Interview: Sulaiman Shahabuddin, Regional CEO, Aga Khan Health Services, East Africa

What is being done to improve the enforcement of health care standards for private facilities?

SULAIMAN SHAHABUDDIN: The Ministry of Health, Community Development, Gender, Elderly and Children (MoH) is the agency responsible for the enforcement of standards, both in the public and private sectors. The MoH does this through various mechanisms, such as spot checks and registration requirements. Private sector institutions can act as a catalyst to improve health care standards, and as the health care sector continues to expand it is evident that the two drivers of growth are capacity building and education, the latter in the form of medical and nursing schools.

How can Tanzania ensure it attains health-related Sustainable Development Goals (SDGs) while promoting nutrition, health and well-being?

SHAHABUDDIN: Population health programmes, primary care and health systems, and preventative health and screening programmes are all key priorities for the health care system, as is a well-functioning referral network. Aside from this, plenty of funding for HIV/AIDS across the country exists, but palliative and home-based care for the elderly require more facilities. Public-private partnerships targeted at these areas, if constructed properly, can be a major contributor in achieving SDGs.

How can private facilities improve outpatient access to health care?

SHAHABUDDIN: The provision of low-cost care really comes down to care models and to some extent also the health care financing structure. There are various models, which have been piloted across countries to provide low-cost care. The model that we have adopted at Aga Khan Hospital clinics, for instance, is that of differential pricing. This allows us to price services according to population group. In this model the hospital clinic in an affluent neighbourhood subsidises the clinic in a comparatively poorer neighbourhood.

Have chronic diseases placed a greater burden on the health sector?

SHAHABUDDIN: Chronic diseases are on the rise in Tanzania. According to the World Health Organisation, 85,000 Tanzanians will die from cardiac-related diseases and 42,000 from various forms of cancer in 2030. This is a serious burden and dealing with it will require a rapid upgrade of the tertiary care and diagnostic landscape across the country. Today in Tanzania we have only two cardiac catheterisation (cath) labs. There are no linear accelerators in Tanzania, and therefore significant and quick investments will have to be made to improve the capacities of the country to deal with these problems. Another challenging situation that has arisen is that people are now living longer, but the doctor-to-patient ratio is decreasing. Over the course of the next three to five years, Tanzania’s health sector will need to produce more doctors. In the short term, however, this problem can only be solved by relaxing laws which regulate the possibility of health care professionals from more developed countries coming to work in Tanzania, which is currently somewhat restrictive.

What initiatives must authorities take to reduce the volume of imported pharmaceuticals?

SHAHABUDDIN: The MoH needs to provide incentives for establishing manufacturing units that will produce high-quality generic pharmaceuticals within Tanzania. In addition, hospitals should also be allowed to directly import from registered manufacturers, as it is estimated that only around 15% of pharmaceuticals on the world market are available inside the country. This proposed directive would result in a reduction of costs, and also where possible would eliminate the middleman from the supply chain.