Background:

At present 60% of Tanzanians live outside the ten kilometre radius that is defined as ‘having access to healthcare’. Presuming that the health centres in question provide TB and HIV care (which the majority do not), even within this ten kilometre radius problems such as lack of transport, poverty, poor road networks, ill-health and stigma (in the case of HIV and consequently TB), mean that many people are not able or willing to make use of these facilities. The effects of this inability to access care contribute to a higher than necessary mortality rate, an increasing number of orphans, and, especially in the case of HIV, the prospect of the crisis degenerating.

The problems of access are numerous. First and foremost for many Tanzanians is the issue of cost. Dar es Salaam (DSM) has an efficient public transport system but for those who have to take two or even three buses to health centres the cost may be prohibitively expensive (around $1.50) therefore discouraging the use of repeat prescription drugs such as Anti-retroviral therapy (ARVs) for the control of the HIV virus or for TB medication which should be administered under the supervision of a healthcare professional.

Despite the efficiency of the public transport system there are many areas far removed from the nearest bus stop. This may make attendance at health centres problematic. Taxis are prohibitively expensive for most Tanzanians. In many areas of DSM roads also remain unsealed and therefore difficult to negotiate during the wet season (March-May).

For those who are seriously ill, public transport may not be an option. These patients may need door to door transport and supervision during the journey.

For some access to treatment may be more simple: it may be that home based carers need transportation themselves to access communities; and in many cases people need food and nutrition or clean water to support the drugs they are taking.

Home Based Carers (HBCs) reduce the burden on overcrowded hospitals and are more convenient for patients as they are able remain at home with their families. Especially for those patients with HIV, HBCs are necessary to provide support and advice. HBCs and Community Support Workers therefore play a crucial part in HIV policy. Due to a lack of transport HBCs are not working at their full capacity. They are only able to visit a handful of patients and are not able to transport enough of the materials needed by the number of patients they are expected to visit, such as food, gloves, bandages and other medical supplies.

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