strengtheningTanzaniasHealthSystemsTanzania faces multiple challenges in improving health care as it strives to meet the Millennium Development Goals (MDGs). The creation of public-private partnerships has been key to addressing some of these challenges. The Abbott Fund's successful public-private partnership with the Tanzanian Ministry of Health since 2001 is helping to make progress against these goals.

In early 2003, Tanzania was among the first African countries to offer Antiretroviral drugs (ARV's) to its citizens. One of the key barriers to scaling up this effort was providing testing and counseling services to help with prevention and identify those in need of therapy. Another challenge was building capacity to care for the people who would come in to seek these services.

Working with the Ministry of Health, the Abbott Fund began a public-private partnership to meet these challenges. An intensive training program on HIV care and treatment, voluntary HIV counseling and testing (VCT) was begun. Facilities and systems were upgraded at more than 90 sites throughout the country to improve VCT services and prepare for the availability of treatment programs. This work included renovating outpatient clinics to ensure patient privacy during VCT renovating laboratories, donating laboratory equipment, and creating local hospital HIV management teams. More than 19,000 health care worker trainings were conducted to support these improvements. In 2007 the Abbott Fund also donated one million rapid HIV tests to support the Presidential effort to increase testing on a national scale.

At the same time, the Abbott Fund and the Health Ministry identified Muhimbili National Hospital as the epicenter of its health system strengthening efforts. Located in Dar es Salaam, Muhimbili is the national teaching and reference hospital. It was determined that any improvements made at Muhimbili would trickle down throughout the entire health system. A new outpatient treatment center was built, which now serves more than 450 patients per day, and contains a training facility for students and hospital staff. The center was the first to integrate HIV treatment into its other outpatient services, helping to mitigate the stigma associated with HIV status. Hospital management received training to strengthen department organization and financial management, and a modern hospital wide IT system was installed that helps track inventory, prescriptions, and patient health history.

The hospital's Central Pathology Laboratory was modernized and computerized to provide accurate diagnostic testing that is crucial not only for lifelong monitoring of HIV patients, but for those with other chronic illnesses like diabetes. It now performs more than 2,500 tests per day.

As a result of these efforts, the structure was laid to take advantage of ARV programs supported by PEPFAR, the Global Fund, and other donors. In 2007 nearly one in three people on HIV treatment in Tanzania were receiving care at one of more than 90 facilities that have benefited from Abbott Fund support.

The next challenge identified by the Tanzanian Ministry of Health as a key barrier was an aging network of public hospital laboratories that was incapable of meeting the demands of a growing wave of patients with chronic illnesses needing lifelong monitoring.

In 2007, Miles White, the CEO of Abbott, announced the Abbott Fund would support the Ministry of Health effort to modernize every regional-level hospital laboratory across the country. The Regional Laboratory Modernization Project constructed new laboratories or renovated existing laboratories at 23 sites over a three-year period. These labs in turn provide support for 121 district hospital laboratories, improving health care for millions of people with HIV and other chronic diseases across the country. To help address the severe shortage of local, trained lab professionals, Abbott provided employee volunteers to train and mentor the staff and the Abbott Fund provided scholarships for more than 100 laboratory technology students, who are being incentivized to accept positions throughout Tanzania.

More recently, the Abbott Fund/Ministry of Health partnership identified Emergency Medicine as a new area of focus. Emergency Medicine is not a recognized trained medical specialty in Tanzania and there is no formal emergency medical service system. As a result, patients admitted to public hospitals for acute conditions generally receive limited care until a specialist is available to provide treatment. The lack of emergency care has now been recognized as a contributing factor to the country's mortality and morbidity rates.

In 2009, the Abbott Fund helped establish the first public Emergency Medical Department in Tanzania to provide services meeting international standards was dedicated on the grounds of Muhimbili National Hospital and now serves more than 100 patients per day.

While the training and services provided at the new EMD is already having an immediate impact in the Dar region, the broader goal is to utilize the department as the training ground for emergency services. In 2010, the first Emergency Medicine Residency program was established with the goal to elevate the level of emergency care expertise in other hospitals in Tanzania and across East Africa.

In 2011, the Abbott Fund, in partnership with the Baylor College of Medicine International Pediatric AIDS Initiative, opened a specialized pediatric HIV/AIDS clinic in Mbeya, to bring HIV care, treatment and prevention to children and families in the Southern Highlands Region of Tanzania for the first time.

Overall, the Abbott Fund has invested more than $90 million to date to improve health infrastructure and increase access to quality health care for all Tanzanians and has demonstrated the important role that a public-private partnership can play in making progress against the Millenium Development Goals. GHD