[afro-nets] User Charges - A Good Looking Animal with Bitter Flesh

[Selemani Mbuyita <mbuita@yahoo.com>]

User Charges - A Good Looking Animal with Bitter Flesh
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Please, read this story!!

"The health workers at our facility go out for outreach pro-
grammes in turns. One day when it was my turn, I visited a vil-
lage that is about 10 km from here. In one of the households I
saw a patient who had diarrhoea for more than four days. She was
a mother of an 1-year-old baby boy. She was fast asleep and very
weak. I asked them why they did not bring her to the dispensary
and the aunt replied, 'nurse, you have been here for quite a
long time now to know when people have money and when they don't
have. This is a hard time and we don't have money to bring her
there. Had it been the harvesting season we could have brought
her from the first day for her diarrhoea is very bad.' I kept
quiet and provided them with septrine tablets and directed them
how they should give them to the patient. When I was about to
leave, the aunt called me and murmured, 'can we give her the
tablets now? We ask so because we gave her gongo (very strong
local spirit with more than 25% alcohol) a few minutes ago. Peo-
ple told us that it cures acute diarrhoea.' I was stumbled for I
did not know how to help the patient. My dear researcher, we
meet so many cases of the like particularly at the time when
people do not have anything to sell."


A story by a public health nurse in one of the health facilities
in Lindi rural district, Tanzania.

I decided to call this story "Please, Wait Until We Harvest!" It
is not fictitious. I myself encountered the event in one of the
research work I was involved conducted by Ifakara Research Cen-
tre for Save the Children (UK) Tanzania Program.

Recently the National Specialist hospital (Muhimbili) has an-
nounced new cost sharing rates. Sky rates! The least is Tsh
10,000 (about US$ 10). The rate narrated in the story above was
only Tsh 200! (US$ 0.2) and yet was unaffordable!

Only after a few days the impact is obvious! Overcrowded pa-
tients in district hospitals (three of them in the city of Dar
es Salaam). One bed for four patients! Yes it is a bit cheap
there! Definitely the physics people knew it - the principle of
displacement! Put a heavy metal in a container to displace water
out! I also believe that they knew that the displaced water
would drain into soil - the lives of people in graves!! For they
did not put any other container to tap the pouring water. There
was not any preparation to capacitate district hospitals to ac-
commodate the exiles! They wanted it for they say the hospital
is specialist! True! Very true! But what about quality of care
in primary and secondary facilities? What about staffing level?
Do you think the Tanzanians were crazy going all the way to spe-
cialist facility? Everybody needs quality, needs assurance!

Most of the NGOs working in Tanzania strongly recommended for
elimination of the user fees practice in government health fa-
cilities, arguing that time is not yet for that! The contrary is
the response from the government that is struggling to "elimi-
nate poverty". The country that has its economic growth shooting
up monthly - as the president preaches every month!

My dear Tanzanians! Wait until you harvest so that you can be
able to take your child to a health facility for it is only then
you will be able to sell your crops and earn money! Or tell your
child not to fall sick until you have harvested! And pray the
Lord the sun should not be too hot to dry your crops!

I sometime keep asking myself, for whom do they do all that? Is
the situation similar in other African countries or is there a
place our "Majestics" can go and learn about pity and the feel-
ing of being concerned?


Selemani S. Mbuyita
Research Officer
Ifakara Health Research & Development Centre
P.O. Box 53
Ifakara, Tanzania
Tel.: +255-23-262-5164
Mobile: +255-744-653-222
mailto:mbuita@yahoo.com