“The Tanzania Connect Project”
Grantee Institution:
Columbia University, Mailman School of Public Health
Team Leaders:
- James F. Phillips, Ph.D.
Columbia University, Mailman School of Public Health
- Ahmed Hingora, M.Comm.H.
Ifakara Health Research and Development Centre
Project Summary:
Tanzania and Ghana are at the forefront of health development in sub-Saharan Africa. Tanzania is on target to achieve the Millennium Development Goal (MDG) of reducing childhood mortality by two thirds by 2015. One contributing factor in this health system development was the Tanzania Essential Health Interventions Project (TEHIP) which gave local districts the tools to make evidence-based decisions about the allocation of healthcare resources based on burden of disease patterns. After introducing this intervention dramatic declines in child mortality were demonstrated in two rural districts (Rufiji and Morogoro) and later scaled up to 120 districts.
In northern Ghana, the Navrongo Experiment achieved equivalent success in reducing childhood mortality by mobilizing rural communities to develop local health systems and stationing nurses in these villages, the MDG child mortality target was reached in only seven years. In response the Government of Ghana has incorporated community-based nursing into its essential service package through an initiative known as Community-based Health Planning and Services (CHPS).
Although these two examples of successful health development have been lauded, health systems in each country remain fragile. A program of exchange of health systems innovations is taking place that aims to accelerate MDG 4 and 5 achievements in both countries.
In Tanzania, manpower shortages pose a critical barrier to health service accessibility at the village level despite the fact that the majority of Tanzanians live within five kilometers of a health facility. Quality and cost of primary healthcare further inhibit service utilization. To address this problem, the Ifakara Health Institute is collaborating with the Ministry of Health and Social Welfare on an experimental trial of community health service development aiming to strengthen the continuum of care from home to hospital. A new cadre of workers, known as Community Health Agents (CHA), is being trained for deployment in 50 villages of Rufiji, Kilombero, and Ulanga Districts where concurrently district-wide emergency referral systems are being strengthened. Tanzania‘s plans were inspired by Ghana’s strategy for training health extension workers, providing community-based health services, and extending the coverage of essential health interventions.
Columbia University’s Mailman School of Public Health is assisting IHI with evaluation and implementation research. All Connect work will be conducted in close partnership with the Ministry of Health and Social Welfare, fostering the sharing and transfer of information, strategies, plans, and research to contribute to the national Primary Health Care Improvement Program.
Health Demographic Surveillance Survey (HDSS) data collection in progress