'Shortage of specialised doctors frustrates low-income earners'

People suffering from non-communicable diseases have no other choice but to travel long journeys from different parts of the country to seek specialized treatments at Muhimbili National Hospital (MNH) and its Mloganzila branch, Benjamin Mkapa Hospital, Kilimanjaro Christian Medical Centre (KCMC) and at the Ocean Road Cancer Institute (ORCI).

In doing so, they are forced to cede aside special budgets for accommodating family caregivers left behind with their beloved ones admitted in the said hospitals believed to have good numbers of specialized doctors.

The unanswered question is how many low-income earning villagers can afford spiraling accommodation costs while in Dar es Salaam, Dodoma and Moshi to look after their relatives undergoing routinely clinics and treatments normally scheduled two times a week.

“The family had no option but to make arrangements for a temporary settlement in the city. We decided to rent a house at Tangi Bovu in February after having spent a lot of money on accommodation and food for only 15 days,” says a 21-year-old girl Latifah Aziz, who is taking care for her mother aged 50, who was admitted atMloganzila hospital with problems related to breasts and reproductive system.

Thanks to the head of the family Aziz Aboud who opted to subscribe to the National Health Insurance Fund’s (NHIF) Wekeza Afya package for over a year now that covers the treatment costs. Latifah and her family live in Singida town.

She said immediately after her mother was admitted to the hospital, the plan was to get a member of the family who will be visiting the sick mother and she was the one chosen.

After arriving in Dar es Salaam in January this year, her father used to pay 25,000/- a day for her to stay in a lodge at Ilala. She had stayed for 15 days and 375,000/- was paid for lodging when she spoke to this paper.

“We have finally realized that I had spent 220,000/- for food, water, laundry and transport fare to and from Mloganzila to see my mother in the morning and evening. We have opted to rent a room at 300,000/- for four months lasting May 2023,” she said.

The family had paid another 75,000/- to a room broker who had access to landlords with rented houses.

Tanzania has 28 regional referral hospitals which are required to offer 14 different specialized treatments each. In other words, each hospital must have 14 different specialized doctors as per the nation’s health policy 2007.

Unfortunately, the situation on the ground is the opposite with the majority having a maximum of five doctors as the extreme deficit is on Oncologists, Gastroenterologists, Cardiac Surgeons, Gynecologists, Psychiatrics and Nephrologists bites.

Mrisho Mchata (36) was referred to the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) for specialized eyes treatment for his three year old daughter.

He was in Dar es Salaam for two weeks from Nanyumbu district in Mtwara region when he spoke to this paper late March this year.

“There isn’t a single Ophthalmologist at Ligula referral hospital. I'm in Dar es Salaam for my daughter’s eyes’ treatment but life is costly. Seeking treatments far from home attracts reasonable costs,” he said.

According to him, he stays at his elder brother’s house in Mbagala suburb. He doesn’t pay rent but he is subjected to basic needs costs and city transport.

A hardware businessman had spent 260,000/- in the space of two weeks when he spoke to this paper far from treatment costs covered by NHIF under the Najali Afya package.

“I wouldn’t have spent this amount if specialized treatments were offered at Ligula hospital,” he said.

Data from the Ministry of Health shows that as of April 2023 there was one Oncologist across the 28 regional referral hospitals only at Temeke hospital in Dar es Salaam city. Oncologists are specialized in diagnosis and treating cancer.

Only one regional referral hospital has a Gastroenterologist. This is Tumbi hospital in Pwani region. Gastroenterologists treat diseases that affect the digestive system.

Only Katavi regional referral hospital has a Cardiac Surgeon. Mount Meru in Arusha has two Nephrologists while the other 27 hospitals have none. Nephrologists are specialized in diagnosis and treatment of kidneys.

“The deficit of specialized doctors at regional referral hospitals is the main reason why hospitals such as Muhimbili and the Jakaya Kikwete Cardiac Institute (JKCI) are flooded with patients from all over the country,” said Salome Makamba, Special Seats legislator.

Data shows the total number of patients attended at the 28 regional referral hospitals declined to 2,529,971 in 2022/23 from 3,985,169 patients in 2021/22. In other words, every regional referral hospital attended an average of 90,356 patients in 2022/23.

Muhimbili National Hospital attended 375,057 patients in 2022/23 compared to 367,213 patients in 2021/22. Muhimbili Orthopaedic Institute (MOI) attended 171,711 patients up from 154,260 of the corresponding periods.

JKCI attended 93,017 patients in 2022/23 compared to 87,332 in 2021/22; KCMC attended 339,945 patients in 2022/23 up from 297,810 patients in 2021/22. Ocean Road Cancer Institute (ORCI) attended 43,922 patients from 37,882 patients of the periods under review.

The National Health Policy 2007 among other provisions emphasizes on availability of required specialized doctors at all regional referral hospitals. Provision 7.1.4 (vii) reads: “Every regional hospital shall have all kinds of specialized doctors.”

According to the policy it is not necessary for public owned district hospitals, health centers and dispensaries to have specialized doctors.

Data further shows that only one regional referral hospital in the country has a Gastroenterologist, medical doctors specialized in the disorders and diseases that affect the digestive system.

Regina Ndege, Special Seats legislator Manyara region said that at Manyara hospital there are 250 nurses and doctors altogether while the requirement is 468.

“At Kitete region hospital we want the health ministry to deploy one pediatric, one orthopedic specialist, an ophthalmologist, a sleep specialist and a radiologist. There is none of them,” she said adding;

“The shortage of specialized medical doctors is frustrating low-income earners.”

But data shows that Kitete-Manyara regional referral hospitals have five specialists: Three Pediatricians, an Obstetrician-Genealogist (OBGY) and a general surgeon.

There are only four Psychiatrists deployed in two regional referral hospitals namely Amana (2) and Temeke (2) of Dar es Salaam city.

This happens when the ministry of health has declared to upgrade the Dodoma based Mirembe National Mental Hospital (MNMH) status to a National Specialized Institute for Mental Health Diseases in its 2023/24 financial year’s priorities as victims of mental health related diseases surge.

2bn/- has been allocated in the next budget to facilitate this transformation plan that covers grooming mental health professionals in the areas of physiotherapy, occupational therapy and speech therapy.

Dodoma Region Referral Hospital has none of the experts while data shows that between July 2022 and March 2023 Mirembe hospital had treated 212,065 patients of which 138,625 an equivalent of 65.3 percent suffered from mental health disorders.

Mirembe waived medical expenses worth 77.93m/- that covered 10,867 patients who were unable to pay for the received treatments.

During 2020/21 the hospital had attended 131,711 patients of which 79,619 an equivalent 60.4 percent were mental health victims.

Dr. Christina Mzava, Special Seats legislator, argued that in the sake of helping low-income earners, it is high time the health ministry finalizes the arrangement of the Universal Health Insurance Bill 2022 that has stalled for almost a year.

She blamed shortage of medical doctors and nurses at dispensaries across the country. Dr. Mzava referred to the Ministry of Health Medical Doctors Availability current report saying it shows that the requirement for primary care doctors is pegged at 100,646 doctors while the availability is 30,625 as of April 2023.The shortage is 70 percent.

“In health centers the requirement stands at 68,204 while the availability is 25,354 making a shortage of 63 percent. At district hospitals the requirement is 123,424 while the availability is 29,409, a shortage of 76 percent,” said Dr. Mzava.

She asserted that at Kahama district hospital for instance, there were between 450 and 717 outpatients.

The hospital attends patients from other districts namely Geita, Urambo, Kaliua, Msalala and Nzega with 280 nurses and 16 medical doctors while the requirement of the experts is two-fold.

Only Mount Meru regional referral hospital is allocated with Nephrologists of the 28 hospitals.

It has two Nephrologists implying that all patients with kidney serious cases across the country must be admitted to the hospital if they are in a situation not to afford treatment cost at private hospitals.

Data shows there are only three Dermatologists in three different referral hospitals, three Urologists and four Haematologists deployed in four different hospitals.

Data further reveals that there are 67 Obstetrician-Genealogist (OBGYs) deployed in the 28 hospitals with each having at least two. There are 46 Pediatrics with an average of two per hospital, 41 General Surgeon and 34 Physicians.

There are 28 Orthopaedic Surgeon, 20 Radiologists, 19 Ophthalmologists, 18 ENT Surgeon, 10 EMD Specialist, seven Anaesthesiologists and seven Dental Specialists.

Stanslaus Nyongo, Chairman Health Parliamentary Permanent Committee argued that on 27 April 2001, African governments made an historic pledge to allocate at least 15 percent of their annual budgets to the health sector. This vow became known as the Abuja Declaration.

“As of April 2023 only 2.8 percent of the total annual budget is allocated to the health ministry. The first human man’s capital in his life is good health,” said Nyongo.

He argued that the majority of rural residents can’t afford treatment costs due to poverty thus the government is responsible for investing in affordable and accessible health services.

The National Bureau of Statistics (NBS) states as of June 2021, 26.4 percent of Tanzanians live below the one dollar poverty line, with 31.3 percent of the population living in the rural areas and falling below the poverty line.

Tabling the 2023/24 budget estimates pegged at 1.24trn/- in the National Assembly recently, Health Minister Ummy Mwalimu said in addressing the shortage of specialized doctors, the ministry will in 2023/24 continue investing in the new programme dubbed ‘Samia Health Super Specialization’ intended at grooming specialized doctors through scholarships in universities at home and abroad.

As of March this year 981 doctors pursuing a PhD have been enrolled of which 179 are pursuing their studies abroad. The government has spent 8bn/- so far on this programme for the past twelve months.

“The ministry has already made an arrangement of deploying 100 specialized medical doctors to district hospitals for capacity building, skills transferring and mentorship programmes in district hospitals across the country,” said Mwalimu.