ANALYSIS OF FACTORS CONTRIBUTING TO INSUFFICIENT HEALTH CARE SYSTEM IN AFRICA: CASE STUDY OF TANZANIA FROM THE

AFRICAN SUB-SAHARAN CONTEXT

MBA 627 : ADVANCE RESEARCH PROJECT

INSTRUCTOR : DEREJE TESSEMA, PHD, PMP, CEA

STUDENT : SOPHIA .E. SALLU.

Content

CHAPTER 1: INTRODUCTION

1.1 Background of the study

1.2 Problem Statement

1.3 Purpose

1.4 Research Questions

1.5 Hypothesis

1.6 Theoretical Framework

1.7 Expected outcome.

CHAPTER 2: LITERATURE REVIEW

2.1 History and Evolution

2.2 Current challenges in exploring the matter

2.3 Trend

2.4 Annotated Bibliography

CHAPTER 3: RESEARCH METHOD

3.1 Research design

3.2 Sampling design

3.3 Types of data collection

3.4 Data processing and Analysis

CHAPTER 4: DATA COLLECTION AND ANALYSIS

4.1 What is Health System?

4.2 Country experience on the Ebola Epidemic

4.3 Management of healthcare system.

4.4 HIV/AIDS in Sub Saharan Africa.

4.5 African’s efforts on healthcare system.

4.6 How poverty in Africa increases unsatisfied healthcare system

4.7 Effects of diseases and infection on economic growth

4.8 Various Global responses to the aftermath of the Ebola epidemic

Cont’d: ContentCHAPTER 5: CONCLUSION AND RECOMMENDATION

5.1 The accepted Null Hypothesis

5.2 Limitations of the study

5.3 Findings ( Sub-Saharan Africa)

Abstract

The content of this study will focus on health care system. Last year, Africa was in a crisis after the Ebola outbreak, where several people in western countries became victims. The health care centers and agencies in Africa have awaken to set their retention strategies as to avoid further epidemic diseases. The purpose of this study intend to show the investigated factors, while providing recommendations that would lead to improvement. The literature review aims to identify the main challenges in health care sector in Sub Saharan Africa, with special emphasis to Tanzania’s health care system. This research will use both qualitative and quantitative methods to test the given hypothesis with respect to effectiveness.

Chapter oneIntroduction

To a larger extent, public healthcare systems in Sub Saharan African countries have recently been characterized by frequent epidemics, that have resulted into untold suffering the last of which has been on the Ebola Crisis, of which have enraged the entire West African Countries.

Towards this end, many Sub Saharan African Countries were caught unprepared for the scourge, and this even further aggravated the epidemic far across national and international frontiers.

Statement of the problem: Prevention of epidemics in Africa as a whole, offers a serious

challenge with respect to different regional challenges that are generally caused by a wide variety of

circumstances in which people become easily infected. This study was aimed at identifying these

factors, as mentioned through the respective hypothesis, and attempts to present key issues that

significantly lead to Cross-Country Epidemic Outbreak.

Cont’d Chapter one

The Purpose: The Researcher envisaged to investigate factors leading to epidemics in an African context, and provide recommendations for improvement at national level, with a view to proposing effective measures that will play a role in mitigating the persistent challenges as reflected on the hypothesis, that were laid down to guard the researcher, to determine ways that may go on to prevent the re-occurrence of a similar fatal communicable diseases from happening againResearch Questions:

- What is the Global state of Health care delivery system comparative to sub Saharan Africa with special focus to Tanzania?

- What should be done to improve the status quo?

- What is general overview of healthcare services to selected African countries comparable to Tanzania?

- What is the future pro-active trend for Sub Saharan Africa on prevention of epidemic, with particular focus to Tanzania?

The Objectives:

- To examine the major cause of insufficient health system in Sub Saharan Africa , with particular focus to Tanzania

- To examine the impact of insufficient of healthcare system on the physician performance.

Hypothesis

Null Hypothesis

HO: Education, access to technology, income have a

positive impact on the healthcare delivery system

HO: Cultural background of many African states

affects healthcare management

Alternative Hypothesis

H1: Education, access to technology, income do not have a positive impact on

the healthcare delivery system

H1: Cultural background of many African states do

not affects healthcare management

Theoretical Framework Theory of Economics

According to John M. Keynes, his theory lies in the view about the role of the

government in the capitalist economy. He believed that there is a way out for any government to start

spending in order to put money into private sector pockets and get demand for goods and services. This

will ensure availability of resources to African government, of which the distribution could guarantee the

requirement of public health systems.

Theory of Self-determination

Edward Deci and Richard Ryran argued that; this is a theory of motivation and personality that

addresses three universal, innate and psychological needs to improve both socially and economically to

better their lives.

Demand and Supply Theory

With reference to Koolhunkk theory which states that “A rise in price increases the supply,

whereas a decreases in price decreases the supply”. Thus shift take place due to factors other than price

such as weather conditions, technology and the poor purchasing power of the Sub-Saharan Africans with

regard to health management.

Expected Outcome

The expected outcome from this research

is to enable one to understand the level and the

degree of commitment Sub Saharan Countries

dedicate their resources in the provision of

health care while recognizing the progress that

has so far been achieved, comparatively to

global dimensions, with a special focus to

Tanzania and some other named countries i.e.

Nigeria, Liberia, Uganda, DRC Congo, Angola

and Botswana in line with the recent Ebola

crisis.

Chapter 2: History & Evolution Africa has 54 countries including Algeria, Libya,

Egypt, Sudan, Chad, Niger, Mali, Congo, Ethiopia, Tanzania, Angola, Namibia, Zimbabwe, Zambia, Botswana, South Africa and more.

Tanzania health care is made available to the population and financed by both government and private enterprises. As in large sense, the elements of health system embrace personal health care services for individuals and families available at hospitals, dispensaries and to any similar agencies.

An improved health status leads to increased productivity, educational performance, life expectancy, saving and investments and reduces debts and expenditures on health care. Ultimately it can lead to greater equity, economic return, political and social stability.

Cont’d Chapter 2. Healthcare Programs include, additional to teaching

medical professionals, engage in medical research work and other related activities that are aimed to widen a body of knowledge and contribute to the world of science, with a purpose of alleviating further human suffering.

However, Medical Insurance Schemes are still highly fragmented in the country, where the Government of Tanzania has established a Regulatory Body, to oversee their operations to safeguard the rights of the citizenry.

Current challenges

Fig.1 The Vicious circle of poverty

Low Consumption

Low Income

Low Savings

Low Investmen

t

Low Productivity

Cont’d Chapter 2 Deeping Poverty: African experience a

disproportionate burden of poverty. It limits access to services, increasing vulnerability, while ill health directly affects productivity, especially in labor intensive economies.

Shortages of drugs and medicine coverage.

Labor turnover.

Lack of effective staff supervision.

Poor collection of Tax.

Poor transport and communication infrastructure.

Trend: Many Policy analysts have expressed fears that at the current rates of progress, Sub Saharan will not be able to provide satisfactory health care to its inhabitants by 2020, and will not achieve any of the United Nations millennium development goals due to increasing poverty.

In the coming years Tanzania is likely to rely more on technology as to develop its health system by 2025.

Annotated Bibliography From the private sector perspective; Peter Botha the Chief executive of AMI came

with the listed African medical investments, of which currently operates private

specialist hospitals in some of the African countries including Tanzania, Mozambique

and Zimbabwe. AMI is looking forward to go extra mile to expand markets into

Kenya, Ethiopia, Nigeria and Uganda. Botha adds that his company sees strong a

demand in Africa for “Quality, International standard healthcare” whereby this is so

caused from the emerging middle due to steady economical growth and the

government’s participation on improving the overall health care system through the

introduction of private sector participation on health management, as well as on Cost

Sharing to public hospitals.

Chapter 3 Research Method Qualitative research method:

- case studies are useful tool in investigating trends and specific situations in many scientific disciplines. The target population: People in Africa mainly in

Tanzania.

Secondary Data: The internet, reference books, Journal articles and Organizational reports.

Primary Data: The interview.

Chapter 4: Data collection and AnalysisWhat is Health System? With reference to the definition as offered by the World Health Organization (WHO), health system is defined to consist of all organizations, people and actions whose primary intent is to promote, restore and maintain health, where this involves efforts that influence the determinants of health.

Country Experience on the Ebola Epidemic (Sub Sahara)

- Guinea

- Uganda ( Managed to contain the last Ebola Epidemic)

- Liberia

- Nigeria (How did it managed to contain Ebola outbreak)

- Tanzania

Cont’d

Cont’dManagement of healthcare system

Health system in African countries are generally directed through a set of policies and plans that are adopted by governments, private business and other groups.

HIV/AIDS in Sub-Saharan Africa (Focus to Tanzania)In Sub-Saharan Africa, people with HIV related

diseases occupy more than half of all hospitals beds, where large number of healthcare professionals are being directly affected. Example Botswana has lost 17% of its healthcare workforces due to AIDS between 2005- 2012.

More children have been orphaned by AIDS in Africa countries than anywhere else. Many children are now raised by their extended families and some are even left on their own. The disease is having a devastating effect on the already inadequate supply of teachers in many African countries.

African’s efforts on Healthcare system However during the Abuja African union summit on HIV/AIDS in April 2001, the heads

of governments from Botswana, Ethiopia, Mali, Nigeria, Kenya, Rwanda, Uganda and South Africa established the AIDS Watch Africa (AWA) advocacy platform. The initiative as was formed to mainly increase efforts by government as to implement their commitments to fight against HIV/AIDS and mobilize the required national and international resources.

How Poverty increases the high rate of unsatisfied healthcare system. Poverty in Tanzania increases the chances of inadequate health

care delivery system. Infectious and neglected diseases kill and weaken millions of poorest countries and most vulnerable people each year.

Effects of diseases and infection on economic growth for Sub-Saharan Africa

Highly affected countries in Africa, billions of economic activity are lost in each year as a result to illness and death from Ebola, HIV, TB and Malaria.

In Tanzania, for example, Malaria reduces economic growth by 1.7% that hinders the country development.

Various Global responses to the aftermath of the Ebola Epidemic in Africa

After the Ebola outbreak world leaders and international organizations slowly started to woken up to the impact of the most frequent epidemics in the African continent. The latest high level International Conference on Ebola was held in Brussels, Belgium on March the 3rd, 2015 of which deliberated on how to combat epidemics at local and international level

• While Donor countries have since been helpful to Sub Saharan Africa, a new concept of Donor-fatigue following the global economic downturn has resulted into dwindling grants or loans to Sub Saharan governments sometimes leading to budget – deficit to Sub Saharan African national budgets,

Chapter 5: Conclusion and RecommendationsEducation is the major key to reduce health inequalities simply because

it enables people to have better health literacy and take preventative healthcare measure. Implementation as seen from the chapter four could strongly influence the future shape of health care in Tanzania (East Africa).

Limitations of the Study

- Budgetary concern; as most of the detail had to be referred from secondary data, available in the web and telephonic consultation.

- The time factor was equally limited.

- Limitation to Travel

Cont’d Chapter 5 As a measure dedicated to prevent similar epidemics from

happening again in Sub Saharan Africa, various African governments have effectively prepared well-designed health care delivery systems, to enable a quick response to any similar epidemic in future

Findings (Sub-Saharan Africa)

- Quality training to medical personnel.

- Lack of incentives to medical personnel

- Check on medical staff attendance to duty, and time spend with patient.

Cont’d - Difficulties in assessing performance level of medical

personnel- Doctors preference on working to urban based hospitals.- Poor communication and infrastructure.- Poor coordination of health centers to referral hospital.- The need for African Sub Saharan Governments to show

increased political will as urgently needed to contain wide spread epidemics.

- Unbearable cost of Training new personnel

REFERENCESAfrica Union. (2001). Abuja Declaration and the Abuja Framework Plan of Action

on HIV/AIDS, Tuberculosis and other related infectious diseases in Africa. Abuja, Nigeria.

 A. S. Deaton, R. Tortora. People In Sub-Saharan Africa Rate Their Health And

Health Care Among The Lowest In The World. Health Affairs, 2015; 34 (3): 519 DOI: 10.1377/hlthaff.2014.0798

 Baize, S., Pannetier, D and Oestereich, L. Emergence of Zaire Ebola Virus disease in

Guinea-preliminary report. N. Engl. J. Med. 2014.  Boerma, T & Carla AbouZahr. (2005). Health Information Systems: The Foundations

of Public Health. Bulletin of the World Health Organization, 83: 578-583.  Centers for Diseases Control and Prevention (2010) have pointed out the “HIV/AIDS

diseases is one of the top ten leading causes of death in the African Continent.

EPIDEMICSWithout due attention even

developed, Nations are subject to it.

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