VZCZCXRO7557
RR RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHDR #0156/01 0500948
ZNR UUUUU ZZH
R 190948Z FEB 10
FM AMEMBASSY DAR ES SALAAM
TO RUEHC/SECSTATE WASHDC 9435
INFO RUEHNR/AMEMBASSY NAIROBI 1653
RUEHKM/AMEMBASSY KAMPALA 0179
RUEHJB/AMEMBASSY BUJUMBURA 3202
RUEHLGB/AMEMBASSY KIGALI 1679
RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHLMC/MCC WASHINGTON DC
RUEHPH/CDC ATLANTA GA

UNCLAS SECTION 01 OF 03 DAR ES SALAAM 000156 
 
SIPDIS 
 
DEPT FOR AF/E JTREADWELL, AF/RSA KMOODY 
STATE PASS AID AFR/SD 
 
E.O. 12958: N/A 
TAGS: EAID TZ
SUBJECT: CODEL DURBIN REVIEWS TANZANIAN HEALTH ISSUES 
 
DAR ES SAL 00000156  001.2 OF 003 
 
 
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. 
 
 
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 
 
DAR ES SAL 00000156  002.2 OF 003 
 
 
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. 
 
--------------------------------------------- ---- 
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 
 
DAR ES SAL 00000156  003.2 OF 003 
 
 
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 
programs. 
 
-------- 
Comments 
-------- 
 
¶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 
point! 
 
¶11. Mr. Chris Homan, Office of Sen. Durbin, cleared this message. 
 
LENHARDT