Tanzania’s Dual Burden

This article was exclusively written for The European Sting by Ms. Ameena Shafiq, a 2nd year medical school student at Weill-Cornell Medicine – Qatar. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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The majority of deaths in Tanzania are attributed to HIV/AIDs, Malaria and Tuberculosis. Unlike other developed countries which have seen a vast decrease in HIV/AIDs incidence and mortality, it is still at large in Tanzania. Although majority of deaths in Tanzania are caused by communicable diseases, the burden of non-communicable diseases is becoming very significant¹. NCD’s like cardiovascular diseases, cancer, diabetes etc. once considered a rarity in Tanzania, are now commonplace. In 2015, 31% of the deaths were attributed to NCD’s². This number is expected to reach 46% by 2030³. Despite the serious implications of NCD’s, their funding is disproportionately low. In 2015, the funds allocated to fight NCD’s were just 1-2% of the total global financing⁴. The exclusive focus on communicable diseases has come at a cost. Diseases like diabetes, cardiovascular diseases and cancers which can often be screened and treated at early stages of the diseases, are presenting at later stages and are leaving patients with little access to care due to the associated high costs¹. Diversion of resources to designated diseases is compromising the comprehensive development of the medical system. Global health agendas are usually influenced by the national interests of donor countries. For instance, in a joint statement by the US Department of State and the US Agency for International Development (USAID) in 2004–2009, US foreign policy and development policy are fully aligned to advance the National Security Strategy. The strategy is aimed at prosperity of American markets in foreign lands and creating conditions for investment and trade in the recipient countries⁵. Selective interventions to treat infectious diseases rather than broader infrastructure development fits this premise well⁵. In an interview conducted with key policy makers in Tanzania, many admit that health policy decisions don’t necessarily correlate with needs on site. Some maintain that communicable disease programs were highest on the agenda but that other issues like health system development should be given greater attention. One health development partner said, “Sometimes things get funded because they become a high enough priority. Some things, they become a high priority because of funding⁶. Governments of poor countries can’t assert themselves against donor priorities as it is hard for governments to operate or implement policies without donor assistance. Donor countries usually have an upper hand in the decision making process as they have the funds and higher technical expertise backing their position⁶. Progress in making policies that are in line with the needs on the ground can be achieved when partnerships are based on robust evidence and not through the hegemony of technology and money. Global health needs a goal which aims to mobilize investments and foster research that helps countries like Tanzania build local health systems that can, in the future, stand on their own feet and not have to depend on the support of richer countries⁷. Health equity is what the global community should make their priority.   References 1) Mayige, Mary et al. “Non Communicable Diseases in Tanzania: A Call for Urgent Action.” Tanzania Journal of Health Research 13.5 (2012): n. pag. Web. 11 Sept. 2017. 2) “WHO -NCD Progress Monitor 2015.” n. pag. Web. 13 Sept. 2017. 3) Nyaaba, Gertrude Nsorma et al. “Tracing Africa’s Progress towards Implementing the Non-Communicable Diseases Global Action Plan 2013–2020: A Synthesis of WHO Country Profile Reports.” BMC Public Health 17.1 (2017): 297. Web. 13 Sept. 2017. 4) WHO. “Financing National NCD Responses.” n. pag. Web. 13 Sept. 2017. 5) Ollila, Eeva. “Global Health Priorities – Priorities of the Wealthy?” Globalization and health 1.1 (2005): 6. Web. 10 Sept. 2017. 6) Fischer, Sara Elisa, and Martin Strandberg-Larsen. “Power and Agenda-Setting in Tanzanian Health Policy: An Analysis of Stakeholder Perspectives.” International journal of health policy and management 5.6 (2016): 355–63. Web. 11 Sept. 2017. 7) Maher, D, and J Sekajugo. “Research on Health Transition in Africa: Time for Action.” Health Research, Policy and Systems 9 (2011): n. pag. Web. Bibliography Koplan, Jeffrey P et al. “Towards a Common Definition of Global Health.” Lancet (London, England) 373.9679 (2009): 1993–5. Web. 18 Sept. 2017. Maher, D et al. “Research Needs for an Improved Primary Care Response to Chronic Non-Communicable Diseases in Africa.” Tropical Medicine and International Health 15 (2010): n. pag. Web. Maher, D, L Smeeth, and J Sekajugo. “Health Transition in Africa: Practical Policy Proposals for Primary Care.” Bull World Health Organ 88 (2010): n. pag. Web. Maher, Dermot, Nathan Ford, and Nigel Unwin. “Priorities for Developing Countries in the Global Response to Non-Communicable Diseases.” Globalization and Health 8.1 (2012): 14. Web. 13 Sept. 2017. Nugent, R A, D Yach, and A B Feigl. “Noncommunicable Diseases and the Paris Declaration.” Lancet 374 (2009): n. pag. Web. Young, F et al. “A Review of Co-Morbidity between Infectious and Chronic Disease in Sub Saharan Africa: TB and Diabetes Mellitus, HIV and Metabolic Syndrome, and the Impact of Globalization.” Global Health 5 (2009): n. pag. Web. About the author Ameena Shafiq is a 2nd year medical school student at Weill-Cornell Medicine – Qatar. She is a general member of the Qatar Medical Student Association and is passionate about global health equity. She was part of a service trip to Mwanza, Tanzania in 2017, where she learned about the Tanzanian health care system at different levels and witnessed the experience of the healthcare providers on ground.