denying them access to quality health care. “Our aim is to ensure that everyone is served. The government is really committed to seeing that health care is improved…this time the government has also increased the budget for the health sector,” he said.

HEALTH

by Ben Taylor

Ebola border alert
The government has established health screening of travellers entering the country from the Democratic Republic of the Congo (DRC), as the spread of Ebola continues through parts of the DRC. By late August, a total of 90 people in the DRC had been diagnosed with Ebola with 50 people pronounced dead since the outbreak began earlier this year.

Minister for Health, Community Development, Gender, Children and Elders Ummy Mwalimu, told a press conference in Dar es Salaam that although the World Health Organisation (WHO) had recently in its report placed Tanzania at a higher risk, there was not even a single case reported in the country.

The minister added that the government has deployed 35 medics along with thermal body scanners to key entry points. “Thermal Scanners are devices meant to detect high body temperature as a clue for Ebola dis­ease,” explained the Minister. Ms Mwalimu noted that the government has enhanced its integrated disease surveillance and response system in the country’s border posts that are frequently used by DRC nationals to cross into the country.

Ms Mwalimu noted further that the government will closely work with the World Health Organisation (WHO) and other international organi­sations responsible for health as per the law to prevent the Ebola preva­lence. “We have also convened an emergence meeting for our National Task Force responsible for the disease,” she said.

Ms Mwalimu assured the public that there was so far no any case of person with Ebola in the country, urging the people to remain watchful against the disease. (Daily News)

New HIV/AIDS Strategy launched
The Minister also launched the fourth national multi-sectoral strategic framework for HIV and AIDS plan, saying the new plan aims to reach out to the entire population in the country.

We want everyone to understand their HIV status. This is the only option that will help end the fight against AIDs,” she said.

The global target set for 2030 is to end HIV and AIDs, while the UN aims by 2020 to have 90% of people living with HIV diagnosed, 90% of diagnosed people on antiretroviral treatment and 90% of people in treatment with fully suppressed viral load. However, Tanzania remains some distance off these targets. The minister said 48% of the population of people living with HIV and AIDs do not know their status.

A key element of the new strategy is to reach out to every place where people gather in large numbers, including football matches and popular music concerts. “We will not force people to test for HIV, but we will make sure there are facilities everywhere for people to understand their status,” said the Minister.

“We’re also looking at the possibility that the law should allow indi­viduals to get HIV test kits and test on their own,” she said, explaining that this will encourage a lot more to seek medical help after knowing their status.

The plan will increase the number of health centres providing Voluntary Counselling and Testing (VCT) services to 2,800. It will also focus on cultural barriers that hinder the fight against Aids, including ending stigma and discrimination which experts say kills and discourages peo­ple especially men seeking medical help.

United Nations agency for HIV and AIDs (UNAIDs) and the United States Agency for International Development (USAID) representatives praised the government initiatives for fighting HIV/AIDS but called for action to be stepped up in order to meet the global targets. (Daily News)

HEALTH

by Ben Taylor

Calls for local production of medicine
President Magufuli has argued that the country must build its capacity for local drug factories. “Only 6% of the medicine is produced here… why? We must do something,’’ he said during an event hosted by the Medical Stores Department (MSD) in Dar es Salaam. According to data from the Ministry of Industry, Trade and Investment, Tanzania spends over TSh 800 billion every year on importing medicine and medical supplies.

In response, researchers, investors and government leaders are now trying to answer the question: Can the local pharmaceutical industry recover its former glories?

Industrial players and researchers largely concur that current policy is unfavourable. Mr Jayesh Shah, Group Managing Director of Sumaria Group and former owner of Shelys, one of Tanzania’s largest pharma­ceutical firms, urged the government to “come up with a policy that makes local manufacturing of drugs mandatory, unlike the current one which favours importation.’’

“The cost of production was higher than the profit I was making, that’s one of the reasons I had to move out of the business,” he added. A report published by REPOA, a research institution, in 2014 found that pharmaceutical production had been a Tanzanian industrial success in the mid-90s, but that such former success is now history. By 2014, the industry was in decline, said the report. “There is a lack of active public sector support for local firms as compared to other competing coun­tries,’’ says the report. “It requires a change of mind-set for policy mak­ers in Tanzania to turn to prioritising and actively engaging in selective support of the sector,’’ suggested an academic study published in 2016, Making Medicines in Africa.

Some investors sense an opportunity. Mr Ramadhan Madabida, Managing Director of Tanzania Pharmaceutical Industries Limited (TPIL), says the pharmaceutical demand is USD $550 million per annum, but added that “locally active pharmaceutical industries in Tanzania which produce medicine are still not enough to curb the shortage.”

A report by the Ministry of Industry, Trade and Investment shows that there are 13 pharmaceutical factories in the country, but that only five are currently active and only four are fully licensed.

Mr Madabida says the government needs to work in collaboration with local investors in filling the gap. But, he emphasises that “the govern­ment should formulate policies that enable investors to access funding from financial institutions to encourage more investment.”

“It is important now to think of motivating the local investors through tax incentives and opportunities for borrowing. There is no letter of credit being given to the local investors to enable them access funding from local financial institutions, as compared to foreigners,” he added.

Following the President’s intervention, calling for local manufacturing of drugs, over 10 local investors have expressed an intention to put up local drug factories, according to the Ministry of Industry, Trade and Investment. The Ministry added that the government is now laying groundwork for a National Pharmaceutical Sector Strategy, intended to ease operations for local investors.

According to the Ministry, this strategy will create a 15% price advan­tage for locally manufactured medicines compared to imported medi­cines, develop a list of medicines to be manufactured locally, create a pharmaceutical industrial park and cut taxes on imported raw materi­als.

Activists protest expansion of cigarette production for local market
Executive Director of Tanzania Tobacco Control Forum (TTCF), Lutgard Kagaruki, argued that the opening of Mansoor Industries Limited – an affiliate of Philip Morris International – in Tanzania, is bad news for the country’s health sector as smoking youths will likely fall victim to killer diseases such as cancer.

The company has started rolling out its products under the Chesterfield brand, according to a statement issued by Mrs Kagaruki.

She claimed that more than 2.4 million adults (15+ years) in Tanzania and 17,000 children aged 10-14 years smoke tobacco. “Research at Ocean Road Cancer Institute indicated that 32% of all cancers at the institute were tobacco-related, costing government more than $40m annually,” she added.

Expansion of health service facilities
The government has spent a total of TSh 162 billion (USD $72 million) in recent months on improving 170 health centres, President John Magufuli has said. He was speaking at a function to unveil 181 vehicles – worth TSh 20 billion – belonging to the Medical Stores Department.

Upon completion of the improvement exercise, he explained, the 170 health centres will be capable of performing emergency operations on pregnant women and children as the country seeks to further reduce maternal death and child mortality.

Apart from upgrading the 170 health centres, said Dr Magufuli, the government has also built a 268 more health centres, bringing the total number of such facilities across the country to 7,284.

“This includes construction of regional hospitals in the new regions of Njombe, Geita, Katavi and Simiyu. We are also introducing and improv­ing specialized services in various hospitals in the country,” he said.

Reports of Dengue fever outbreak
The Ministry of Health has confirmed several cases of Dengue fever in Dar es Salaam in early 2018. “11 patients have been diagnosed with the disease,” said the Ministry’s Permanent Secretary, Prof Mpoki Ulisubisya, adding that outbreak control measures are being imple­mented.

He said the ministry in collaboration with the National Institute for Medical Research (NIMR) and local clinics will continue to make diag­nosis to uncover more cases of the disease if any. Surveillance activities will be conducted in the coastal cities of Dar es Salaam and Tanga, according to the Ministry.

The worst dengue fever outbreak in Tanzania occurred in 2014 when more than 400 patients in Dar es Salaam were diagnosed with the disease and at least three died. Dengue fever is said to affect about 390 million people in the world every year, and is particularly prevalent along the East African coast.

There is no medicine or vaccine for dengue, so health experts recom­mend prevention by preventing mosquito bites. Mosquitoes that spread dengue are not the same as those that spread malaria, and bite both during the day and night.

HEALTH

by Ben Taylor

Prize for Dr Malecela
Tanzania’s Dr Mwele Malecela has been awarded the 2017 Kyelem Prize in recognition of her work in combating neglected tropical diseases (NTDs). Dr Malecela, now serving as a Director in the World Health Organisation (WHO) African regional office, was previously director general of the National Institute for Medical Research (NIMR) in Tanzania. She was fired from that position by President Magufuli in December 2016, the day after she told the media there were signs that the Zika virus was present in Tanzania.

Dr Malecela’s prize was received on her behalf by Dr Upendo Mwingira, the NTD programme manager in the Ministry of Health, Community Development, Gender, Elderly and Children. “It’s a real honour to have Dr Upendo receive the award on my behalf! Thanks Tanzania NTD Programme, it’s our collective success!” said Dr Malecela.

The Kyelem Prize is awarded by the NTDs research coalition (CORNTD), a group of researchers, programme implementers and their supporters with a shared goal of optimising elimination of NTDs. The prize is named after the late Dr Dominique Kyelem, a medical doctor from Burkina Faso who worked tirelessly in combating NTDs. (The Citizen)

Innovation in malaria prevention
The London Times recently published an article by Kate Wright about what it described as ‘Trojan cows’ and the worldwide campaign to defeat malaria. A biotech company is going further than the use of nets or insecticides to thwart the mosquitoes that carry malaria from person to person. They have now begun using livestock doused in human scent to lure mosquitoes to their deaths.

In much of East Africa livestock such as cows and goats often live alongside people. These animals get malaria. Mosquitoes tend to prefer sucking blood from humans. A potent cocktail of four or five human odour compounds has now been developed that can be sprayed on to animals so that they can develop their own alluring ‘eau de human’ rather than ‘eau de cologne’.

The concept has been tested on a small scale where researchers conducted experiments in which they go into a greenhouse, and then, together with the goats, face the mosquitos, noting where each one landed. The researchers found that mosquitos were attracted to the goats sprayed with a common worming medicine that also kills mosquitos. The mosquitos can thus be persuaded to bite cows or goats that will kill them and prevent them from spreading malaria. (The Times)

Malaria past and present
A new study has found that the prevalence of malaria in sub-Saharan Africa is at the lowest point since 1900. A team of researchers led by Professor Bob Snow of the Centre for Tropical Medicine & Global Health at Oxford University, spent 21 years finding and analysing data from over 50,000 surveys of malaria prevalence from across Africa.

The study found an overall decline of 24% in the number of children infected with malaria between 2010 and 2015, and a 40% drop between 1900 and 1929.

“Investment in malaria control in Africa has been sporadic in the past,” said Professor Snow. “The world has seen a reduction in malaria over the last 15 years, based largely on the use of treated bed nets and antimalarial drugs. If we take our eye off the ball, then rising drug resistance and falling control will lead to the sorts of increases we saw in the 90s.”

The financial boost provided by the Global Fund has, since 2005, led to one of the largest drops in malaria infection prevalence witnessed. However, gains made after 2005 have stalled since 2010. A decline in funding, coupled with increased insecticide and drug resistance, are the main obstacles to the elimination of malaria in Africa. (The Conversation)

HEALTH

by Ben Taylor

Concern over rising diabetes burden
Experts on non-communicable diseases (NCDs) have predicted that the cost of curbing diabetes in Tanzania and other eastern African countries will increase from $3.8 billion in 2015 to $16.2 billion by 2030. The Lancet Diabetes and Endocrinology Commission on Diabetes in sub-Saharan Africa, say the cost associated with the disease could more than double in sub-Saharan Africa by 2030, with Tanzania, Kenya and Ethiopia especially hard-hit. They say that this is likely to happen if type 2 diabetes cases continue to increase.

“We conclude that sub-Saharan Africa is not prepared for the increasing burden of diabetes brought about by rapid and ongoing transitions,” said the commission’s report. “Effective management of diabetes in sub-Saharan Africa will require careful considerations about the expansion of services to meet current and future burden, while ensuring that services are integrated with those for other chronic diseases. The health, economic, and societal consequences of inaction will be huge. Decisive action is needed now, by all stakeholders, to address the scale and urgency of diabetes in sub-Saharan Africa.”

The report estimates that the economic cost of diabetes in sub-Saharan Africa in 2015 totalled $19.5 billion, equivalent to 1.2% of the region’s GDP. More than half of this economic cost is spent on accessing diabetes treatment, including medication and hospital stays. The remaining economic costs were a result of productivity losses, mostly from early death, as well as people leaving the workforce early, taking sick leave and being less productive at work due to poor health.

Rapid societal transitions that are producing increases in wealth, urbanisation, changing lifestyle and eating habits, more sedentary work practices and aging populations have led to increased risk of type 2 diabetes. (The Citizen)

Tanzania moves to put all people living with HIV on ARVs
TANZANIA officially started anti-retroviral (ARV) treatment for people living with HIV after testing positive effective October last year, with the government announcing that the new arrangement targets 1.2 million victims. The move comes in the wake of a World Health Organisation (WHO) directive in 2015 that any HIV-positive person must immediately be put on anti-retroviral treatment regardless of CD4 count.

The WHO directive followed studies that established that it was safer for patients to start using the drugs before the CD4 count dropped. Previously, Tanzania was applying a system under which only patients whose CD4 cell count had dropped to below 350 qualified for the therapy.

The Deputy Minister for Health, Community Development, Gender, Elderly and Children, Dr Hamisi Kigwangalla, told Parliament that between July 2015 and June 2016, about 84,000 people who had tested HIV positive were enrolled for ARVs treatment.

“We will ensure that whoever is found with HIV, including children and elders, start taking the drugs straightway,” said the deputy minister.

The government also plans to include a new generic version of the antiretroviral drug Dolutegravir (DTG) in the national HIV/Aids treatment protocols. The Minister of Health, Community Development, Gender, Elderly and Children, Ms Ummy Mwalimu, told The Citizen that the ARV had been lined up for registration and licensing by the Tanzania Food and Drugs Authority (TFDA). A generic of DTG, first approved in the United States in 2013, is already in use in Kenya and has the backing of Unitai, the global health initiative working to end tuberculosis, HIV/ Aids and malaria epidemics.

“Shipments are scheduled to start in January 2018 after the TFDA’s registration process is completed,” said the Minister. She added that Tanzania would start using the generic drug in combination with other ARVs. DTG, whose brand name is Tivicay, is produced by ViiV Healthcare, which is majority-owned by British pharmaceutical giant GlaxoSmithKline.

A total of 1.4 million Tanzanians were estimated to be living with HIV in 2015. An estimated 54,000 new infections and 36,000 AIDS-related deaths occur in Tanzania each year. (Daily News, The Citizen)

Government reiterates respect for traditional healers
The Minister for Health, Community Development, Gender, Elders and Children, Ummy Mwalimu, told parliament that traditional healers are legally recognised by the government through the Traditional and Alternative Health Practice Council, 2002. She said that the government has set-up a new registration system for herbalist and traditional healers, where they are supposed to register at their specific localities under the office of the District Medical Officers (DMOs).

The minister was responding to questions from MPs. Joseph Kasheku, Geita Rural MP, expressed concern with the level of education of some of the practising herbalists in the country, and called on the government to come up with an educational plan for traditional healers, especially since many Tanzanians depend on their services. Ushetu MP, Elias Kwandikwa, wanted to know why the government was arresting traditional healers in Ushetu District.

In 1974, the Traditional Medicine Research Unit was established at the University of Dar es Salaam, and in 1989 the government set up a Traditional Health Services Unit in order to unify traditional health practitioners and mobilise them to form their own association.

Traditional health services were officially recognised in the National Health Policy of 1990, and in 2002 the Traditional and Alternative Medicines Act was introduced. (Daily News)