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Cablegate: Codel Durbin Reviews Tanzanian Health Issues

DE RUEHDR #0156/01 0500948
R 190948Z FEB 10




E.O. 12958: N/A

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SUMMARY: On February 13-15, 2010, Senator Richard Durbin (D-IL),
Senate Majority Whip and Member of the Senate Appropriations
Committee (SAC), led a Congressional Delegation (CODEL) on official
committee business to Tanzania. Tanzania was the first stop of the
CODEL's seven-day, four country visit (also included Congo, Sudan
and Ethiopia). Other members of the CODEL included Senator Sherrod
Brown (D-OH) and spouse, Mrs. Connie Schultz, a Pulitzer prize
winning journalist; Mr. Chris Homan, Office of Sen. Durbin; Mr. Max
Gleischman, Office of Sen. Durbin; Mr. Doug Babcock, Office of Sen.
Brown; and Lt. Col. Tracey Watkins, USAF. The purpose of their
visit to Tanzania was to learn more about U.S. foreign assistance
programs, in particular global health and child/maternal mortality.

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CODEL members spent the majority of their trip in Mwanza, on the
shores of Lake Victoria. They traveled two-hours by road from
Mwanza to review health services in rural Tanzania provided by CARE
Tanzania. This visit emphasized scarcity of resources and
challenges in delivering health services to rural areas. In Mwanza
town, they visited a referral hospital and a health center. They
also met with the Minister of Home Affairs, the Regional
Commissioner of Mwanza, and had a round table discussion with
representatives from Baylor University (pediatric AIDS), Touch
Foundation and Abbott Fund to discuss health sector human resources
issues in the lake region of Tanzania. END SUMMARY

Breakfast Meeting with USG Assistance Team

1. Over an informal breakfast, the delegation met with an
interagency group of senior USG officials working on health and
development issues in Tanzania. The USG representatives were from
State, DoD (including Walter Reed MRU), TREAS, HHS/CDC, Peace Corps,
and USAID. After a brief introduction from the Mission's assistance
team, the Senators engaged in a frank discussion on numerous health,
development, defense and diplomatic issues that concern USG
assistance to Tanzania. Key topics covered included contributing
factors to Tanzania's high rates of infant and child mortality;
access to and application of family planning; the state of education
in Tanzania; issues affecting human resources for health (including
emigration of skilled health care workers); successes of malaria
interventions in Zanzibar and certain mainland districts; HIV
vaccine efforts underway in Tanzania; economic opportunities in
Tanzania as well as Government accountability and transparency; the
perception of America in Tanzania and, finally, China's relations
with Tanzania.

CARE Visit to Gambajiga Village

2. In Gambajiga, the CODEL was able to visit with health workers and
community leaders who, through CARE technical assistance, have taken
concrete steps to improve the quality of health care for pregnant
women in their area. Despite having access to only very basic
dispensary and reproductive health services, villagers have taken
steps to significantly reduce maternal mortality. The CODEL also
met with members of the Mwagala Village Savings and Loan group
supported by CARE. They learned how this program is improving the
lives of its members and of their community. CODEL members
expressed their appreciation for this experience of rural Tanzania.

--------------------------------------------- --------
Meeting with Lawrence Masha, Minister of Home Affairs
--------------------------------------------- --------

3. Masha emphasized the critical importance of improving education
in Tanzania. He said that Tanzania's building blocks of peace and
stability will be the basis for its success. He stressed that change
will come through an educated society. President Kikwete's
administration is building a foundation for this through the
construction of schools and training of teachers. He pointed out
that the Kikwete government has built more schools in the past five
years than the total built from the time of independence up until he
was elected. He also mentioned that Tanzania has over 100,000
students in higher education, exceeding numbers in Uganda and Kenya.
Senator Durbin asked Masha's opinion on the policy of switching
from Swahili to English instruction in later years of schooling.
Masha strongly felt that instruction should be either all in English
or all in Swahili from the beginning.

4. Durbin also raised the issue of a shortage of health workers and

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incentives to keep doctors and nurses in country and deployed to
rural areas. Masha stated that the government was considering
reinstating a national service program. Students who take part
would be forgiven their student loans. Masha also mentioned the
need for more foreign investment in Tanzania. He was discussing
with an Iowa investor about developing a large hog farm in Mwanza.

--------------------------------------------- -------
Breakfast Meeting on Public-Private Partnerships and Human Resources
Issues in the Health Sector
--------------------------------------------- -------

5. Senator Durbin cited a discussion the previous evening with
Minister of Home Affairs Masha concerning the issue of human
resources for health. He spoke of bonding health workers,
especially those receiving financial assistance, to go to remote
locations for specified periods of time after their training. He
was very focused on emigration of doctors and nurses to other
countries and ways to reduce this phenomenon. However, he learned
that for Tanzania only about 10 percent at most of health workers
are employed outside the country and that the health worker shortage
is mainly an inability to produce enough doctors and nurses. The
other issue is an urban bias in the distribution of healthcare
workers, causing significant shortages in rural areas.

6. Sen. Durbin asked the doctors present about lessons learned.
They mentioned that improvement in clinical results requires support
systems that reliably provide supplies, commodities and functioning
equipment. They also spoke of the importance of working closely
with local government authorities to expand services to rural
communities. They favored in-country training of health
professionals as opposed to foreign training. They insisted that
most clinicians really don't want to leave their country, but need
retention interventions. They also cited the need to capitalize on
the political will to support the health sector to improve
management capacity and overall systems.

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Meeting with Regional Commissioner, Abbas Kandoro
--------------------------------------------- ----

7. During this courtesy visit, the Regional Commissioner (RC)
discussed specific challenges in the health sector including the
shortage of health workers, insufficient infrastructure capacity
relative to the size of the population it serves; and the
president's primary health care initiative aimed at building a
dispensary in every village. He also mentioned the Kilimo Kwanza
initiative (Agriculture First), stressing the tremendous agriculture
potential of the lake region. He lamented that only five percent of
the land is irrigated, greatly inhibiting growth in the agriculture
sector. Senator Durbin also asked the RC's opinion about the impact
of switching to mandatory English teaching in later years of
schooling, which the RC defended.

Visit to Bugando Medical Centre

8. The visit to Bugando provided the CODEL a chance to understand
the opportunities and challenges faced by Tanzania public health
facilities, especially those serving referral, teaching and
specialized hospitals. At Bugando, the CODEL specifically visited
the HIV Care and Treatment Clinic (including adult and pediatric
services) as well as the fistula/maternity and neonatal ward.
Senator Brown was very knowledgeable about, and asked numerous
questions on tuberculosis (TB) and multidrug-resistant TB. En route
to the Fistula ward, they asked questions about the needs for
fistula repair vis-a -vis the ability to meet the need, and
recognized there is considerable unmet need (i.e. approximately 720
women each year need the surgery, and they are only able to perform
approximately 200 repairs/year).

Visit to Makongoro Health Center

9. In the briefing en route to Makongoro Clinic, USG/Tanzania staff
highlighted that the facility was an atypical health centre in that
they did not have delivery facilities, since it was an urban health
centre and 80 percent of deliveries occur in rural settings.
Questions then arose about maternal mortality/safe delivery, also
stimulated by discussion about obstructed/prolonged labor at the

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obstetric fistula unit at Bugando. Causes of maternal and infant
mortality were detailed, and a report on the ability of rural health
facilities to handle these problems was cited. This report from
UNICEF detailed what proportion of various levels of health
facilities were prepared to provide specific components of care for
complicated deliveries. Most of questions focused on asking
patients about services in health facilities, about personal
challenges, and the integration of family planning into other


10. We believe the CODEL took away an understanding that the U.S. is
doing a lot of good work in Tanzania and tax payer money is being
well spent to help a lot of people. (They talked to some HIV
positive patients on antiretroviral treatment (ART) and mothers in
Preventing Mother-to-Child Transmission (PMTCT), antenatal and
family planning clinics all heavily USG supported). They saw that
services are being offered in an integrated way, but that the
facilities in the town are overwhelmed with patients. They also saw
an impressive public-private partnership with Baylor, Abbot and
Touch Foundation. They were impressed with the exchange programs
going on (U.S. physicians deployed at the referral hospital. There
were about 10 - 12 U.S. physicians from Baylor, Cornell and
Northwestern providing direct services and training at the referral
hospital in Mwanza, mostly young residents doing short rotations of
six weeks, except for Baylor, which as a long-term presence under
PEPFAR). They also witnessed the need to provide family planning
services that extend beyond health facilities, the issue of
decision-making in the household and importance of reaching women in
rural Tanzania. At the post natal clinic they talked to a mother
that just delivered her 14th child so we think that emphasized the

11. Mr. Chris Homan, Office of Sen. Durbin, cleared this message.


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