Background to Tanzania, Development and HAPA

Introduction

This set of pages have been designed to give volunteers a better understanding of Health Actions Promotions Association and the environment in which it operates, though it can only touch very lightly on subjects that are worthy of much deeper study. We hope that this will encourage to you find out more for yourself as you will get far more from your time in Tanzania if you are able to understand the background to which organisations like HAPA work and the particular way in which HAPA tackles the many problems that they face. To help you we will be adding more resources to the site though please don't restrict yourselves to these. Many more are available, it will just take a bit of effort on your part to search them out.

Background

Health Action Promotion Association (HAPA) is a Tanzanian NGO established in 2000 and formally registration in May 2001. HAPA seeks to provide support to community initiated efforts that tackle the development of health, education and good governance.

VolunteerAfrica was established in 2001 with the aim of giving volunteers from around the world the opportunity to learn from others whilst working abroad.

In purely practical terms the funding provided by the Volunteer Programme will be of major importance to the HAPA team, providing them with regular untied funding that can be used as the local staff and trustees see best fit. The reality is that at the worst of times this money will help to keep HAPA afloat, at the best of times it will be used as the foundations from which much larger funding grants will become accessible.

Whilst the money raised by volunteers is important it must always be remembered that we have to ensure that different needs of the two programmes are properly balanced. When you are in Tanzania as a volunteer you will live in and work with villagers. We are committed to ensuring that you get the maximum possible from your time in Tanzania but we also have a duty to the Tanzanians to ensure that the long-term development needs of their communities come ahead of the short-term needs of visiting volunteers. What this means in practice is that the work that we do, and in particular the construction projects, always operate at the pace that is of most benefit to the community. If problems occur in a community, as they frequently do, such as a reduction in motivation of villagers, or maybe problems paying craftsmen, HAPA staff put every appropriate effort into facilitating and in getting things moving again. However this does not mean that we artificially force the pace of projects just to keep Volunteers happy.

Finally it is through Volunteers that other people in other countries will learn about the realities of development, the efforts that people are making to improve their own lives and the work of organisations such as HAPA. It is important that you learn about the work of HAPA if you are to be an ambassador for the people that we exist to support.

The rest of the paper will include:

• Tanzania - a snapshot
• Aid and Development - What is it?
• Primary Health Care (PHC) and its role in development
• Government and Health Care systems in Tanzania
• The HAPA Development Programme - the overall objectives and our current interpretations and practice
• The Project Planning Cycle

So here goes.....

Primary Health Care (PHC) and its role in development

To me "Primary Health Care" means providing people with access to health care facilities that are appropriate to their needs, physically assessable and affordable.

Traditionally Health Care has been provided in a "top down" way with big hospitals at the top of the heap and untrained or auxiliary staff at the bottom.

Big hospitals have always absorbed by far the largest part of any health care budget yet the vast majority of people in countries such as Tanzania will never be able to use these places, relying instead on the services provided by their local health workers.

Even in the richest of countries it is not possible to meet all health care needs - we are all constantly being reminded of the difficulties being faced by our own health service and Britain is not a poor country - by any stretch of the imagination.

Therefore it is unlikely that countries like Tanzania will ever be able to fully meet all the health care requirements of its people.

Having said this there is hope - and this is where Primary Health Care comes in. PHC is not just about providing more resources at the level of the health service that most people come into contact with it - it is far more proactive than that. It is about giving people the skills and knowledge that they need in order to stay healthy in the first place. It is about helping people to understand the causes of ill health and enabling them to make changes that will not only improve their quality of life but that will reduce demand on the health services - enabling limited and valuable resources to be stretched further. The ideals behind this are great but do remember that the sorts of changes that we are talking about are enormous. Even in our highly educated society much of our health services resources are devoted to treating the effects of over-eating, smoking, drinking etc.

Government and Health Care systems in Tanzania

Before I go on to talk about the work of HAPA in Tanzania I want to talk briefly about way in which government and the health service are organised as this does differ quite a bit from the UK - and familiar sounding terms can actually have quite different meanings.

In Tanzania most people live in hamlets or villages. For administrative purposes these are grouped together as "Wards" with a population of 8 - 12,000 people. In urban areas these communities can be continuous, with the boundary being just a line on a map. Rural communities are more spread out and in places even the different villages that make up a "ward" can be many hours walk from each other.

People's health care needs in a ward are usually served by a village Dispensary and Mother & Child Health Unit. In UK terms we would equate this with our GP health centres.

Four or five Wards, together, will form a Division. This population of 40 - 60,000 people will be served by a Health Centre. Health Centres have in-patient facilities, larger out-patient departments, very basic laboratory facilities and more senior medical staff. In theory this would be the equivalent to a Cottage Hospital in the UK.

Four or five Divisions form a District with a District Hospital, whilst four or five Districts make up a Region. There are 20 Regions in Tanzania and HAPA works in just two of them; Tabora and Singida.

The first time you would usually meet a graduate doctor in the Tanzanian system is in a District Hospital. Even at this level there is often only the one Doctor who may double up as the District Medical Officer (with a variety of administrative and planning functions).

To Europeans the idea that the majority of health care needs are met by paramedical staff is hard to comprehend. However the reality in many countries is that putting medical staff through a university education is expensive and unlikely to produce the numbers required. In addition university trained doctors do not, on the whole, want to spend their lives working in remote villages without access to running water or power and with little scope for personal development. Many countries have realised that it is much more realistic to give people a shorter, though more focused training. These medical workers normally have far more in common with the subsistence farmers that they are needed to serve, thus enabling health care services to be taken out of the big cities and into the rural areas.

The Project Planning Cycle

One way of thinking about the way in which HAPA now works is through the "Project Planning Cycle".

They undertake a lot of work or projects that, individually, have an impact on peoples lives. However if we think about these projects, purely in isolation, we are losing out on a tremendous amount of potential for positive change.

Every project that HAPA undertakes or support must be considered as part of a much longer process. Finishing the construction of a building is not the end of a project it is vital that we encourage people to review and build on what they have achieved. The Volunteer Programme and the construction projects both make an important contribution to this process though they are not necessarily an end in themselves. The dispensaries, schools and wells will meet vital short-term needs but it is the process of developing ideas, making plans, implementing them, reviewing and hence developing new ideas that is really important.

Finally

The opportunity that you will have in Tanzania to see the workings of a Development Agency is a rare privilege. In order for you to get the most out of this it is important that you read and learn as much as possible about development before you travel overseas. This means that you we be able to get the maximum possible out of your time in Tanzania.

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Tanzania - a snapshot

Tanzania lies just below the equator on the east coast of Africa and is boarded by Kenya, Uganda, Rwanda, Burundi, Congo (across Lake Tanganyika), Zambia, Malawi and Mozambique.

Twenty nine million people from over a hundred tribal groups peacefully share the land and make up the country that we know as Tanzania. In fact Tanzania is actually a Republic made up of two separate countries, Tanganika and Zanzibar, that united in 1964 to form "Tan - Zan - ia".

Tanzania is a country with very few resources and when measured in pure financial terms it is one of the very poorest in the world. However this is deceptive as the policies of the government over the last 35 years, including experiments with an African form of socialism, and a genuine desire to share its resources amongst all the country's people, mean that in terms of Human Development, which includes measures of the freedoms and rights of people and their the access they have to the basics required for human life such as food, shelter, education and health care, places Tanzania much higher up the list of the world's nations.

Aid and Development - What is it?

Now this really is an enormous subject which is impossible to cover in the short paper such as this. However there are a couple of points that I would like to make. These are:

What is the difference between Aid and Development?
and What is Structural Adjustment and what does it mean to a country like Tanzania?

First of all the difference between Aid and Development. "Aid" or Emergency Aid is the dramatic side of the industry. This is the providing of short-term emergency support usually during or after periods of famine, flooding, war, etc. It is the provision of emergency food aid and refugee camps with all that entails, i.e. proving water supplies, health care, food etc. This is the stuff that makes good stories for the evening news as westerners are seen dashing in saving lives.

The amount of money spent on Development Aid is actually much higher but is also much lower profile. If the work carried out in this sector is done well there should be fewer demands for emergency aid.

Development Aid is about helping to meet the basic rights of ordinary people for health care, clean water, education and food. It takes much longer to produce results but if done properly has effects that last for many years to come.

There is a saying that summarises this:

Now, very briefly, on to refer to Structural Adjustment.

This is collective name for a number of policies that are currently in vogue with major world institutions such as the International Monetary Fund (the IMF).

Some of the changes that are being imposed are long overdue as there is no doubt that many government ministries and parastatals are inefficient and not providing their people with the services they deserve. Whether the way in which the IMF wants to see things changed is another issue. What is probably of more importance is that these policies are having an enormous impact on people in countries that do not have support systems to help those losing their jobs or the money to pay for alternative health care and education when government services and cut back. Devaluing your currency may sound fine in practise but when your income is dependent on the sales of a cash crop, such as tobacco, cotton or coffee, it just means you ended up poorer. Making imports more expensive to stop consumers from buying them does not help when the only imports that you use are drugs or spares parts for your village water pump. A cynic would suggest that these policies can actually have more of an impact on the richer nations of world, reducing the amount that we have to pay for our tobacco, cotton and coffee.