“We Must Change in Order to Improve the Quality of Health Services in Zanzibar”

Although I’ve been known to embrace Halloween for its fantastic excuse to stuff my face full of sugary, chocolate goodness, my holiday was a bit different this year, but it was great nonetheless.

On October 31st, the 6th annual Zanzibar Health Sector Review was held for the first time in Pemba (it’s always taken place in Unguja before). Mr. Yahya asked me to go as a representative for the Ivo de Carneri Foundation and I was honored by the opportunity. After working at the hospital for the last 3 months, it was a great way to see how things operate on a higher level and it gave me a view into the healthcare system as a whole.

Dr. Ali M. Shein, President of Zanzibar

The day, with the theme of We Must Change in Order to Improve the Quality of Health Services in Zanzibar, was filled with interesting presentations regarding current Ministry of Health (MoH) planning and also various projects that are currently underway in including malaria prevention, salt iodization, family planning efforts and nutrition. Not only did the President of Zanzibar and the Minister of Health make an appearance, but it was a great opportunity to meet various individuals that work with development partners in Zanzibar from big wigs like the World Health Organization to smaller entities such as JHPEIGO (an international health NGO that works in collaboration with John’s Hopkin’s University). It was also great to meet some of the individuals working in the Zanzibar MoH, most of them healthcare professionals by training.

A couple of the take-home messages that I got from the day is that the MoH is starting to push for more coordination between donors, as they have set up a “basket fund,” for development partners to contribute to. Then those funds will be used based on MoH determined needs. This also goes along with an urge for health systems strengthening and a move away from vertical, non-integrated programs.

A lot of time was spent discussing maternal mortality and the hopes to meet the Millennium Development Goal #5, which deals with maternal mortality as well as access to reproductive health. While there has been a significant decrease in the maternal morality ratio (the number of maternal deaths per 100,000 live births) in the last 5 years, there is still a long way to go in order to reach the MDG goal in Zanzibar. Reproductive health experts emphasized that it is is critical to address the underlying and behavioral factors that lead to these deaths. For example, cost-sharing for natural births and c-sections may detract woman from going to health facilities for delivery.

One comment that really stood out to me was made by the Director General of the MoH at the end of the day. He said that although the questions and resulting discussion had been great, he reminded the audience that most of the questions and comments had come from international development partners and NOT those of the MoH or the Zanzibar health community. In addressing the Zanzibari audience, he reminded everyone that “this in OUR review” and that he hoped in years to come, this would change.

Although the day lasted nearly 12 hours, it was a great experience and I really felt lucky to have been included. Mr. Yahya was actually able to attend, so it was great to share the day with him as well as Shaaban who managed to make it. It was also a great sign that for the first time the meeting was held in Pemba, showing greater commitment to the smaller and at times forgotten island in the archipelago.


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