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The World Health Organization (WHO) defines health as “the state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.”
Health is one of the main determinant factors for measuring the social and economic development of any nation. In Tanzania, according to the country’s Constitution, health is a right and not a privilege. As Article (11), (1) of the Constitution states,
“The state authority shall make appropriate provision for the realization of a person’s right to work, to self-education and social welfare at time of old age, sickness, or disability and in other cases of incapacity. Without prejudice to those rights, the state authority shall make provisions to ensure that every person earn his livelihood.”
The Tanzanian government has taken some steps to improve health access to all citizens, including a budget increase of 35 per cent. But this is not matched by improvement in the working conditions of health workers who deliver health services to the populace. Terms and conditions of employment in the sector remain grossly inadequate.
Government investment has been mainly concentrated in new infrastructure, whereas healthcare staff are demanding more training, health and safety protection and salary increases.
Tanzania has more health workers per 1,000 of the population compared to several other sub-Saharan African countries, but the ratio remains low. This is partly due to the small number of students in medical and health schools. The government has increased the number of students enrolled to pursue health related courses from 13,002 in 2015/2016 to 13,632 in 2016/2017.
The government has worked on increasing the number of new employees in the health sector. The figure went from 7,471 to 9,345 in 2014, and continues to increase.
However, many health workers migrate abroad or to other sectors, due to retention-related factors including poor remuneration and adverse working conditions.
As part of the National Health Security Plan, 2017/2021 aimed to combat epidemic disease like Ebola, 110 health workers have been trained on how to overcome epidemic infectious diseases.
However, the provision of immunization and vaccination, which is the best measure against Hepatitis C and Ebola, is inadequate. The trade unions have highlighted the need for the government to also provide health and safety training to prevent health employees from occupational hazards and diseases such as those linked to Ebola, Hepatitis B and C, HIV/AIDS and other occupation related disease. The International Labour Organization has published a detailed list of the measures employers need to adhere to in providing information, education, training, and protection measures including vaccination to workers:
The health workers’ trade union TUGHE believes that to improve both the quality of services in the health sector and productivity in the country, the government should invest more in improving health employees’ working conditions and motivation. This includes: providing support for health workers by putting more emphasis on training especially on job training; increasing the number of health employees, and; better pay to boost health workers’ morale.
The government needs to recognize that workers are the main resource in providing better health services and to improve our productivity, government needs to invest in health employees through increased salaries, personal emolument and other forms of motivation such as training. For the health sector to operate effectively and efficiently, the government must provide the necessary tools for workers.
National health insurance should be improved and extended to cover all Tanzanians regardless of their income, contribution or economic status. In short, the national health insurance policy must be reviewed to ensure that everyone is covered and enjoy better health services.
The unions, as part of the broader civil society movement, are looking at implementing campaigns to promote the right to health and safety as well as to protect the environment. And this is in line with the Public Services International’s global Human Right to Health campaign. Some issues the campaign will cover in Tanzania are trade union responses to climate change as suggested by national climate change strategy 2012, and cleanliness in the workplace to promote good occupational hygiene.
The health sector is a key sector for socio-economic development of the country and a driver of other economic sectors. The government must recognize that by investing in the health workforce, this will improve the living conditions not only of the workers but of the general population.
This article is an extract from the “Right to Health” newsletter issue 04 (April/May 2018). Subscribe to the newsletter. Send us your stories.