The overall objective of the Health Policy of Tanzania is to provide free and comprehensive basic health services to all Tanzanians. The policy puts more emphasis on preventive and promotive health care, rather than on curative care. It also emphasizes the construction of smaller health facilities in preference to hospitals. In addition to that, emphasis is put on training mid-level and low-level cadres of health workers to man the facilities.
The commitment of the Government of Tanzania to its policy can easily been shown. For example at present there are about 3100 health units in the country of which about 2800 are Dispensaries and about 300 are Health Centres.
It has always been a major component of the Health Policy to ensure the availability and accessibility of essential drugs and basic health services as near to the people as possible. As a result today the potential coverage of the population with health services has increased to the extent that over 90% of the population lives within a distance of 10 km from a health facility.
However, as for many developing countries this policy has faced a number of problems, including:
1. The steady increase in the cost of maintenance and expansion of health facilities, plus the increased expenditure on drugs and medical supplies to meet the growing demand and utilisation of the facilities, has led to a substantial increase in the budget requirements for the health sector.
Since the central budget of the government is generally limited, the country has experienced a disproportion between the funds available for the purchase of drugs and medical supplies and its real requirements.
In 1984 the situation became worse to the extent that funds for procurement became so inadequate, that supplies and services were seriously reduced or cut out and funds were being taken from other equally important economical and social sectors to the detriment of these.
2. The expansion of the health services has not gone in parallel with an increase of relevant pharmaceutical and medical personnel. The drug supply systems - including procurement, distribution, inventory control, storage and general management - suffered from lack of qualified and experienced technical personnel. This resulted into inadequacies in supply management and procedures and insufficient and unsuitable distribution and storage facilities.
The consequences of such deficiencies have been the waste of scarce resources and valuable drugs through increased procurement costs and losses.
3. The lack of or limited knowledge about the provision of adequate clinical and pharmaceutical services has created major problems in the rational use of drugs. Problems have been observed in patient management procedures and in diagnostic, prescribing and dispensing practises.
Due to ignorance patient compliance with therapies has been low. Such problems have caused the waste of substantial proportions of vital or essential drugs. Drug shortages have led to irrational prescribing and dispensing practises, which seriously affected the provision of health services and the public perception and general credibility of health personnel.
4. Increased demand for modern health services and shortages of qualified health professionals have increased the workload of the few available workers. This resulted in an inability to provide the expected quality of health care.
Shortage of training opportunities and facilities and lack of supervisory staff meant that many health care providers, once qualified, have had no chance to benefit from systematic and continuing in-service training or upgrading courses. Their skills have therefore not been raised to current requirements. Lack of promotional opportunities for health care workers affected their morale negatively, resulting in lower efficiency of care.
5. Critical shortages have been observed in the availability of suitable, simple, practical, relevant reference materials in the form of guidebooks on modern practises in areas such as drug prescribing, drug utilization, patient management and management of health facilities. Distribution and use of such materials was also lacking. This problem contributed to the lack of under standing of current requirements and poor efficiency in the medical-pharmaceutical fields.
6. Absent, deficient or inaccurate record keeping of patient attendances, morbidity and drug prescribing and dispensing has led to difficulties at all health facilities in preparing even semi-accurate estimates of drug requirements. Consequences of this have been overstocks and expiry of drugs in some situations, but more serious were the acute shortages or stock-outs of even vital drugs. Valuable resources have thus been wasted at the expense of health needs of patients.
7. Political will and efforts by the Government to raise the level of public awareness on health matters has improved substantially over the years. Yet gaps and widespread misconceptions are still to be found in their knowledge about self-diagnosis and -treatment, correct utilisation and storage of drugs and appropriate use of the limited available health facilities.
Health facilities are often overburdened with patients seeking symptomatic relief or treatment for minor ailments, which could have been easily and cheaply treated with Over-The-Counter drugs (OTC) or even without drugs.
8. The public as well as health professionals are often confused by drug names. In addition to this a multiplicity of available brands of certain products, together with confusion about their dosage regimens, often leads to inappropriate treatment of diseases such as malaria. This represents a further waste of drugs and resources and contributes to the spread of resistance to some drugs of common infectious diseases.
9. Lack of up to date comprehensive and relevant drug legislation, coupled with lack of enforcement of existing drug laws (e.g. control of importation, manufacturing, distribution, prescribing and dispensing), has resulted into non-essential and occasionally harmful drugs of questionable quality entering the country.
