ANNUAL REPORT OF HEALTH PROGRAM:
ANGLICAN DIOCESE OF DAR ES SALAAM
(November, 2005 – December, 2006)
Submitted by:
Dr. Henry Ziegler, Health Director, and Dr. Priscilla Ziegler, Nursing Director
We are pleased to submit this annual report for 2006. Since we actually began working in Buguruni in mid-October, 2005, this report includes November and December of 2005. Our mission has been to show God’s love here in Tanzania through creating a strong caring community health system that decreases death and suffering, especially for the poor and needy in the Dar es Salaam and Coastal Regions. We believe that our team’s accomplishments are outstanding.
Summary of Accomplishments:
* Well child and pregnancy visits not available for November and December, 05.
Program Description
Buguruni Anglican Health Centre (BAHC) belongs to the Anglican Church of Tanzania, Diocese of Dar es Salaam and is part of the health program of the Diocese. The health program is also developing village and church-based health initiatives throughout both Dar es Salaam and the Coastal Region. BAHC was first formalized as a health centre in 1998. From 2002 until October, 2005, BAHC maintained a dedicated staff who generally gave good care despite medication, laboratory and other shortages, very low wages, and an inadequate physical plant.
In October of 2005, Drs. Henry and Priscilla Ziegler, U.S. Episcopal missionaries, joined the Diocese as Director of Health Services and Director of Nursing Services. Both quality and quantity of services have increased dramatically. This has been done by: finding cheaper sources of drugs, lowering the drug prices, writing protocols both in English and Kiswahili for medical and nursing care, teaching staff, expanding the services offered, and improving the building. Daily patients have increased from 10 -18 a day to 50 - over 100 a day.
The health centre provides primary care services and some inpatient care. Care is given on a walk-in basis seven days a week, 24 hours a day. Services include adult and pediatric care, well-child care, prenatal care, deliveries, postnatal care, minor surgery and HIV voluntary counseling and testing. There is a pharmacy with an active formulary of over 100 medications. The laboratory performs the following tests: HIV (both initial and confirmatory), malaria smear, glucose, urinalysis (both dipstick and microscopic), Widal test for typhoid, pregnancy test, anemia screen, complete blood count with hemoglobin, hematocrit, white blood count, and platelets, stool for ova and parasites, sedimentation rate, liver tests, kidney tests, and cholesterol tests. There are seven ward beds and a newly established delivery room. There is an average of three to four inpatients each day, the majority for severe malaria. The staff is all full time and includes:
BAHC staff has been trained in AIDS treatment and have developed AIDS policies and procedures. A letter asking to be a formal AIDS treatment site has been sent to the Tanzanian Ministry of Health. Within three months, BAHC should have been formally inspected for AIDS treatment and begun doing AIDS treatment. This will be part of a comprehensive AIDS program which will include: the current HIV/AIDS counseling and testing, a program to decrease maternal to child transmission of AIDS, expanding community prevention/health education efforts, home-based care, an AIDS nutrition program, and the already existing AIDS orphans program.
To make BAHC’s care more available and better funded, BAHC is now a site for the National Health Insurance Fund and is seeing a growing number of government employees (654 in December, 2006). Except for charity care, the clinical care part of our program is close to breakeven with daily expenses and gross revenue matching.
The health centre has been completely rebuilt with a water tower, sinks in every room, new wiring, new ceilings, higher walls, a new roof, a new large laboratory with its own waiting area, and a washing room with a clothes washer. It has also been completely repainted and much of the floor tiled. A health education area for health education and video presentations has been completed as has a second building to house outpatient AIDS treatment, delivery suites, and more inpatients.
In addition to providing clinical care, the BAHC is developing a strong community public health program. Partnership meetings have been held with 11 poor village areas near the health centre, representing a population of 3,000 people. Village health workers have been identified and special child health wellness days organized with each village – the objective is the assessment and treatment of the children and education of the parents.
Currently, we have 12 trained village health workers who are doing household surveys, identifying sick community members (including those with AIDS), identifying who has not been tested for HIV, identifying the need for mosquito nets, and helping increase the use of clean water. Eight more village health workers have begun training. Over 960 household assessments and 117 assessments of 15-35 year old individuals have been done by village health workers. Four focus groups have taken place in the urban villages to identify health knowledge, attitudes and practice. An additional four focus groups have been conducted in the urban villages specifically about AIDS.
BAHC is partnering with the St. Augustine Primary School to provide health care and health education to its students. All 660 of the children have had a health assessment. A health survey was also done of 102 Archbishop Sepeku Secondary School students and their students have been helping develop video materials for health education.
Since treated mosquito nets decrease malaria transmission by 50%, BAHC purchased 500 nets in bulk and sold them at a reduced price through the village health workers and at the health centre. We have been approved for a mosquito net distribution grant for 30,000+ treated nets from Episcopal Relief and Development which will begin in January, 2007.
We have had planning meetings with the Health Education section of the Ministry of Health. In partnership with the Ministry of Health, we are developing materials, both written and video, for a large health education campaign for the Buguruni community. Initial flyer distribution has already begun and draft videos have been prepared.
Three rural villages (Kiromo in Bagamoyo District, Mauri Mngwata in Kisarawe District, and Kikali in Rufiji District) in the Coastal Region are working with BAHC concerning AIDS, wells for water, and general preventive education. Focus groups have been done in two of the three villages and are scheduled for the third. Thirteen village health workers have had training and other four are scheduled to begin training. Two home health workers will also being trained in one of the villages.
In addition, BAHC has a grant-funded program from the Incarnation Episcopal Church in North Carolina to identify and assist AIDS orphans. The Incarnation AIDS orphan program identifies AIDS orphans in the Buguruni area and then supports extended family or community members in taking care of them. Fifty-three AIDS orphans have been identified and are receiving health, food, and educational assistance.
The educational programs of the Diocese of Dar es Salaam and the Health Program are part of a new non-profit organization (NGO), called MEA Foundation (Taasisi ya Maendeleo, Elimu na Afya- Foundation for Development, Education and Health). MEA was recently certified by the Tanzanian government to operate as an NGO subsidiary of the Diocese. The MEA Foundation combines the health programs, St Augustine Primary School, Archbishop John Sepeku Secondary school, and microeconomic initiatives into a coordinated comprehensive community development effort. MEA gives the programs more flexibility in partnership, greater impact through the coordination of programs, a very strong and transparent method of monitoring grant objectives, and funds. MEA Foundation also serves as a vehicle for fund raising. Since its inception in May 2006, MEA Foundation has already monitored over $70,000 in education and health grant funds.
Goals of BAHC/Anglican Diocese of DSM Health:
The community oriented primary care model being used combines public health and self help development with clinical care. The public health work is integrated with the development of economic groups (two women’s economic groups have been started) and school health programs (two in active partnership).
Evaluation of programs:
An evaluation of the first year of the expanded BAHC program has been compiled. To date, 960 urban household and 117 individual 15-35 year old surveys have been done. Fourteen community focus groups have been conducted and have gathered formative data for the development of health education campaigns. In the schools, 102 secondary school and 660 primary school assessments were completed and will be repeated in 2007 to identify progress.
Description of communities in partnership:
Buguruni, a poor part of the Ilala District of Dar es Salaam, has an urban population of over 250,000. Most of the occupants are mostly living in squatter and slum housing. Sanitation is very poor and available water is not safe. Buguruni leads Dar es Salaam in cholera, has one of Dar es Salaam’s highest HIV+ rates, and has one of its highest malaria rates.
The three rural villages are all poor. Two have 1,500 people each and the third has 3,000. One is along a busy road, one is remote and up a mountainous road, and one is remote and near the coast. All three have a desperate need for water. (Wells are part of the current grant funded program and a working well is now in place in Marui Mngwata.) Sanitation is poor and water and food borne diseases very common. Both AIDS and malaria are also very common.
The leading causes of death (male/female) for all ages according to 2002 Dar es Salaam sentinel site data are:
2007
In 2007, we look forward to working with our community and health partners to further strengthen the community health system and to improve the health of thousands of Tanzanians living in the Dar es Salaam and Coastal Regions. Major programs include:
Currently the 2007 budget is $117,000 in expenses and $107,000 in revenue. The deficit will need to be made up from additional patient revenue or donations. This does not include $180,000 in the Episcopal Relief and Development Malaria Net and Health Education Grant or any other grants or donations that may be obtained.
