List of Abbreviations
AIDS- Acquired immunodeficiency Syndrome
CED – Community Economic Development
GDP- Gross Domestic Product
HIV- Human Immunodeficiency Virus
PLHA’s - People Living with HIV and AIDS
PRSP- Poverty Reduction Strategy……
TDHS-
Table of Contents Page
1.0 Introduction 3
2.0 The Problem Statement 5
3.0 Policy Appraisal 8
4.0 Policy Implications 9
5.0 Conclusion 10
6.0 Policy Recommendations 12
References 13
Title: Health care for People Living with HIV and AIDS in
1.0 Introduction
Access to health care in
The policy planning process in
It is true that there have been increases in personnel allocations since 2000 to improve the social services for poverty reduction. Moreover, the government aimed at raising production life of Tanzanians by promising to place special emphasis on reducing morbidity, improving nutrition and strengthening access to health services and safe water. Also it was planned to address decline in life expectancy due to HIV and AIDS and raise it to 52 years by 2010 (PRSP Poverty Progress Repot 2003).
What is not clear is what is being done to facilitate healthcare access to the larger communities and especially to the People Living with HIV and AIDS (PLHA) and orphans. Unfortunately, these communities are also affected by other factors detrimental to their access to health care. These include poverty, low level of education, proximity to primary healthcare facilities and nutrition.
This policy brief provides the situation caused by lack of the healthcare access for PLHA’s as well as orphans, the implications on the community with a particular emphasis on Nganjoni village in Kilimanjaro region where some research was conducted. This is despite the existence of the National AIDS Policy (2001). Some recommendations are given on what could be done to alleviate the situation and make the world a little better for the most at risk groups targeted by the policy.
2.0 The Problem Statement
For over one generation now, HIV and AIDS have been recognized as the greatest global threat leading to development crisis and abject poverty. According to the Tanzania Country Profile, Adults and children (0-49) living with AIDS at the end of 2005 were 1.4 million. As at 30th September 2007, individuals who received antiretroviral treatment were 96,700. Estimated annual deaths in
Moreover, from the national economic point of view, HIV/AIDS is threatening the attainment of poverty reduction and development goals as there is a substantial social and economic impact on those people living with and affected by the disease. A macroeconomic simulation model estimated that the impact of HIV/AIDS on the growth path of the Tanzanian economy would be to reduce
The latest national research results are contained in the Tanzania HIV Indicator Survey of (2003 -2004) which indicated that 11% of children under age 18 have lost one or both biological parents whereas 4% have lost their mothers, 8% have lost their fathers and 1% has lost both parents.
Neither orphans nor PLHA’s are not supported by the government. The community itself has not been empowered to address this important policy deliberation. In
Figure 1
In Kilimanjaro region more than 200,000 children infected with and affected by HIV/AIDS are being deprived their right to education in order to work and raise income for their households or to take care of sick relatives. Most orphans are cared by female caregivers as the case for Nganjoni shows in Figure 1. In many cases, orphans’ care is left in the hands of widowers and grandparents are becoming parents again. A quantitative questionnaire administered in May 2008 on a random sample of 40 families caring for orphans showed that they were caring for a total of 77 orphans at an average of 2 orphans per household with 2% cared by their fathers, 30% by their mothers, 2.5% by aunt and 27.5% by grandmothers. These grandmothers are the elderly citizens who are not even covered by the social welfare system and who have lost their children as bread winners. They find themselves being parents once more.
The majority of PLHA’s and families caring for orphans suffer financial capabilities or getting money for treatment. Costs of accessing health care include opportunity costs, transport, cost sharing, purchase of medication for opportunistic infections and others. Basically, rapidly rising HIV and AIDS related healthcare costs are increasingly a burden to the marginalized communities who are generally vulnerable to all sorts of health and economic risks.
Moreover, findings by the TDHS are that 40% of women from poor communities cited distance as a big problem when they wanted to access health care with a mean distance of 25.7 kilometres. As for urban women it was 20% only with a mean distance of 5 kilometres. In the community under my study, the villagers have to travel an average of 18 kilometres to the nearest hospital.
In a research conducted in Nganjoni village , Kirua Vunjo East ward Moshi Rural district in August 2008 any people said they had to walk 18 kilometres to Kilema hospital while others had to walk more than 5 kilometres to the health centre and dispensary. ( See Figure 2 and Table 1.
Figure 2
Table 1
| | | | |
| Respondents means of travelling vs type of health facilty | | ||
| Variable | Facility | | |
| Means of travelling | Hospital | Health centre | Dispensary |
| Walk | 9/19(75%) | 2/19(16.7%) | 1/19(8.3%) |
| Bicycle | 2/19(66.7%) | 1/19(33.3%) | 0 |
| Public | 2/19(66.7%) | 0 | 1/19(33.3%) |
| Other | 0 | 0 | 1/19(100%) |
Apart from all this is the procedure for accessing free ARV’s and medication for opportunistic infections as promised by the AIDS policy. One has to go through a street or sub village leader and even after that loss of confidentiality, the hospital or health centre pharmacies have no such free medicine
Furthermore, an estimation of more than 50 out of 529 households is caring for the AIDS patients unawares due to poor perception of HIV and AIDS and therefore do not take necessary precautions.
3.0 Policy Appraisal
However, looking at policy issues, the National Health Policy (1990) that aims at improving the health status of all Tanzanians in urban and rural areas by reducing morbidity and mortality and raising life expectancy through the provision of “adequate and equitable maternal and child health services” is yet to be realised.
Moreover, it is stipulated under the National HIV/AIDS Policy (2001), that the government aims to promote early diagnosis of HIV infection through voluntary counseling and testing with professionally conducted pre and post-test counseling. The main aim is to measure and encourage approximately 85 – 90% of population who are HIV-negative to take definite steps not to be infected, and those who are HIV-positive to receive the necessary support in counseling and cope with their status, promoting their levels and not to infect others. Consequently this was to lead to reduced rate of new infections, reduced death rates and reduced percentage of children who are orphaned due to AIDS. Unfortunately, many of the proposed strategies and promises in the National Multisectoral Strategy of 2003 – 2007 have not been fulfilled.
Furthermore, neither was the policy implementation process clarified nor the resources identified.
Literature based on “Power and the Policy process” shares that both the health and AIDS policies are at the macro level and therefore at high politics while the policy implementation is at the low politics micro level. The latter is what touches community life most. Both macro and micro policies influence policy decisions. We are also told that the government is the main actor in setting the agenda and works under pressure of authors of structural development policies, PRSP inclusive. Micro policies do raise questions on the possibilities of devising rational policies if there is pressure from many groups on their demands being met.
In short, at the policy macro level, Nganjoni village has no access to VCT as promised by the AIDS policy , no health facility within 5 kilometres as promised by the Health Policy. At the micro level there are no HIV and AIDS awareness raising programmes, no HBC programmes. Also there is no trace of the promised community health insurance. Where are the District level policy implementers? These are the ones who influence policy and bring about outcomes. Is it the bureaucracy? Are the implementers powerless because policies are top down?
Amidst all these, through the health sector reform, the Tanzanian government introduced the Community Health Fund (CHF) in 1995 as a new country‘s health financing strategy.. This is a district –level voluntary prepayment scheme targeting 85% of the population living in rural areas and /or employed in informal sector. Kamuzora and Gilson ( 2007) observe low enrolment into the scheme and lack of trust for district CHF managers of the scheme, limited coverage with exclusion of the poor and those most in need, people living with HIV and AIDS notwithstanding.
4.0 Policy Implications
There are still limitations of citizen’s access to healthcare as per PRSP 2003 report. There is also need to address institutions that influence policy formulation by serving their own interests through pressurizing the government. The fourth stage of policy making which is evaluation should be conducted and tell us if the policy is achieving its objectives or having unintended consequences. Even if the government decides on policies that need changing and revising it is not clear how they search issues to be reviewed. The media could be activated in this as an agent for change.
The implementation components of both the Health and AIDS policies appear to have been made stagnant by not being socially formulated with the consciousness of impeding factors. Consequently, there has been poor resource allocation to have well distributed health facilities, sufficient availability of medication for opportunistic infections and knowledge dissemination to the community on the facts regarding prevention and care related to HIV and AIDS.
Moreover, it is not clear if any monitoring of the policy implementation has been done. As observed by Wangwe (1997), it is important to know if any achievements or gain in the implementation process are being met and whether there is need for policy review. I concur with Smithson (2006) who suggests that different policy measures are required to address each of the barriers… and also to “rethink the configuration of services” to ensure access to rural people and to make the policies more pro-poor.
5.0 Conclusion
It is apparent that despite the promising frameworks in
What have been presented as problems depict a desperate situation for People Living with HIV and AIDS as well as orphans. They face physical accessibilities to consume health care at health facilities, they get low quality care at home and they are poor and sometimes discriminated. Apparently, PLHA’s and orphans’ health care, status and human and material resources allocation in
6.0 Policy Recommendations
Policies are good at macro level but experience shows that implementers at micro level become powerless when they are at the interface between the bureaucracy and the community. Healthcare should be strategically regulated by avoiding imposition of policies on policy implementers and the citizens. As policy consumers, they are the major stakeholders and the majority of the Tanzanians population including vulnerable groups should be involved in policy formulation and regular evaluation. With the bottom-line of poverty, all efforts and resources have to be mobilized to rescue the citizens’ from non facilitative and impractical policies. The policy makers ought to be open to alternative ways whereby the vulnerable communities secure resources Social Polices to build on pro-poor priorities with HIV and AIDS mainstreamed.
Also, as it is with CED, social policy formulation and implementation strategies should be people centered with inclusion of all categories of community members and addressing accessibility barriers. This will presumably lead to the minimizing of physical barriers, financial barriers and social barriers which block health care access. PLHA’s require urgent and long term treatment and care. The elderly need to be supported economically in their new caring roles; mobility will be promoted between homes and health facilities.
There is need for activating awareness raising campaigns for early diagnosis and early access to treatment and care and discourage discrimination at homes and health facilities introducing. People centred policies should reintroduce zero fees for the unemployed community. Alternatively policies should help communities to address abject poverty through small business interventions which will enable them to afford cost sharing. In this way and as Kamuzora and Gilson observed, “use of participatory approaches in the design and implementation of policy is necessary.”
Finally, the participatory reviewed policy will need to be popularized and eventually emancipate the most at risk groups and enable communities to live in a world that appreciates the health care needs of PLHA’s and orphans.
References
- PRSP Progress Report (2003)???
- Basic Methods of Policy and Planning UNDP- Human Development Report2002, 2003 and 2007.Prentice Hall????
- HIV/AIDS/STI Surveillance Report. January – December 2004. (Issued October 2005). Report Number 19. The United
- HIV/AIDS/STI Surveillance Report. January – December 2003. (Issued October 2004). Report Number 18. The United
- National Policy on HIV/AIDS. (December, 2001). The United
- United
- Smithson P.(2006) Fair’s fair. Health Inequalities and Equity in
- Health Policy and Planning. Advance Access published online on February 13, 2007. Oxford University Press in association with The London School of Hygiene and Tropical Medicine. http://heapol.oxfordjournals.org/cgi/content/full/czm001v1. Kamuzora P. and Gilson L . Factors influencing implementation of the Community Health Fund in
- Power and the policy process. pp 35 -73
- The United
No comments:
Post a Comment