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The role of religion and traditional medicines in fighting COVID-19 in Tanzania | Africa at LSE

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The role of religion and traditional medicines in fighting COVID-19 in Tanzania | Africa at LSE

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Alongside the use of herbs, churches and mosques have played a significant role in responding to the coronavirus in Lindi region, which is mainly composed of Muslims and Christians. The Muslim population constitutes the majority, at around 65% of the total regional population, due to the influence of Arabs who interacted with Lindi communities/tribes such as Ngindo and Matumbi as early as the 7th century. The Christian population is approximated at 35%. Despite Lindi being a religious region, few attend churches and mosques and during this period of the coronavirus, churches and mosques remained attended by regulars.

Across the Lindi region, churches and mosques encouraged believers to follow the measures instructed by the Ministry of Health. However, they also organised serious prayers to ask God to save the community and the country from the virus. This began taking place from April 2020 onwards, following the President's national call for every religion to conduct prayers against the disease.

Bishop Bruno Pius Ngonyani, of Roman Catholic diocese of Lindi, ordered all Roman Catholic Churches in the region to fast and hold prayers for nine days. This was 'Novena for heart of Christ' - Christian prayers practiced over a series of days, involving fasting and praying for a significant event. Novena was also conducted in a few Anglican churches, including the main Anglican church of Lindi. Churches have also encouraged similar prayers during periods of flooding, which occurred in Lindi region, specifically in Kilwa, Ruangwa and Liwale districts, at the end of January and early February 2020.

Father Hugo Heusinger, the parish priest of Roman Catholic Church for the parish of Nyangao, and another seven sub-parishes located in neighboring villages, explained that 'In our parish and sub parish churches, we had nine days of Novena prayers in March which were attended by all believers. Novena prayers were special for Coronavirus disease as we were asking God to protect our community and the country against the pandemic.' Throughout villages and small townships - such as Kilwa, Kipatimu, Pande, Kilwa-masoko, Kiwalala, Liwale and other areas - the majority were viewed as responding positively to Novena.

Other parishes did not hold Novena. Instead they practised normal prayers, but directed these towards the coronavirus. For example, most Anglican churches, including the small parish of Nyangao, added to the liturgical prayers to ask God to help overcome the epidemic.

Alongside prayers, in April and early May, some Roman catholic, Anglican and Lutheran churches (the dominant denominations in the region) encouraged worshippers to offer charity, which was used to buy soap and buckets to be given to the poor and disabled. This was more evident in large parishes and churches located in Lindi town, such as Andrew Kagwa Roman Catholic and Saba Saba Roman Catholic churches.

Muslim leaders also encouraged believers to follow health instructions and led special prayers, called Qunut, among the five daily prayers for almost three months from March to May. Imam Salum Alli - the leader in Islam, mosque leader in Nyangao - explained that the Islamic religion has taught believers to conduct Qunut whenever society faces catastrophes such as killer diseases, drought and floods.

Qunut is a special supplication (dua) that Muslims perform during the daily obligatory standardised prayers (five salat) in order to ask for God's help regarding a serious problem. It involves the Imam reciting Arabic words taught by prophet Muhammad, in addition to words which specify the problem to be solved, such as diseases, floods or war. Whenever the Imam recites Qunut, followers reply by saying 'Amen'. Qunut can last for a number of days, weeks or months and it can be stopped at any time once the problem is seen to stop or decrease. It can also be carried out by individuals at home to ask for God's help. When the rate of COVID-19 spread was high in the country and Lindi Region - specifically in April - most mosques conducted Qunut to ask God to help overcome the virus.

Both Muslims and Christians believe prayers to have worked in Tanzania, attributing their prayers to a decreased rate of infection in the region. Surprisingly, these prayers have not been enacted for other diseases like HIV/Aids and diabetes. When I spoke with respondents in the region as to why this may be the case, they explained that COVID-19 was an exceptional virus. Indeed, the coronavirus has been perceived differently from other diseases, such as Ebola and HIV/AIDS, mainly due to the fact that no other virus has affected Europeans and Americans to a greater extent than Africans. This has made many people think that the virus is more dangerous than others faced in the past.

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The role of religion and traditional medicines in fighting COVID-19 in Tanzania | Africa at LSE

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Alongside the use of herbs, churches and mosques have played a significant role in responding to the coronavirus in Lindi region, which is mainly composed of Muslims and Christians. The Muslim population constitutes the majority, at around 65% of the total regional population, due to the influence of Arabs who interacted with Lindi communities/tribes such as Ngindo and Matumbi as early as the 7th century.

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Taking stock of health sector achievements and challenges - United Republic of Tanzania | ReliefWeb

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Taking stock of health sector achievements and challenges - United Republic of Tanzania | ReliefWeb

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Every year, Ministry of Health and partners meet to review progress in implementation of its Sector Strategic Plan and identify priority actions to be implemented in the following year. This year, the Joint Annual Health Sector Technical Review meeting was convened in Dodoma from 8-10th October 2019 to deliberate on the Health Sector Strategic Plan IV midterm review (HSSP IV MTR) and identify priorities for Health Sector Strategic Plan V that is expected to roll out in July 2020. In this meeting, WHO was awarded a plaque of recognition for its contribution in supporting midterm review of the current health sector plan.

The attendance in this key meeting reflected the growing understanding that ensuring effective health programs calls for participation of more sectors in the health outcomes. Sector ministries that participated included the Ministry of Health, Community Development, Gender Elderly and Children; President's Office Regional Administration and Local Government; Prime Minister's Office; Ministry of Lands, Housing and Human Settlements Development; President's Office-Public Service Management and Good Governance; Ministry of Energy; Ministry of Water; Ministry of Works, Transport and Communication; Non-Governmental Organizations; Civil Society and Private sector representatives.

WHO Representative, Dr. Tigest Ketsela and technical staff participated in this meeting and made a presentation on Sustainable Development Goals (SDGs) and recommended how Tanzania can attain the health related goals.

The meeting reviewed the Health Sector Strategic Plan IV that is ending in June 2020 and made recommendations for the next Health Sector Strategic Plan V. The meeting also formulated policy recommendations for 2020/2021 that will be presented at the 20th Joint Annual Health Sector Policy meeting later in November.

The review noted that there is improvement of quality of health services in many areas. This is partially attributed to the star rating exercise which has often encouraged staff to work harder improve quality of health services. Health performance is also improving as evidenced by almost all indicators except for maternal and neonatal mortality. The challenges remain on health financing and human resources for health.

One of the key focus for the Health Sector Strategic Plan V will be to ensure more vibrant participation of community members at grassroot level in the efforts towards universal health coverage. Other priorities include improvement of governance, fair and sustainable health financing, adequate human resources for health, efficient and effective Monitoring and Evaluation/ Information, Communication and Technology, and high-performance health services delivery.
For Additional Information or to Request Interviews, Please contact:
Mr. Maximillian Mapunda Tel: +255 754 228 848 Email: mapundam@who.int

Dr Neema Kileo Email: kileon@who.int Tel: +255 755 551 804

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Taking stock of health sector achievements and challenges - United Republic of Tanzania

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Every year, Ministry of Health and partners meet to review progress in implementation of its Sector Strategic Plan and identify priority actions to be implemented in the following year.

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Magufuli sacks Tanzania health deputy minister - The East African

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Magufuli sacks Tanzania health deputy minister - The East African

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By THE CITIZEN
More by this Author

Tanzania's President John Pombe Magufuli has appointed Dr Godwin Mollel as the new deputy minister for Health after sacking Dr Faustine Ndugulile.

Dr Ndugulile's sacking comes as a surprise to many and follows other changes at the ministry a fortnight ago.

Dr Ndugulile, 51, a microbiologist and public health advocate, has served in the ministry for about three years.

He assumed the post in 2017 when President Magufuli reshuffled his Cabinet, replacing Dr Hamisi Kigwangala who is now the minister for Tourism and Natural Resources.

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A statement from the Directorate of Presidential Communications said the new Health deputy minister begins his appointment on May 16.

This is the second shake-up within weeks at the ministry following the transfer of Permanent Secretary Zainab Chaula to the communications docket and the retiring of Chief Medical Officer Mohamed Bakari.

President Magufuli picked Prof Mabula Mchembe as the new PS at the ministry while Prof Abel Makubi was named the new chief medical officer.

Prof Mchembe was previously the medical adviser at State House, while Prof Makubi was heading Bugando Medical Centre in Mwanza.

The changes have come at a time when the Covid-19 pandemic is ravaging the country with all eyes trained on the Health ministry.

The incoming deputy minister, who is the MP for Siha Constituency, holds a degree in medicine from Muhimbili University of Health and Allied Sciences.

President Kenyatta said the closure of the borders was necessitated by an increase in the number of "imported" coronavirus cases.

The restrictions exempt cargo trucks, however, their drivers must undergo compulsory Covid-19 tests.

Kenya has also closed its border with Somalia.

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By THE CITIZEN More by this Author Tanzania's President John Pombe Magufuli has appointed Dr Godwin Mollel as the new deputy minister for Health after sacking Dr Faustine Ndugulile. Dr Ndugulile's sacking comes as a surprise to many and follows other changes at the ministry a fortnight ago.

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Tanzania Needs to Urgently Invest in the Health and Education of its Youth – New World Bank Report

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Tanzania Needs to Urgently Invest in the Health and Education of its Youth – New World Bank Report

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DAR ES SALAAM, July 18, 2019 - Tanzania needs to undertake important and urgent investments to accelerate progress in the health and education of its citizens, especially the youth, if the country is to improve its human capital for sustainable development, according to the latest Economic Update published by the World Bank.

In recent years, Tanzania has made gains in human development, with reduced under-five mortality, an increase in the average number of years of schooling for its youth, and improved adult survival. However, its human capital index (HCI) of 0.40 means that children born today in Tanzania may reach only 40 percent of the earnings that they could have attained with full health and education.

"Tanzania's wealth has increased by 45 percent since 1995 and this is an important achievement, but the country's population has also grown, leading to a decreasing of per capita wealth which is not sustainable," says Bella Bird, World Bank Country Director for Tanzania. "For the country to achieve sustained and inclusive growth, it needs to make a concerted investment in its people, as human capital is the most important asset of any country."

The World Bank launched the HCI in October 2018, as part of the new Human Capital Project to encourage countries to invest more and better in their people. The index focuses on five factors that have an important bearing for future earnings: the survival rate of children past age five; the expected number of years of education completed by youth; the quality of learning in school; how long workers will remain in the workforce, as measured by adult survival past 60; and prevention of stunting in young children.

There is a lot to for Tanzania and other countries to learn from the four countries that top the HCI ranking-Singapore, South Korea, Japan, and Hong Kong-whose success is explained by the fact that they made investing in youth a top priority, focusing on education and skills development at all stages of their progress," says Quentin Wodon, World Bank Lead Economist and co-author of the 12th Tanzania Economic Update.

Given its level of development, Tanzania performs especially poorly in the number of years of schooling that children complete and the risk that children under the age of five will be stunted. In addition, the report finds that gender inequality in earnings is also affecting the country's ability to increase its human capital wealth and thereby its total wealth per capita.

To tackle the country's barriers to human capital development requires boosting investments in multiple areas using a "whole of government" approach to providing quality services. A special emphasis should be placed on reaching vulnerable adolescent girls' sectors and targeting areas of the country that are lagging behind. In addition, to narrow the gender earnings gap, the authors recommend reducing the time women spend in unpaid work and redistributing care responsibilities to enable them to spend more time in the labor market; giving women more access to and control of productive assets; and addressing market and institutional failures that limit opportunities for women.

The latest Economic Update also provides a snapshot of recent economic developments and the outlook over the next few years. The external environment for trade and investment in Sub-Saharan Africa remains challenging, and there has been softening on both fronts in Tanzania. However, it is the pace of domestic policy reform implementation that will remain most critical for the country's growth outlook. Government action to improve the business environment and fiscal management should be top priorities, including lowering the costs of regulatory compliance, reducing domestic arrears (VAT refunds and payments to suppliers), preventing new arrears, and ensuring a prioritization of investment projects based on sound criteria and growth-enhancing prospects as well as securing adequate and affordable financing to complete these projects on schedule.

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Tanzania Needs to Urgently Invest in the Health and Education of its Youth - New World Bank Report

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DAR ES SALAAM, July 18, 2019 - Tanzania needs to undertake important and urgent investments to accelerate progress in the health and education of its citizens, especially the youth, if the country is to improve its human capital for sustainable development, according to the latest Economic Update published by the World Bank.

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Towards improved health service quality in Tanzania: contribution of a supportive supervision approach to increased quality of primary healthcare

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Towards improved health service quality in Tanzania: contribution of a supportive supervision approach to increased quality of primary healthcare

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Towards improved health service quality in Tanzania: contribution of a supportive supervision approach to increased quality of primary healthcare

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Sabine Renggli, 1, 2 Iddy Mayumana, 3 Dominick Mboya, 3 Christopher Charles, 3 Christopher Mshana, 3 Flora Kessy, 3 Tracy R. Glass, 1, 2 Christian Lengeler, 1, 2 Alexander Schulze, 4 Ann Aerts, 5 and Constanze Pfeiffer 1, 2 Universal Health Coverage only leads to the desired health outcomes if quality of health services is ensured.

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Tanzanian Health Facility Registry Dataset | Kaggle

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Tanzanian Health Facility Registry Dataset | Kaggle

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Tanzanian Health Facility Registry Dataset

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Tabular form of official Tanzanian Health Facility Registry data

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A spatial database of health facilities managed by the public health sector in sub Saharan Africa | Scientific Data

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A spatial database of health facilities managed by the public health sector in sub Saharan Africa | Scientific Data

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Background and Summary

Defining the location of health services in relation to the communities they are intended to serve is the cornerstone of health system planning, ensuring the right services are accessible to the population and that no one is geographically marginalized from essential services. Across sub-Saharan Africa (SSA), health services are offered with increasing levels of medical sophistication, from community providers who handle basic care to hospitals which play a critical role in providing emergency care1,2,3. However, these services are not accessible to everyone equally4. This inability to reach quality assured health services able to provide life-saving interventions contributes to the sustained high burden of communicable and non-communicable disease morbidity and mortality in SSA relative to other regions of the world5,6. The Global health agenda now aims to ensure Universal Health Coverage (UHC), to ensure that all people obtain the health services they need and underpins the health-related Sustainable Development Goals. Defining and planning for universal equity in access to health services demands better data on the location of both services and populations they are intended to serve.

While countries have been encouraged to develop health Master Facility Lists (MFLs)7,8 and censuses of service provision9, this has not been universal and most inventories lack coordinates. In Kenya in 2003, we began an exercise to compile and geocode a single, public health MFL from a variety of government, non-governmental (NGO), community-based (CBO) and faith-based organization (FBO) listings10, the first time a national map of service providers had been developed since 195911. Over the next 15 years we extended this approach across other countries in SSA, coinciding with a regional impetus to improve master health facility lists7,8.

Access to health care is a complex and multidimensional concept and can be defined in a variety of ways, however, in its most basic sense, it refers to geographic availability. Improved data metrics on health access demands at the very least a knowledge of where service providers are in relation to populations. Provider-to-population ratios were used to estimate availability in 1970s and earlier12,13,14, then the emergence of Geographic information systems (GIS) in 1980s and 1990s led to the evolution of distance as a metric15,16,17 while network analyses, floating catchment area methods and cost-distance analyses are more recent18,19,20,21. By identifying top tier hospitals and lower tier facilities, it is now possible to estimate specific access to emergency care and surgeries18,22,23,24. Other extensions are application in defining access to Basic and Comprehensive Emergency Obstetric and Neonatal Care (BEmONC/EmONC) services25, evaluating public health sector service delivery26 and community-based interventions27,28,29. In the future, it is likely that this will be extended to understanding health care optimization. Georeferenced health service inventories, beyond defining equitable access, increase the epidemiological value of defining the evolution of emerging, epidemic pathogens30, antimicrobial resistance, and defining sub-national disease epidemiology as well as improving the potential of routine health data use31.

Notwithstanding previous efforts to extract health service providers from OpenStreetMap complimented by volunteered information ( https://www.healthsites.io), there is no single, georeferenced and comprehensive public health facility inventory for sub-Saharan Africa. Building on a previous audit of public hospitals in sub Saharan Africa18, we provide a geo-coded inventory of 50 countries in sub-Saharan Africa, provided as an open-access resource. We have focused on public health facilities managed by government, local authorities, FBOs and NGOs. A wide variety of primary sources of information were consulted, from websites and data portals of ministries of health, national and international organizations, health sector reports, to sourcing data through personal communications. Facility types and numbers for each country were validated using reported data in national health sector strategic plans and other health sector reports.

Methods

Data sources

We undertook a data assembly process to compile a comprehensive health facility database across SSA, starting with Kenya in 200410,32, and expanding to the rest of SSA between 2012 and 2018. Country-specific public health facility databases were developed through a systematic and iterative process of data assembly from a variety of sources, data abstraction, geocoding and technical validation of the data. For each country, the Ministry of Health (MoH) website was the first source of authoritative MFLs consulted. This was done through online searches and downloads of MFLs or maps hosted on the MoH website or on data portals managed by the MoH such as the National Health Map ( Carte Sanitaire), health facility registries and online Health Management Information Systems (HMIS) including District Health Information Systems version 2 (DHIS2). In some instances, MoH publications with information on facility lists or maps were used. Occasionally, while the MoH sources did not have comprehensive lists of facilities or maps, other government agencies' websites, for example national statistical agencies, hosted health facility listings and these were consulted. Where the governmental ministries and agencies had no facility listing information or was inadequate, other sources of data were consulted, including data hosted by the United Nations Office for the Coordination of Humanitarian Affairs' (UNOCHA) Humanitarian Data Exchange (HDX) portal and websites of other UN agencies, and where relevant, websites of FBOs and NGOs working in each country. For countries where no health facility data were available online, we made attempts to directly contact people working with National Malaria Control Programmes, World Health Organization or other health-oriented agencies to aid in locating health facility listings. Often, more than one source of data was consulted for each country and assembled into a single list as illustrated in Online-only Table 1 and Fig. 1.

The methodological framework applied in assembling each country's Master Facility List. Percentages for "Data sources" refer to proportion of the 50 countries with that source as the main or only source of data, while percentages under "Geocoding" refer to the proportion of all 98,745 health facilities.

Locations of existing health facility data for sub-Saharan African countries are fragmented. Half of the 50 countries had an MoH website/HMIS/data portal as the main source of data used; 4 (8%) had other governmental bodies, mainly national statistical agencies, as the main data source; 9 (18%) countries had UNOCHA HDX as the main data source, while we used other sources like NGO and FBO websites for 7 (14%) countries. The main source of data for the remaining 5 countries (10%) is unpublished data obtained through personal communication. In total, 93 different sources of data were consulted to develop the first sub-Saharan Africa geocoded inventory of health service providers across all levels of service provision (Online-only Table 1).

We have classified the 50 countries into 4 broad categories according to each country's main source of health facility data consulted (Online-only Table 1). We have treated Zanzibar as a separate entity from mainland Tanzania as it has a separate health system. The first category includes 17 countries (Burundi, Central African Republic, Ghana, Guinea, Liberia, Malawi, Mali, Mozambique, Namibia, Nigeria, Rwanda, Sierra Leone, Somalia, South Africa, South Sudan, Tanzania and Zimbabwe) that have an online list of health facilities and for which data are available either fully or near fully geocoded. The second category includes 11 countries (Botswana, Chad, Comoros, Gambia, Kenya, Lesotho, Senegal, Seychelles, Togo, Uganda and Zambia) that had MFLs available online but lacked coordinates and where a process of geocoding was undertaken. The third category includes 17 countries (Benin, Burkina Faso, Cameroon, Cape Verde, Cote d'Ivoire, Djibouti, Equatorial Guinea, Eritrea, eSwatini, Ethiopia, Gabon, Guinea-Bissau, Mauritania, Mauritius, Niger, São Tomé & Príncipe and Zanzibar) that had maps available online where a facility list was created through a process of onscreen digitization of locations in a GIS platform. The fourth category are 5 countries (Angola, Congo, Democratic Republic of Congo, Madagascar and Sudan) where adequate data were not available online, and for which we relied on personal communication and in country contacts to acquire these data. We could not locate data for lower tier facilities for Guinea-Bissau and Sudan, and for 10 provinces in Angola (Online-only Table 1).

Data abstraction

Broadly, there are two main categories of health care delivery systems across sub-Saharan Africa - public and private. Private includes private-not-for-profit and private-for-profit33. We have focused on the public and private-not-for-profit sectors where health facilities are managed by the MoH, local authorities, NGOs, FBOs and CBOs. Private health facilities, though important in extending provision of health services, were excluded as previous audits of MFLs reveal that private sector facilities are often under-represented in MoH registries, located in urban centres, accessible only to those able to afford services, unregulated and do not often feature in MoH commodity distribution systems17. Their exclusion was a pragmatic decision based on difficulties with enumeration within the private sector10,32 and the complexity of its structural and organizational system34,35,36,37. Enumerating and regulating this sector has remained a challenge in most countries in sub-Saharan Africa. The private sector was difficult to audit despite extensive searches from multiple sources, where available, completeness varied wildly from country to country, and most of the facilities were often based in large cities and smaller urban areas. Our focus, therefore, has been on providers of public health sector services that cover services including expanded immunization programmes, health data surveillance and receive government funding to provide services to the general population. We have made a single exception to this rule, in Botswana, where many private company-owned health service providers also provide care to the general public and are more formally integrated into the government health system38. Across all countries, we excluded government facilities serving special groups, for example prisons, armed services, police, schools, universities and government service clinics. These services are often not available to the general population. Further exclusions were made to remove specialized care service providers such as blood transfusion centres, HIV Voluntary Counselling and Testing (VCT) centres, maternity and nursing homes, family planning clinics and specialist facilities (e.g. dental, eye, psychiatric, tuberculosis, rehabilitation, ophthalmic) (Fig. 1). The spatial location of these services is equally important for health system planning but were not universally documented across national health facility listings. Our ambition was to provide a geo-coded inventory of operational facilities providing broad clinical care services to the general population. It was notable across several data sources that not all facilities were deemed operational, and those labelled as "under construction" or "closed" were excluded. In total, 98,745 public health facilities were assembled for 50 countries in sub Saharan Africa.

Data cleaning

From all sources a single set of minimal descriptive data was possible for each facility: first level administrative unit, facility name, facility type, and details on facility ownership. A common feature across all databases was the presence of duplicates and these were identified by a careful review of each country's list and where identified were discarded. For facilities without names, we adopted names of the smallest administrative units i.e. wards, towns or villages, in which they are located if these were included in the original lists, with the assumption being that it is likely that a public facility has same naming orientation as the ward, town or village its located in. For those without names and information on admin units but with coordinates, we adopted the name of the nearest populated place based on calculated relative distances. In instances where information on facility ownership was missing an attempt was made to assign ownership based on the facility name e.g. all facilities that had a Christian name or church name such as Saint, protestant, mission, evangelical or Islamic were assigned FBO ownership, facility names with NGO names were classified as NGO-owned while the rest were assigned government ownership.

The size and definition of level of health facilities varied considerably within and between countries (Online-only Table 1). There doesn't exists a universal standardized definition of facility types making cross country comparisons difficult, and definitions provided in national health policies varied between countries hence while we are relatively confident in the hospital definition used here, the definition for subsequent tiers were harder to reconcile between countries. We have therefore elected to include the information as shown in primary data sources consulted (Online-only Table 2).

Geocoding

Facilities that had GPS coordinates from original data sources were 47,805 (48%), while 10,759 (11%) coordinates were obtained from digitizing health facility maps. For the remaining 40,181 (41%) health facilities with missing coordinates, we used a variety of existing location data and digital resources for geocoding. As a priority, where Global Positioning Systems (GPS) data for previously mapped infrastructure like schools were available, we used these to match to names of the health facilities in the same administrative zones to assign coordinates (n = 9,656; 10%). The most useful digital resources were Geonames digital place name gazetteer (n = 6,270; 6%), Google Earth/Maps (n = 5,672; 6%) and other digital place name gazetteers including Encarta, OpenStreetMap, HereMaps, Bingmaps, iTouchMap and Fallingrain (n = 11,925; 12%) (Fig. 1). A comprehensive list of all digital place name gazetteers used is presented in Table 1. Matching facility names to place names proved difficult in some situations. Although digital gazetteers strive to realize standard nomenclatures and unique naming strategies, these are difficult to achieve at national levels where spellings change between authors, overtime and where the same names are replicated across different places in the country39. Since all data were stored in a standard format in MS Excel (Microsoft, Redmond, USA), where maps were available, facility locations were digitized in ArcGIS 10.5 (ESRI, Redlands, USA), attribute information captured and converted to MS Excel.

Table 1 List of all digital place-name gazetteers and software used to geo-position health facilities.

For facilities that could not be geo-located using any of the above resources, we used a combination of sources and methods to geocode these (n = 4,308; 4%). This involved finding descriptions of locations of villages matching health facility names in journal papers and news articles and using this information to triangulate these locations in Google Earth, or using shapefiles of the smallest administrative divisions of a country, matching these with the same administrative units in the facility databases and placing the facility location on a populated place in Google Earth, but only in administrative units that were roughly 5 square kilometers in area to minimize the location error. Within small administrative units in Google Earth, populated places were not always obvious to locate visually so we located them by tracing footpaths, roads, rivers or streams that led up to populated places. Facilities that could not be geocoded using any of the sources in Table 1 in the final SSA MFL are 2,350 (2%). Figure 2 shows the location of the geocoded 96,395 public health facilities in sub Saharan Africa.

The distribution of 96,395 geocoded public health facilities in sub Saharan Africa. Red dots represent hospitals (n = 4,930) and green dots represent non-hospitals (n = 91,465). Facilities have been mapped on Global Administrative Unit Layers (GAUL) 2008 admin0 boundaries ( http://www.fao.org/geonetwork/srv/en/main.home).

Data Records

The geocoded master facility list described here has been made publicly and freely available through both the figshare repository40 and through the World Health Organization's Global Malaria Programme ( https://www.who.int/malaria/areas/surveillance/public-sector-health-facilities-ss-africa/en/) in Microsoft Excel format. While the dataset available through figshare40 will be preserved in its published form, the one available through the World Health Organization's Global Malaria Programme website will be updated through further in-depth validation and updating in collaboration with individual countries. The Database includes data from 50 countries in sub-Saharan Africa. Each data record represents a health facility and has 8 descriptive variables - Location identifiers including: country, first level administrative division, latitude, longitude and LL source (source of the coordinates). Coordinates are rounded off to four decimal places for uniformity, allowing an accuracy of 5-10 metres in decimal degrees coordinate format. We have included only the first level administrative divisions for each country that were in the primary data sources as they are least ambiguous and do not change much over time unlike second level administrative divisions which can change rapidly and are not consistent over time for most countries. The other pertinent details are the facility name, facility type and facility ownership. Facility types definitions vary between countries (Online-only Table 2), for example, a health centre in Kenya may not necessarily equal to a health centre in Sierra Leone in terms of services offered. Ownership expresses who owns or manages a facility e.g. MoH (government), local authority, NGO, FBO or CBO. Health facility coordinates are given in decimal degrees format in the World Geodetic System 1984 (WGS84) coordinate system.

Technical Validation

Heath facility locations

Facility locations were validated in ArcGIS using two datasets and by visual inspection in Google Earth. In ArcGIS, the Spatial Join and Select by Location tools were used to identify facilities that fell slightly off international boundaries or slightly outside of their correct region and/or district. The Global Lakes and Wetlands Database (GLWD)41 shapefile was used to ensure facilities were within defined land areas. While in theory GPS coordinates should represent an unambiguous spatial location, these required careful re-evaluation to ensure that facility locations were on their true position on the Earth's surface. We therefore routinely verified all GPS data from all sources using place names and/or Google Earth to ensure coordinates were located on populated places. Despite 47,805 (48%) facilities in the original lists having coordinates, some of the these plotted in wrong districts, on water bodies and or outside country boundaries. These were assigned new coordinates using Google Earth and minor shifts made in ArcGIS.

Service delivery levels and number of health facilities

Health facilities levels are defined based on the complexity of services they offer. Health facilities types, specifically at the primary level, vary between countries in their definitions, specialization, size of populations they serve and the essential services they provide, infrastructure and staffing. Health centres, medical centres, polyclinics, health posts, dispensaries, clinics, health huts, health units etc. may have similar functions but equally may represent different levels of service provision between countries. To cross-reference the completeness of our national inventories of facilities and to understand this variation, we first identified and defined service provision and health facilities at each level based on information from health sector policies and strategic plans for each country. We compared this against information in our database and for most countries, there was good concordance across all levels of service provision. Secondly, the number of health facilities at each service provision level for each country were compared with the corresponding number of facilities reported in the most current Health Sector Strategic Plans (HSSP) and other health sector reports and these were found to be largely similar with minor variations (Online-only Table 2). Most of these variations are partly because HSSPs and other health sector reports usually under-report mission and NGO facilities or do not at all, and in some instances, there was temporal misalignment between the data included in the database and the HSSPs consulted. While this inventory serves as a useful entry point to future facility censuses in Africa, the accuracy and completeness of this resource now requires further country and regional level validation.

Usage Notes

The definitions of health facility levels provided in national health policies and across country specific MFLs varied between countries hence the arbitrariness of health facility definitions used here. This has been noted previously8 and demands development of uniform health service delivery definitions across Africa. Importantly, indicators of service availability cannot accurately reflect access to and utilization of services. Hence service accessibility must be accompanied with improved quality of care at facilities. Accessibility on its own does not by itself guarantee that services are available42. Defining the scope, service provision and laboratory capacities and optimal catchment populations for health care providers should therefore be a priority.

We have elected to exclude the facility codes provided in the original sources because, though important, we are unsure of the fidelity of these facility codes as unique facility identifiers in each country without further investigation, and these codes were absent from most of the original data sources we consulted. While we acknowledge the significance of facility codes in managing database updates and providing linkages to other datasets, we encourage countries to create a uniform national coding system for facilities to be used by all stakeholders. For now, future updates and linkage to this dataset will be possible through name and admin units matching, while facility type and ownership can also be used to refine the matching.

The private sector has grown significantly over the last two decades in many countries in Africa, and they will provide an important role in achieving universal health coverage. However, enumerating and regulating this sector has remained a challenge in most countries in sub-Saharan Africa and are difficult to audit within current master health facility lists. Future iterations of the African database of public service providers released here should aim to include private sector providers following improvements in their national enumerations and auditing.

In addition to the data release through the figshare repository40 this dataset will simultaneously be hosted by the World Health Organization's Global Malaria Programme (WHO-GMP) ( http://www.who.int/malaria/areas/surveillance/public-sector-health-facilities-ss-africa/en) who will henceforth facilitate further in-depth validation and updating in collaboration with individual countries covered. This will also bring the possibility of assigning the facility codes for future updating, data linkages and comparisons. We have focused this work on SSA countries as this is the region our previous work has focused on, is most lacking with respect to comprehensive MFLs and it's the region under the World Health Organizations' Regional Office for Africa, who we have collaborated with on this work.

We recognize that, despite our best efforts, this dataset is incomplete and will change over time. As such, we encourage readers to alert us via email to additional and/or newly available data so that we may add them, if appropriate.

Code Availability

The data assembly was performed using MS Excel (Microsoft, Redmond, USA). The datasets included in this paper were manipulated using ESRI ArcGIS v10.5 and Google Earth V7.3.2.5776. Where maps were available, facility locations were digitized in ArcGIS, attribute information captured and converted to MS Excel.

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Acknowledgements

J.M. is supported by funding to RWS through his Wellcome Trust Principal Fellowship (number 103602); E.A.O. is funded through a Wellcome Trust Intermediate Fellowship (number 201866); P.M.M. and P.O.O. acknowledge support for their Ph.Ds under the IDeALs Project (number 107769); V.A. is funded through his Wellcome Trust Training Fellowship (number 211208); R.W.S. is funded by Wellcome Trust Principal Fellowship (number 103602) and is grateful to the UK's Department for International Development for their support to a project "Strengthening the Use of Data for Malaria Decision Making in Africa" (DFID Programme Code 203155). P.M.M., J.M., P.O.O., B.M., E.A.O., V.A. and R.W.S. acknowledge the support of the Wellcome Trust to the Kenya Major Overseas Programme (number 203077). The funder of the study had no role in study design, data collection, data preparation, or writing of the report. The authors thank David Kyalo, Pamela Thuranira, Stephen Oloo, Ezekiel Gogo, Viola Kirui, Betsy Makena and Caroline Kabaria for their support with cleaning processes in the initial assembly of this dataset.

Author information

Affiliations

1. Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya

Joseph Maina

, Paul O. Ouma

, Peter M. Macharia

, Victor A. Alegana

, Benard Mitto

, Robert W. Snow

& Emelda A. Okiro

2. Geography and Environmental Science, University of Southampton, Southampton, UK

3. World Health Organization, Regional Office for Africa, Brazzaville, Congo

4. Global Malaria Programme, World Health Organization, Geneva, Switzerland

5. Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK

6. Faculty of Science and Technology, Lancaster University, LA1 4YR, UK

Contributions

J.M., E.A.O. and R.W.S. drafted the manuscript. J.M., P.O.O., P.M.M., V.A. and R.W.S. acquired and assembled the raw data. J.M., P.O.O., P.M.M. and B.M. undertook the geocoding and data pre-processing. J.M. produced the final datasets and performed the technical validation of the raw data and final datasets. J.M. prepared the tables and figures. V.A. and A.M.N. aided in drafting the manuscript. I.S.F. provided health facility data and contributed to the drafting of the paper. V.A., R.W.S. and A.M.N. conceived the study. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Emelda A. Okiro.

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Maina, J., Ouma, P.O., Macharia, P.M. et al. A spatial database of health facilities managed by the public health sector in sub Saharan Africa. Sci Data 6, 134 (2019). https://doi.org/10.1038/s41597-019-0142-2
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A spatial database of health facilities managed by the public health sector in sub Saharan Africa

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Design Type(s) data integration objective * database creation objective Measurement Type(s) Healthcare Facility Technology Type(s) digital curation Factor Type(s) geographic location * Facility * organization Sample Characteristic(s) Sub-Saharan Africa * public infrastructure Machine-accessible metadata file describing the reported data (ISA-Tab format)

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(PDF) Service readiness of health facilities in Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Uganda and the United Republic of Tanzania

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(PDF) Service readiness of health facilities in Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Uganda and the United Republic of Tanzania

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United Republic of Tanzania: WHO Coronavirus Disease (COVID-19) Dashboard

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United Republic of Tanzania: WHO Coronavirus Disease (COVID-19) Dashboard

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WHO Coronavirus Disease (COVID-19) Dashboard

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World Health Organization Coronavirus disease (COVID-19) situation Dashboard

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TANZANIA IN FIGURE COVER november 2017 kama 2016

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TANZANIA IN FIGURE COVER november 2017 kama 2016

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Tanzania’s digital doctor learns to speak Swahili | Financial Times

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Tanzania’s digital doctor learns to speak Swahili | Financial Times

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With one doctor per 25,000 people, the Swahili-speaking east African country of Tanzania struggles to serve the needs of its 59m people.

Life expectancy is 62 for men and 66 for women, while just two-thirds of the population live within 5km of a health facility.

"Traditional models will not fix this problem," says Hila Azadzoy, managing director of the Global Health Initiative unit at Ada Health, a Berlin-based artificial intelligence-powered medical company. "Technology can empower users to take decisions about their own health by putting the power of AI into their hands," she adds.

Available since 2016, Ada Health's chatbot symptom checker app has attracted 9m users worldwide, including 3m in low- and middle-income countries. The free-to-download app invites users to input symptoms and pre-existing medical conditions before using AI-based questioning to pinpoint possible diagnoses - it then recommends next steps such as resting or seeking professional help.

The digital doctor now speaks Swahili - the lingua franca of 100m people in east Africa - thanks to Ada's Global Health Initiative. Launched last November, the project is aimed at improving access to healthcare in developing countries by offering reliable medical advice via its chatbot app.

Ada, which was designed in 2011 to help doctors in Germany diagnose rare diseases, now faces the challenge of integrating into a country hampered by poor infrastructure and a shortage of medical staff.

The app can help Tanzania overcome obstacles of low accessibility and unaffordable healthcare fees, says Nahya Salim, a lead clinician at Muhimbili University of Health and Allied Sciences in Dar es Salaam. "The lower levels of the healthcare system are overwhelmed with too many patients and not enough resources," she adds.

Salim, who partnered with Ada to build the app alongside Swiss non-profit group Fondation Botnar, believes it will improve access to healthcare by encouraging "timely and appropriate health seeking behaviour", though the user base remains limited to young city-dwelling men. This is the demographic that is most likely to use smartphones, Salim explains, while adding that Ada must increase awareness of the app across the population. The company says it is working towards this. Its target is 1.5m users in the country by the year-end, although it is yet to reveal its current user numbers and only 7.5m Tanzanians own a smartphone capable of downloading the app.

Aidan Peppin, a researcher at the Ada Lovelace Institute in London, says that involving locals in the app-building process is vital to ensuring that Ada can integrate with the population. Ada Health says it has worked with local partners to make the app culturally relevant.

Despite the similarity in names - both a nod to 19th century British mathematician Ada Lovelace - Peppin's institute is more sceptical about AI's prospects for solving health problems. "These apps use a crude reductive process," Peppin says. "In medicine there are too many unknown anomalies and AI can only deal with what it has seen before, it can't make inferences."

Sheena Visram, an associate editor at the Future Healthcare Journal and a clinical dietitian, agrees: "Digital health can supplement and enrich decision-making but it isn't a silver bullet. Clinical decision-making is multifactorial, often with clinicians of different specialities working together to deliver patient care."

Although trust and accuracy have been problems for various symptom checking apps, Ada acknowledges that it offers a "probabilistic assessment of possible causes for symptoms", rather than definitive diagnoses.

Ada's Swahili language app was built in a year by a 250-strong team, including 60 doctors, which prioritised diseases prevalent in east Africa such as malaria. While donors such as the Bill & Melinda Gates Foundation have financed Ada Health projects, the company also runs a for-profit model and has raised $69.3m from investors since 2011.

Replacing doctors is not Ada's intention - instead it says it wants to facilitate interaction between users and healthcare experts while deterring unnecessary clinic visits by providing health information via smartphones.

Visram agrees that Ada can relieve pressure on Tanzania's healthcare system by educating and triaging patients, but adds that training doctors and building hospitals must follow so that tech can be harnessed to improve health results.

Peppin concurs: "Unless tech is integrated with existing physical systems there's a risk of creating serious health burdens and stretching existing infrastructure."

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Tanzania's digital doctor learns to speak Swahili

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With one doctor per 25,000 people, the Swahili-speaking east African country of Tanzania struggles to serve the needs of its 59m people. Life expectancy is 62 for men and 66 for women, while just two-thirds of the population live within 5km of a health facility.

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Kenya coronavirus: Testing truckers at Tanzania border created perfect conditions for covid to spread - The Washington Post

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Kenya coronavirus: Testing truckers at Tanzania border created perfect conditions for covid to spread - The Washington Post

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NAMANGA, KENYA - When Habibu Juma Ali lined up his truck full of Whitedent toothpaste behind hundreds of others waiting to cross the border from Tanzania into Kenya, he didn't expect to wait two weeks to get tested for the novel coronavirus.

Truckers are permitted to drive across the otherwise closed border between East Africa's two biggest countries, but for the first two months of the pandemic, they had to get tested at the crossing. More than 150 tested positive and were turned back. The rest spent interminable days waiting for their results.

Ali has spent his days on both the Kenyan and Tanzanian sides of the border town of Namanga, where, when you're on foot, you can cross the border as easily as crossing a road. He has bought food at shops, exchanged money at banks and, at night, he sleeps huddled with other drivers on cardboard mats underneath his truck. They cook and share meals with newcomers as the line of waiting trucks grows. Others find racier ways to pass the time - chewing khat, shooting dice, hiring sex workers.

The truckers' growing web of interactions points to a dilemma at international borders: how to let essential trade through without the virus slipping in with it. At a meeting Friday to resolve the growing crisis, Kenya and Tanzania agreed that starting next week, drivers will have to get negative test certificates before starting their journeys. For many of the thousands of truckers who have already spent days or weeks in Namanga waiting for tests, that decision will have come too late.

"If my results come back positive, who can say how many people I'd have infected?" said Ali, 47. "I'm almost sure most of us here have now got the virus."

The porous border, inefficient testing and limited contact tracing made this town an ideal place for the coronavirus to spread. Truckers say the long waits left them more susceptible to the virus and cost them time and money. The town's business people, who interact with them on a daily basis, were caught between fear of contagion and unwillingness to give up their livelihoods.

[Sign up for our Coronavirus Updates newsletter to track the outbreak. All stories linked in the newsletter are free to access.]

Truck drivers distribute goods but also sometimes diseases, as became especially clear during HIV's spread in Africa, where they carry the virus at double the rate of the general population. Truckers' contacts are harder to trace than those of people who've traveled by airplane, for instance, where passenger lists are available. In Namanga, truck drivers have blended into the town as they wait, making contact tracing nearly impossible.

Kenya's tests at the border have been the only real indication of the extent of the outbreak in Tanzania: The government hasn't released data on new cases since April 29. Tanzanian President John Magufuli has said numbers are falling, but a U.S. Embassy statement last week said that many hospitals in the former capital, Dar es Salaam, had been overwhelmed and that the likelihood of contracting the virus in that city was "extremely high."

Tanzania has taken fewer day-to-day measures to control the virus's spread than Kenya, which has a dusk-to-dawn curfew, mandatory mask-wearing and localized lockdowns. Kenya has over 1,100 confirmed cases and has been generally praised for the seriousness of its response, despite crackdowns on curfew offenders that have killed more than a dozen people and evictions of slum dwellers, who've been left homeless at a time when hygiene and sanitation are paramount.

In Namanga, because contact tracing is done only once someone tests positive, the lag in getting results means truckers can rack up hundreds of contacts before knowing their status. And because Kenyan authorities simply turn around infected Tanzanian truck drivers instead of quarantining them at the border, they lose the opportunity to interview them in person about contacts.

"Contacts are traced using phones or physically by community health volunteers, area leaders or security agencies," said Esther Somoire, who directs the health response in the Kenyan county where Namanga is located. "But it's complicated, especially at international borders like Namanga."

The growing number of positive cases at the border escalated into a confrontation between the Kenyan and Tanzanian governments. A Tanzanian regional government official said on Wednesday that Kenya was falsely reporting positive test results for Tanzanian truckers as " a deliberate sabotage strategy designed by Kenya against our tourism industry," and that the government had done its own tests on those drivers and they came back negative. The two countries compete over lucrative wildlife tourism.

In his daily briefings, Kenya's health minister, Mutahi Kagwe, has called the border posts "hot spots" but has offered assurances that diligent testing means infected Tanzanian truck drivers are not "in our midst." Friday's agreement stipulated that the results of all further tests of truck drivers will be released publicly but "without mentioning the nationality of the infected."

In Europe, many countries have exempted truck drivers transporting goods from checks at their borders. The United States and Canada don't test truckers crossing their 5,500-mile border. In East Africa, though, testing is more common: Uganda has found dozens of infected Kenyan truck drivers, and Zambia closed its border to Tanzanian truckers after an outbreak at the border created a hot spot there.

Truckers like Ali who are hoping to enter Kenya were at their wits' end Wednesday as they waited hours for health officials to take throat swabs. Dozens of them were told to wait in a bare concrete room with no seats. Some crouched with their heads in their hands, trying to nap while waiting. When a health official showed up, he asked the drivers to practice social distancing, and the crowd lunged at him, many saying it was ridiculous to expect them to distance when they weren't even given a place to sit.

"Really, honestly, you are not preventing, you are spreading," said Robert Kimani, a Kenyan driver transporting tomatoes from Iringa, in central Tanzania, who had his own reason to be angry. He had initially been tested five days earlier, but when results were announced, his name was missing from the list.

"There were four of us like that. They didn't even have the courtesy to tell me what happened," he said in an interview later. "In the days I've been waiting, where have I not been? I have been all over. Maybe the virus can be all over, too."

Kenyan health officials declined to comment on the missing results.

All who rely on the border town's economy, from shop owners to sex workers, are warily continuing business as usual. For most, that involves crossing the invisible border that runs through it.

Jenny Heri, 39, and Marcy Mwajuma Kioko, 32, said they get paid to have sex with six to 10 trucker clients a day, mostly Tanzanians. On Wednesday, they were on the Kenyan side to pick up hundreds of condoms at a government clinic, as well as change Tanzanian shillings into Kenyan shillings to wire home to their children. Kioko put some of the condoms in a dispenser in a men's bathroom at the entrance to the border post before looking for more clients among the drivers waiting on the Tanzanian side.

Heri said that she and other sex workers have adopted new practices, like not facing clients while having sex and sanitizing the parts of their bodies their clients touch, but that they knew they were putting themselves at high risk.

"We know it's not perfect," she said. "But this job we do, we do to make enough so our kids don't suffer."

Business people in Namanga who interacted with Kimani, the driver who said his first test sample disappeared, described a deep sense of worry about coming into contact with so many truck drivers on a daily basis.

"If they are really serious, they would follow up with us," said Elizabeth Wanjiku, 42, who runs a small money exchange. "Or government should give us money to stay home if they want to protect us."

Unlike Ali, who sleeps under his truck, Kimani can afford to stay at Joseph Kitalama's guesthouse, where sanitizer is provided. But Kitalama's rooms are often rented and shared by strangers looking to save money.

"People are doing so much to protect themselves - washing hands all the time, making their own masks out of cloth," said Kitalama. "We are doing our best, but the government should also do its part."

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At a busy East African border, testing truckers created perfect conditions for coronavirus to spread

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NAMANGA, KENYA - When Habibu Juma Ali lined up his truck full of Whitedent toothpaste behind hundreds of others waiting to cross the border from Tanzania into Kenya, he didn't expect to wait two weeks to get tested for the novel coronavirus.

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Half of the world's population lack access to essential health services - are we doing enough?

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By collaborating across sectors, drawing on our complementary skills, expertise and reach, our impact is magnified beyond the sum of its parts

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Tanzania's president shrugs off Covid-19 risk after sending fruit for 'tests' | Global development | The Guardian

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Tanzania's president shrugs off Covid-19 risk after sending fruit for 'tests' | Global development | The Guardian

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Tanzania's divisive president John Magufuli has said the economy is "more important than the threat posed by coronavirus", adding that he wants to reopen the country for tourism despite warnings that Africa could face the next wave of the disease.

The comments by Magufuli, who has modelled his populist response on that of Donald Trump and Brazil's Jair Bolsonaro - in repeatedly denying the risk of the pandemic to his country - come amid mounting alarm among Tanzania's neighbours over his approach.

So far there have been 21 officially recorded deaths in Tanzania.

Magufuli made the remarks on Sunday during a mass in his hometown of Chato, where he said he intended to keep Tanzania's borders open with its eight neighbours. The remarks follow a series of statements in recent weeks minimising the threat of coronavirus.

In a video the Tanzanian president once again touted natural remedies for coronavirus, saying these had helped his son.

"My own son, after contracting the virus, closed himself in his room, took a lemon and ginger solution before getting well and is even able to do push-ups," he said in a video that went viral.

"We have had a number of viral diseases, including Aids and measles. Our economy must come first. It must not sleep. If we allow our economy to sleep, we will not receive salaries ... Life must go on," he added.

"As I am talking here," he continued, "some airline operators are fully booked - until August - with tourists who want to visit Tanzania."

The president's latest comments follow several bizarre interventions - including his order that animals and fruit be tested for the virus as a demonstration of "false positives". He has also been accused by health professionals of covering up the true number of infections.

Elected in 2015, and nicknamed the "Bulldozer", he has become Tanzania's most high profile leader since Julius Nyerere both for his popularity and also for his reputation of targeting those critical of him.

Even as the US embassy has warned of the risk of "exponential growth" of Covid-19 cases in the country, adding that hospitals were "overwhelmed", Magufuli has accused international health officials of exaggerating the crisis and suggested some health workers "may have been put on the payroll of imperialists".

While Tanzania has introduced some of the same social distancing measures as its neighbours, Magufuli's own preferred solution has been to encourage people to attend services in churches and mosques, insisting that prayers "can vanquish" the "satanic" virus.

While neighbouring countries have watched with mounting concern, the stunt by the former maths and chemistry teacher of sending samples from animals and fruit to the country's main testing laboratory to undermine testing credibility has been baffling.

According to Magufuli, samples were secretly obtained by "testers", including from a sheep, a goat and a pawpaw, given human names and sent to the country's national referral laboratory to test for coronavirus which, according to Magufuli, came back positive.

Calling for an investigation into the "dirty game" in the laboratory, he suggested that "equipment or people may be compromised", hinting at "sabotage" in a speech broadcast on the state-run channel. What he did not address, as he ordered the firing of the head of the lab, was where the testing kits had come from or how accurate they are.

Controversy over $500m loan that allows Tanzania to take pregnant girls out of their classroom

"I have always raised my suspicions about how our national lab has been conducting the Covid-19 cases," the president said in a speech.

Like Trump, Magufuli is facing elections in the autumn and is no friend of his country's media. He is a follower of charismatic Nigerian preacher TB Joshua, who subscribed to magical thinking predicting the virus would stop spreading on 27 March.

When that did not happen he revised his prophesy to say that he meant that the virus would stop spreading from Wuhan on that date. Perhaps equally worrying is how Magufuli (again like Trump) has used the pandemic to further his own political ends, including calling for self-isolating opposition MPs not to be paid.

The country has denied it has been weak in the face of the pandemic. "The claims that Tanzania has wavered and isolated itself in the fight against Covid-19 are not true because Tanzania has provided leadership in the economic bloc of the southern African countries (Sadc), which the country chairs, and it has continued to do so with respect and all efforts required," said foreign affairs minister Palamagamba Kabudi.
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Tanzania's president shrugs off Covid-19 risk after sending fruit for 'tests'

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Tanzania's divisive president John Magufuli has said the economy is "more important than the threat posed by coronavirus", adding that he wants to reopen the country for tourism despite warnings that Africa could face the next wave of the disease.

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Herbal Cures for COVID-19 Spreading in Tanzania Despite No Evidence They Work | Voice of America - English

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Herbal Cures for COVID-19 Spreading in Tanzania Despite No Evidence They Work | Voice of America - English

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DAR ES SALAAM - In Tanzania, there has been a surge of claims for herbal cures for the coronavirus. Despite endorsements by some public officials, medical experts warn that no treatments should be taken at face value until scientifically tested.

At her farm on the outskirts of Dar es Salaam, Mwajuma Saidi collects peppers, mango leaves, and other ingredients to steam and prepare what she believes is a cure for COVID-19.

Her granddaughters are taking it, too, even though they are not sick. Mwajuma says they just do it as a precaution.

She says they took lemon, ginger, pepper and onions, then blended them and put it all in a bottle. She added that they started using it in the morning, afternoon and evening for four days, and then they stopped.

There is no evidence Mwajuma's potion does anything to combat the coronavirus nor any others that are being touted.

But the number of people in Tanzania who claim to have discovered a cure for the novel coronavirus keeps rising.

Some are pushing an untested herbal potion, among them Hamis Malebo who promotes Covidol.

Calling it an herbal cure, he says it has been used by a few people and among those who used it, there has been some success. Hamis adds that it has been found to lower fever faster, and that it fights respiratory problems, influenza, and body fatigue - things that emerge with the disease.

Authorities say any coronavirus treatments need to be tested first under strict clinical trials to see if they are effective.

Yunus Mgaya, the director general of the Institute for Medical Research, says what researchers are waiting for are instructions from the institute's general secretary so they can include the herbal medicine in their research.

Meanwhile, Mwajuma and her granddaughters continue to do their best to protect themselves from the virus, even though they are unsure if their concoctions actually work.

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Herbal Cures for COVID-19 Spreading in Tanzania Despite No Evidence They Work

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In Tanzania, there has been a surge of claims for herbal cures for the coronavirus. Despite endorsements by some public officials, medical experts warn that no treatments should be taken at face value until scientifically tested.

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Tanzania Says COVID-19 Defeated With Prayer Despite Fears | Time

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Tanzania Says COVID-19 Defeated With Prayer Despite Fears | Time

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Tanzania Says COVID-19 Defeated With Prayer Despite Fears

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President John Magufuli has led a crackdown on anyone who dares raise concerns about the virus's spread in Tanzania

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Equipping Tanzanian health workers with skills for critical care | WHO | Regional Office for Africa

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Equipping Tanzanian health workers with skills for critical care | WHO | Regional Office for Africa

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Dar es Salaam - Health care workers across Africa are boosting their emergency response skills to tackle COVID-19. Much is still being learned about the pandemic as measures are reinforced to contain rising infection in many countries in the continent. "We were in completely unchartered territory," says Dr Abel Musa, a critical care specialist at a hospital in Zanzibar, after a recent online training.

In April, Dr Musa along with about 160 other health workers in Tanzania attended a three-day virtual training organized by the Ministry of Health and the World Health Organization (WHO) focusing on caring for critically ill COVID-19 patients. Only a small percentage of COVID-19 patients become critically ill necessitating intensive care, which is the only measure that can save their lives.

Critically ill patients are at a heightened risk of experiencing acute respiratory disease syndrome, septic shock, multi-organ failure, kidney or cardiac injury. These patients require increased attention, with around the clock monitoring. They may also need oxygen support. The professionals caring for these patients are often the last line of defence against the disease.

"If the essential care of such critical illness is provided correctly, including maintaining a free airway, administering oxygen and giving intravenous fluids to patients in shock, many lives can be saved," says Dr Tim Baker, a critical care consultant with WHO Tanzania.

Providing critical care also entails important measures such as how to identify severe and critically ill patients, assessing a patient's breathing and oxygen needs, how to administer oxygen, and treating shock or low levels of consciousness. Globally, around 3% of COVID-19 patients become critically ill. The majority present fever, cough and shortness of breath as symptoms. About 40% of cases seem to be mild.

Dr Musa says that the training has given a fillip to infection prevention and control (IPC) procedures at Tasakhtaa Global Hospital, where he works. He had initially established standards to handle COVID-19 patients, but with the training, the latest in an ongoing series, the protocols have been adjusted in line with nationally recommended practices.

"We have a number of COVID-19 patients in our critical care. Because of careful planning and staff commitment to IPC we have managed to keep other patients and all frontline responders safe," says Dr Musa.

WHO is working with governments in Africa to train health workers, improve surveillance, testing, contact tracing and treatment. More than 7000 health workers, including over 400 in Tanzania, have been trained in WHO African Region since the beginning of the pandemic. WHO is also providing technical expertise in countries, either remotely or by embedding experts in national response teams.

Most countries on the continent, however, do not have the capacity to manage many critically ill COVID-19 patients. There are on average nine intensive care unit beds per one million people, according to a March 2020 survey based on self-reports by 47 countries in the WHO African Region. Improvements are being made to increase the number of ventilators in intensive care units and more critical care clinicians are being trained.

Ansbert Sweetbert Ndebea, a doctor from Tanzania's Kilimanjaro region who also attended the virtual training, says he has yet to handle a critically ill COVID-19 patient but was now prepared to do so. His region has not reported a high number of cases.

For Dr Musa, the new protocols at his hospital mean patients are now being screened upon entry. If triage staff suspect a COVID-19 case, the person is taken to an isolation area until staff designated to care for COVID-19 patients arrive. COVID-19 care is limited to specific staff members to ensure that other essential health services continue. These newly formed COVID-19 teams work under modified schedules, serving for 14-day stretches before taking two weeks to rest. The method helps the treatment teams to stay focused and reduces the likelihood of onward infection.

With improved infection prevention measures, the safety of health workers also gets a boost. As of 19 May 2020, 1920 health workers had been infected with COVID-19 in 32 counties in the WHO African Region since the beginning of the outbreak.

Infections continue to rise across the continent. However, the pandemic can still be controlled in many countries by the aggressive implementation of both containment and mitigation measures. Recent analyses of the evolution of the outbreak in Africa show that the disease has largely affected urban populations, with most rural communities relatively unaffected or only reporting sporadic cases.

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Equipping Tanzanian health workers with skills for critical care

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Health care workers across Africa are boosting their emergency response skills to tackle COVID-19. Much is still being learned about the pandemic as measures are reinforced to contain rising infection in many countries in the continent. "We were in completely unchartered territory," says Dr Abel Musa, a critical care specialist at a hospital in Zanzibar, after a recent online training.

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United Republic of Tanzania | WHO | Regional Office for Africa

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United Republic of Tanzania | WHO | Regional Office for Africa

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The World Health Organization (WHO) is building a better future for people everywhere. Health lays the foundation for vibrant and productive communities, stronger economies, safer nations and a better world. Our work touches lives around the world every day - often in invisible ways.

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Coronavirus: Tanzania hospitals overwhelmed - US - BBC News

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Coronavirus: Tanzania hospitals overwhelmed - US - BBC News

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Tanzania's Magufuli panned as Covid-19 cases jump, three MPS die — Quartz Africa

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Tanzania's Magufuli panned as Covid-19 cases jump, three MPS die — Quartz Africa

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With Covid-19 cases on a sharp rise in Tanzania, there is now widespread speculation that three of its lawmakers who died in a space of 11 days might have contracted the virus. It's a concern which has prompted the country's leading opposition party Chadema to call for a suspension of parliament.

Chadema told its MPs to self-isolate for two weeks and stay away from parliamentary buildings in the capital Dodoma and main commercial City of Dar es Salaam. "Members of the Chadema Party should immediately stop attending parliament sessions and should not go anywhere near parliament offices," Chairman of the party Freeman Mbowe said in statement on Friday.

Justice minister Augustine Mahiga died on Friday morning it follows the death of lawmaker Richard Ndassa on April 29 and Gertrude Rwakatare, who died on April 20.

But despite these high-profile sudden deaths, the Tanzanian government and the political establishment have been vague as to whether the politicians contracted the virus or not.

Adding to the uncertainty and speculation around these cases is the fact Tanzania's leadership had taken a more relaxed approach to preparing for the possibility of an outbreak than neighboring countries.

Ever since the virus found its way into the continent, most African countries have imposed strict measures such as banning public gatherings including closing down churches and mosques to contain the virus. However, Tanzania's president John Magufuli, who is a Christian, has allowed all places of worship to remain open in the country despite the government at same time promoting physical distancing.

Magufuli has described Covid-19 as a demon (shetani), and declared all places of worship to be open because this is where God and "true healing" (uponyaji wa kweli in Kiswahili) are found. However, this has only led to a lot of criticism from public health experts who see it as downplaying a dangerous pandemic and that it will only perpetuate the virus problem in the country. Some commentators have described Magufuli's stance as a failure to adequately address the pandemic.

Tanzania is set to hold general elections later this year to elect the president and the National Assembly, and Magufuli is likely to be the nominee again for the ruling party Chama Cha Mapinduzi. However, his handling of the pandemic might only end up creating a window of opportunity for the opposition even though they have never won an election before.

The Tanzanian government has been heavily criticized on social media on the failure to give daily updates about the situation. This lack of updates led to speculations that the authorities were concealing the true number of cases. Official numbers are that there are now 480 confirmed cases with 16 deaths.

African politicians and public officials have been vulnerable to the disease like it's been the case in Europe with examples including British prime minister Boris Johnson.

This week, Guinea-Bissau's health ministry revealed its prime minister Nuno Gomes Nabiam tested positive for the novel coronavirus along with three of his fellow cabinet members. Nigeria's president Muhammadu Buhari lost his closest aide to the virus, Abba Kyari, often called the second most powerful person in Africa's most populous nation.
Sign up to the Quartz Africa Weekly Brief here for news and analysis on African business, tech and innovation in your inbox

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Tanzania's president is under pressure after three MPs die in 11 days and Covid-19 cases spike

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With Covid-19 cases on a sharp rise in Tanzania, there is now widespread speculation that three of its lawmakers who died in a space of 11 days might have contracted the virus. It's a concern which has prompted the country's leading opposition party Chadema to call for a suspension of parliament.

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Global coalition to accelerate COVID-19 clinical research in resource-limited settings - The Lancet

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Global coalition to accelerate COVID-19 clinical research in resource-limited settings - The Lancet

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Africa :: Tanzania — The World Factbook - Central Intelligence Agency

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Africa :: Tanzania — The World Factbook - Central Intelligence Agency

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Africa :: TANZANIA

Introduction :: TANZANIA

Shortly after achieving independence from Britain in the early 1960s, Tanganyika and Zanzibar merged to form the United Republic of Tanzania in 1964. In 1995, the country held its first democratic elections since the 1970s. Zanzibar maintains semi-autonomy and participates in national elections; popular political opposition on the isles led to four contentious elections since 1995, in which the ruling party claimed victory despite international observers' claims of voting irregularities.

Geography :: TANZANIA

Eastern Africa, bordering the Indian Ocean, between Kenya and Mozambique

note: includes the islands of Mafia, Pemba, and Zanzibar

more than six times the size of Georgia; slightly larger than twice the size of California

Area comparison map:

border countries (8): Burundi 589 km, Democratic Republic of the Congo 479 km, Kenya 775 km, Malawi 512 km, Mozambique 840 km, Rwanda 222 km, Uganda 391 km, Zambia 353 km

exclusive economic zone: 200 nm

varies from tropical along coast to temperate in highlands

plains along coast; central plateau; highlands in north, south

elevation extremes: lowest point: Indian Ocean 0 m

highest point: Kilimanjaro 5,895 m (highest point in Africa)

hydropower, tin, phosphates, iron ore, coal, diamonds, gemstones, gold, natural gas, nickel

arable land 14.3%; permanent crops 2.3%; permanent pasture 27.1%

the largest and most populous East African country; population distribution is extremely uneven, but greater population clusters occur in the northern half of country and along the east coast

flooding on the central plateau during the rainy season; drought

volcanism: limited volcanic activity; Ol Doinyo Lengai (2,962 m) has emitted lava in recent years; other historically active volcanoes include Kieyo and Meru

soil degradation; deforestation; desertification; destruction of coral reefs threatens marine habitats; recent droughts affected marginal agriculture; wildlife threatened by illegal hunting and trade, especially for ivory

party to: Biodiversity, Climate Change, Climate Change-Kyoto Protocol, Desertification, Endangered Species, Hazardous Wastes, Law of the Sea, Ozone Layer Protection, Wetlands

signed, but not ratified: none of the selected agreements

Kilimanjaro is the highest point in Africa and one of only two mountains on the continent that has glaciers (the other is Mount Kenya); bordered by three of the largest lakes on the continent: Lake Victoria (the world's second-largest freshwater lake) in the north, Lake Tanganyika (the world's second deepest) in the west, and Lake Nyasa (Lake Malawi) in the southwest

People and Society :: TANZANIA

note: estimates for this country explicitly take into account the effects of excess mortality due to AIDS; this can result in lower life expectancy, higher infant mortality, higher death rates, lower population growth rates, and changes in the distribution of population by age and sex than would otherwise be expected (July 2017 est.)

mainland - African 99% (of which 95% are Bantu consisting of more than 130 tribes), other 1% (consisting of Asian, European, and Arab); Zanzibar - Arab, African, mixed Arab and African

Kiswahili or Swahili (official), Kiunguja (name for Swahili in Zanzibar), English (official, primary language of commerce, administration, and higher education), Arabic (widely spoken in Zanzibar), many local languages

note: Kiswahili (Swahili) is the mother tongue of the Bantu people living in Zanzibar and nearby coastal Tanzania; although Kiswahili is Bantu in structure and origin, its vocabulary draws on a variety of sources including Arabic and English; it has become the lingua franca of central and eastern Africa; the first language of most people is one of the local languages

Christian 61.4%, Muslim 35.2%, folk religion 1.8%, other 0.2%, unaffiliated 1.4%

note: Zanzibar is almost entirely Muslim (2010 est.)

Tanzania has the largest population in East Africa and the lowest population density; almost a third of the population is urban. Tanzania's youthful population - about two-thirds of the population is under 25 - is growing rapidly because of the high total fertility rate of 4.8 children per woman. Progress in reducing the birth rate has stalled, sustaining the country's nearly 3% annual growth. The maternal mortality rate has improved since 2000, yet it remains very high because of early and frequent pregnancies, inadequate maternal health services, and a lack of skilled birth attendants - problems that are worse among poor and rural women. Tanzania has made strides in reducing under-5 and infant mortality rates, but a recent drop in immunization threatens to undermine gains in child health. Malaria is a leading killer of children under 5, while HIV is the main source of adult mortality

For Tanzania, most migration is internal, rural to urban movement, while some temporary labor migration from towns to plantations takes place seasonally for harvests. Tanzania was Africa's largest refugee-hosting country for decades, hosting hundreds of thousands of refugees from the Great Lakes region, primarily Burundi, over the last fifty years. However, the assisted repatriation and naturalization of tens of thousands of Burundian refugees between 2002 and 2014 dramatically reduced the refugee population. Tanzania is increasingly a transit country for illegal migrants from the Horn of Africa and the Great Lakes region who are heading to southern Africa for security reasons and/or economic opportunities. Some of these migrants choose to settle in Tanzania.

0-14 years: 43.74% (male 11,921,393/female 11,678,536)

15-24 years: 19.86% (male 5,361,747/female 5,351,794)

25-54 years: 29.88% (male 8,098,183/female 8,020,289)

55-64 years: 3.51% (male 836,313/female 1,055,347)

65 years and over: 3.02% (male 687,118/female 940,215) (2017 est.)

population pyramid:

total dependency ratio: 93.4

youth dependency ratio: 87.4

elderly dependency ratio: 6

potential support ratio: 16.6 (2015 est.)

female: 18 years (2017 est.)

35.6 births/1,000 population (2017 est.)

7.6 deaths/1,000 population (2017 est.)

-0.5 migrant(s)/1,000 population (2017 est.)

the largest and most populous East African country; population distribution is extremely uneven, but greater population clusters occur in the northern half of country and along the east coast

urban population: 33% of total population (2017)

rate of urbanization: 5% annual rate of change (2015-20 est.)

DAR ES SALAAM (capital) 5.116 million; Mwanza 838,000 (2015)

at birth: 1.03 male(s)/female

0-14 years: 1.02 male(s)/female

15-24 years: 1 male(s)/female

25-54 years: 1.01 male(s)/female

55-64 years: 0.78 male(s)/female

65 years and over: 0.75 male(s)/female

total population: 0.99 male(s)/female (2017 est.)

note: median age at first birth among women 25-29 (2015/16 est.)

398 deaths/100,000 live births (2015 est.)

total: 39.9 deaths/1,000 live births

male: 42 deaths/1,000 live births

female: 37.8 deaths/1,000 live births (2017 est.)

total population: 62.6 years

female: 64.1 years (2017 est.)

4.77 children born/woman (2017 est.)

0.02 physicians/1,000 population (2014)

0.7 beds/1,000 population (2010)

urban: 77.2% of population

rural: 45.5% of population

total: 55.6% of population

urban: 22.1% of population

total: 46.8% of population (2015 est.)

urban: 31.3% of population

rural: 8.3% of population

total: 15.6% of population

urban: 68.7% of population

rural: 91.7% of population

total: 84.4% of population (2015 est.)

degree of risk: very high

food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever

vectorborne diseases: malaria, dengue fever, and Rift Valley fever

water contact diseases: schistosomiasis and leptospirosis

animal contact disease: rabies (2016)

definition: age 15 and over can read and write Kiswahili (Swahili), English, or Arabic

female: 73.1% (2015 est.)

female: 11.7% (2014 est.)

Government :: TANZANIA

conventional long form: United Republic of Tanzania

conventional short form: Tanzania

local long form: Jamhuri ya Muungano wa Tanzania

local short form: Tanzania

former: German East Africa, Trust Territory of Tanganyika, United Republic of Tanganyika and Zanzibar

etymology: the country's name is a combination of the first letters of Tanganyika and Zanzibar, the two states that merged to form Tanzania in 1964

name: Dodoma (legislative capital), Dar es Salaam (administrative capital); note - Dodoma was designated the national capital in 1996 and serves as the meeting place for the National Assembly; Dar es Salaam remains the de facto capital, the country's largest city and commercial center, and the site of the executive branch offices and diplomatic representation; the government contends that it will complete the transfer of the executive branch to Dodoma by 2020

geographic coordinates: 6 48 S, 39 17 E

time difference: UTC+3 (8 hours ahead of Washington, DC, during Standard Time)

31 regions; Arusha, Dar es Salaam, Dodoma, Geita, Iringa, Kagera, Kaskazini Pemba (Pemba North), Kaskazini Unguja (Zanzibar North), Katavi, Kigoma, Kilimanjaro, Kusini Pemba (Pemba South), Kusini Unguja (Zanzibar Central/South), Lindi, Manyara, Mara, Mbeya, Mjini Magharibi (Zanzibar Urban/West), Morogoro, Mtwara, Mwanza, Njombe, Pwani (Coast), Rukwa, Ruvuma, Shinyanga, Simiyu, Singida, Songwe, Tabora, Tanga

26 April 1964 (Tanganyika united with Zanzibar to form the United Republic of Tanganyika and Zanzibar); 29 October 1964 (renamed United Republic of Tanzania); notable earlier dates: 9 December 1961 (Tanganyika became independent from UK-administered UN trusteeship); 10 December 1963 (Zanzibar became independent from UK)

Union Day (Tanganyika and Zanzibar), 26 April (1964)

history: several previous; latest adopted 25 April 1977; note - progress enacting a new constitution drafted in 2014 by the Constituent Assembly has been stalled

amendments: proposed by the National Assembly; passage of amendments to constitutional articles including those on sovereignty of the United Republic, the authorities and powers of the government, the president, the Assembly, and the High Court requires two-thirds majority vote of the mainland Assembly membership and of the Zanzibar House of Representatives membership; House of Representatives approval of other amendments is not required (2017)

English common law; judicial review of legislative acts limited to matters of interpretation

has not submitted an ICJ jurisdiction declaration; accepts ICCt jurisdiction

citizenship by descent only: at least one parent must be a citizen of Tanzania; if a child is born abroad, the father must be a citizen of Tanzania

dual citizenship recognized: no

residency requirement for naturalization: 5 years

18 years of age; universal

chief of state: President John MAGUFULI (since 5 November 2015); Vice President Samia SULUHU (since 5 November 2015); note - the president is both chief of state and head of government

head of government: President John MAGUFULI, Dr. (since 5 November 2015); Vice President Samia SULUHU (since 5 November 2015); note - Prime Minister Kassim Majaliwa MAJALIWA (since 20 November 2015) has authority over the day-to-day functions of the government, is the leader of government business in the National Assembly, and is head of the Cabinet

cabinet: Cabinet appointed by the president from among members of the National Assembly

elections/appointments: president and vice president directly elected on the same ballot by simple majority popular vote for a 5-year term (eligible for a second term); election last held on 25 October 2015 (next to be held in October 2020); prime minister appointed by the president

election results: John MAGUFULI elected president; percent of vote - John MAGUFULI (CCM) 58.5%, Edward LOWASSA (CHADEMA) 40%, other 1.5%

note: Zanzibar elects a president as head of government for matters internal to Zanzibar; election held on 25 October 2015 was annulled by the Zanzibar Electoral Commission and rerun on 20 March 2016; President Ali Mohamed SHEIN reelected; percent of vote - Ali Mohamed SHEIN (CCM) 91.4%, Hamad Rashid MOHAMED (ADC) 3%, other 5.6%; the main opposition party in Zanzibar, the Civic United Front, boycotted the 20 March 2016 election rerun

description: unicameral National Assembly or Parliament (Bunge) (393 seats; 264 members directly elected in single-seat constituencies by simple majority vote, 113 women directly elected by proportional representation vote, 5 indirectly elected by simple majority vote by the Zanzibar House of Representatives, 10 appointed by the president, and 1 seat reserved for the attorney general; members serve a 5-year term); note - in addition to enacting laws that apply to the entire United Republic of Tanzania, the National Assembly enacts laws that apply only to the mainland; Zanzibar has its own House of Representatives or Baraza La Wawakilishi (82 seats; 50 members directly elected in single-seat constituencies by simple majority vote, 20 women directly elected by proportional representation vote, 10 appointed by the Zanzibar president, 1 seat for the House speaker, and 1 ex-officio seat for the attorney general; elected members serve a 5-year term)

elections: Tanzania National Assembly and Zanzibar House of Representatives elections last held on 25 October 2015 (next National Assembly election to be held in October 2020; next Zanzibar election either October 2020 or March 2021; note the Zanzibar Electoral Commission annulled the 2015 election; repoll held on 20 March 2016

election results: National Assembly - percent of vote by party - CCM 55%, Chadema 31.8%, CUF 8.6%, other 2.2%; seats by party - CCM 253, Chadema 70%, CUF 42%, other 2

Zanzibar House of Representatives - percent of vote by party - NA; seats by party - NA

highest court(s): Court of Appeal of the United Republic of Tanzania (consists of the chief justice and 14 justices); High Court of the United Republic for Mainland Tanzania (consists of the principal judge and 30 judges organized into commercial, land, and labor courts); High Court of Zanzibar (consists of the chief justice and 10 justices)

judge selection and term of office: Court of Appeal and High Court justices appointed by the national president after consultation with the Judicial Service Commission for Tanzania, a judicial body of high level judges and 2 members appointed by the national president; Court of Appeal and High Court judges appointed until mandatory retirement at age 60 but terms can be extended; High Court of Zanzibar judges appointed by the national president after consultation with the Judicial Commission of Zanzibar; judges may serve until mandatory retirement at age 65

subordinate courts: Resident Magistrates Courts; Kadhi courts (for Islamic family matters); district and primary courts

Alliance for Change and Transparency or ACT [Zitto KABWE]

Alliance for Democratic Change or ADC [Miraji ABDALLAH]

Civic United Front or CUF (Chama Cha Wananchi [Seif Shariff HAMAD, Secretary General]

National Convention for Construction and Reform - Mageuzi or NCCR-M [James Francis MBATCA]

Party of Democracy and Development or CHADEMA (Chama Cha Demokrasia na Maendeleo) [Freeman MBOWE]

Revolutionary Party or CCM (Chama Cha Mapinduzi) [John MAGUFULI]

Tanzania Labor Party or TLP [Augustine MREMA]

United Democratic Party or UDP [John Momose CHEYO]

note: in March 2014, four opposition parties (CUF, CHADEMA, NCCR-Mageuzi, and the National League for Democracy) united to form Umoja wa Katiba ya Wananchi (Coalition for the People's Constitution) or UKAWA; during local elections held in October, 2014, UKAWA entered one candidate representing the three parties united in the coalition

Economic and Social Research Foundation or ESRF

Tanzania Media Women's Association or TAMWA

Tanzania Private Sector Foundation or TPSF

ACP, AfDB, AU, C, CD, EAC, EADB, EITI, FAO, G-77, IAEA, IBRD, ICAO, ICC (NGOs), ICCt, ICRM, IDA, IFAD, IFC, IFRCS, ILO, IMF, IMO, IMSO, Interpol, IOC, IOM, IPU, ISO, ITSO, ITU, ITUC (NGOs), MIGA, MONUSCO, NAM, OPCW, SADC, UN, UNAMID, UNCTAD, UNESCO, UNHCR, UNIDO, UNIFIL, UNISFA, UNMISS, UNWTO, UPU, WCO, WFTU (NGOs), WHO, WIPO, WMO, WTO

chief of mission: Ambassador Wilson Mutagaywa MASILINGI (since 17 September 2015)

chancery: 1232 22nd Street NW, Washington, DC 20037

telephone: [1] (202) 939-6125

chief of mission: Ambassador (vacant); Charge d'Affaires Inmi PATTERSON (since 5 July 2017)

embassy: 686 Old Bagamoyo Road, Msasani, Dar es Salaam

mailing address: P.O. Box 9123, Dar es Salaam

telephone: [255] (22) 229-4000

FAX: [255] (22) 229-4970 or 4971

divided diagonally by a yellow-edged black band from the lower hoist-side corner; the upper triangle (hoist side) is green and the lower triangle is blue; the banner combines colors found on the flags of Tanganyika and Zanzibar; green represents the natural vegetation of the country, gold its rich mineral deposits, black the native Swahili people, and blue the country's many lakes and rivers, as well as the Indian Ocean

Uhuru (Freedom) torch, giraffe; national colors: green, yellow, blue, black

name: "Mungu ibariki Afrika" (God Bless Africa)

lyrics/music: collective/Enoch Mankayi SONTONGA

note: adopted 1961; the anthem, which is also a popular song in Africa, shares the same melody with that of Zambia, but has different lyrics; the melody is also incorporated into South Africa's anthem

Economy :: TANZANIA

Tanzania has achieved high growth rates based on its vast natural resource wealth and tourism with GDP growth in 2009-17 averaging 6%-7% per year. Dar es Salaam used fiscal stimulus measures and easier monetary policies to lessen the impact of the global recession and in general, benefited from low oil prices. Tanzania has largely completed its transition to a market economy, though the government retains a presence in sectors such as telecommunications, banking, energy, and mining.

The economy depends on agriculture, which accounts for slightly less than one-quarter of GDP and employs about 65% of the work force, although gold production in recent years has increased to about 35% of exports. All land in Tanzania is owned by the government, which can lease land for up to 99 years. Proposed reforms to allow for land ownership, particularly foreign land ownership, remain unpopular.

The financial sector in Tanzania has expanded in recent years and foreign-owned banks account for about 48% of the banking industry's total assets. Competition among foreign commercial banks has resulted in significant improvements in the efficiency and quality of financial services, though interest rates are still relatively high, reflecting high fraud risk. Banking reforms have helped increase private-sector growth and investment.

The World Bank, the IMF, and bilateral donors have provided funds to rehabilitate Tanzania's aging infrastructure, including rail and port, which provide important trade links for inland countries. In 2013, Tanzania completed the world's largest Millennium Challenge Compact (MCC) grant, worth $698 million, but in late 2015, the MCC Board of Directors deferred a decision to renew Tanzania's eligibility because of irregularities in voting in Zanzibar and concerns over the governments use of a controversial cybercrime bill.

Under the new government elected in 2015, Tanzania has developed an ambitious development agenda focused on creating a better business environment through improved infrastructure, access to financing, and education progress, but implementing budgets remains challenging for the government. Recent policy moves by President MAGUFULI are aimed at protecting domestic industry and have caused concern among foreign investors.

$162.8 billion (2017 est.)

$152.9 billion (2016 est.)

note: data are in 2017 dollars

$51.61 billion (2017 est.)

note: data are in 2017 dollars

household consumption: 65%

government consumption: 13.4%

investment in fixed capital: 34.3%

investment in inventories: -8.6%

exports of goods and services: 17.9%

imports of goods and services: -22% (2017 est.)

services: 47.6% (2017 est.)

coffee, sisal, tea, cotton, pyrethrum (insecticide made from chrysanthemums), cashew nuts, tobacco, cloves, corn, wheat, cassava (manioc, tapioca), bananas, fruits, vegetables; cattle, sheep, goats

agricultural processing (sugar, beer, cigarettes, sisal twine); mining (diamonds, gold, and iron), salt, soda ash; cement, oil refining, shoes, apparel, wood products, fertilizer

24.89 million (2017 est.)

services: 26.6% (2014 est.)

highest 10%: 29.6% (2007 est.)

expenditures: $9.271 billion (2017 est.)

8.25% (31 December 2010 est.)

3.7% (31 December 2009 est.)

15% (31 December 2017 est.)

15.96% (31 December 2016 est.)

$4.869 billion (31 December 2017 est.)

$4.601 billion (31 December 2016 est.)

$8.291 billion (31 December 2017 est.)

$7.613 billion (31 December 2016 est.)

$9.77 billion (31 December 2017 est.)

$9.625 billion (31 December 2016 est.)

$1.803 billion (31 December 2012 est.)

$1.539 billion (31 December 2011 est.)

$1.264 billion (31 December 2010 est.)

$-2.907 billion (2017 est.)

$-2.677 billion (2016 est.)

$5.194 billion (2017 est.)

$5.697 billion (2016 est.)

gold, coffee, cashew nuts, manufactures, cotton

Switzerland 15.1%, India 13.8%, South Africa 12.4%, China 7%, Kenya 6.2%, Democratic Republic of the Congo 5.7%, Belgium 5.6% (2016)

$8.61 billion (2017 est.)

$8.464 billion (2016 est.)

consumer goods, machinery and transportation equipment, industrial raw materials, crude oil

China 20.7%, India 18.1%, UAE 7.5%, South Africa 6%, Japan 4.7% (2016)

$4.174 billion (31 December 2017 est.)

$4.067 billion (31 December 2016 est.)

$15.88 billion (31 December 2017 est.)

$15.21 billion (31 December 2016 est.)

Tanzanian shillings (TZS) per US dollar -

Energy :: TANZANIA

population without electricity: 37,400,000

electrification - total population: 24%

electrification - urban areas: 71%

electrification - rural areas: 4% (2013)

6.025 billion kWh (2015 est.)

4.976 billion kWh (2015 est.)

71 million kWh (2015 est.)

1.187 million kW (2015 est.)

46% of total installed capacity (2015 est.)

0% of total installed capacity (2015 est.)

47.3% of total installed capacity (2015 est.)

6.8% of total installed capacity (2015 est.)

0 bbl (1 January 2017 est.)

60,000 bbl/day (2015 est.)

58,700 bbl/day (2014 est.)

1.1 billion cu m (2015 est.)

1.5 billion cu m (2015 est.)

6.513 billion cu m (1 January 2017 est.)

10 million Mt (2013 est.)

Communications :: TANZANIA

total subscriptions: 129,597

subscriptions per 100 inhabitants: less than 1 (July 2016 est.)

subscriptions per 100 inhabitants: 74 (July 2016 est.)

general assessment: telecommunications services are marginal; system operating below capacity and being modernized for better service

domestic: fixed-line telephone network inadequate with less than 1 connection per 100 persons; mobile-cellular service, aided by multiple providers, is increasing rapidly and exceeds 75 telephones per 100 persons; trunk service provided by open-wire, microwave radio relay, tropospheric scatter, and fiber-optic cable; some links being made digital

international: country code - 255; landing point for the EASSy fiber-optic submarine cable system linking East Africa with Europe and North America; satellite earth stations - 2 Intelsat (1 Indian Ocean, 1 Atlantic Ocean) (2016)

a state-owned TV station and multiple privately owned TV stations; state-owned national radio station supplemented by more than 40 privately owned radio stations; transmissions of several international broadcasters are available (2007)

percent of population: 13.0% (July 2016 est.)

Transportation :: TANZANIA

number of registered air carriers: 5

inventory of registered aircraft operated by air carriers: 17

annual passenger traffic on registered air carriers: 1,239,707

annual freight traffic on registered air carriers: 2,337,440 mt-km (2015)

gas 311 km; oil 891 km; refined products 8 km (2013)

narrow gauge: 1,860 km 1.067-m gauge; 2,707 km 1.000-m gauge (2014)

unpaved: 79,380 km (2010)

(Lake Tanganyika, Lake Victoria, and Lake Nyasa (Lake Malawi) are the principal avenues of commerce with neighboring countries; the rivers are not navigable) (2011)

by type: bulk carrier 10, container ship 9, general cargo 147, oil tanker 29, other 84 (2017)

major seaport(s): Dar es Salaam, Zanzibar

Military and Security :: TANZANIA

Tanzania People's Defense Force (Jeshi la Wananchi la Tanzania, JWTZ): Army, Naval Wing (includes Coast Guard), Air Defense Command (includes Air Wing), National Service (2007)

18 years of age for voluntary military service; no conscription (2012)

the International Maritime Bureau reports that shipping in territorial and offshore waters in the Indian Ocean remain at risk for piracy and armed robbery against ships, especially as Somali-based pirates extend their activities south; numerous commercial vessels have been attacked and hijacked both at anchor and while underway; crews have been robbed and stores or cargoes stolen

Terrorism :: TANZANIA

aim(s): attract Tanzanian recruits to support terrorist operations in Kenya and Somalia

area(s) of operation: maintains minimal clandestine footprint in key cities (April 2018)

Transnational Issues :: TANZANIA

dispute with Tanzania over the boundary in Lake Nyasa (Lake Malawi) and the meandering Songwe River; Malawi contends that the entire lake up to the Tanzanian shoreline is its territory, while Tanzania claims the border is in the center of the lake; the conflict was reignited in 2012 when Malawi awarded a license to a British company for oil exploration in the lake

refugees (country of origin): 224,033 (Burundi); 82,034 (Democratic Republic of the Congo) (2018)

current situation: Tanzania is a source, transit, and destination country for men, women, and children subjected to forced labor and sex trafficking; the exploitation of young girls in domestic servitude continues to be Tanzania's largest human trafficking problem; Tanzanian boys are subject to forced labor mainly on farms but also in mines and quarries, in the informal commercial sector, in factories, in the sex trade, and possibly on small fishing boats; Tanzanian children and adults are subjected to domestic servitude, other forms of forced labor, and sex trafficking in other African countries, the Middle East, Europe, and the US; internal trafficking is more prevalent than transnational trafficking and is usually facilitated by friends, family members, or intermediaries with false offers of education or legitimate jobs; trafficking victims from Burundi, Kenya, South Asia, and Yemen are forced to work in Tanzania's agricultural, mining, and domestic service sectors or may be sex trafficked

tier rating: Tier 2 Watch List - Tanzania does not fully comply with the minimum standards for the elimination of trafficking; however, it is making significant efforts to do so; in 2014, Tanzania was granted a waiver from an otherwise required downgrade to Tier 3 because its government has a written plan that, if implemented, would constitute making significant efforts to bring itself into compliance with the minimum standards for the elimination of trafficking; the government adopted a three-year national action plan and implementing regulations for the 2008 anti-trafficking law; authorities somewhat increased their number of trafficking investigations and prosecutions and convicted one offender, but the penalty was a fine in lieu of prison, which was inadequate given the severity of the crime; the government did not operate any shelters for victims and relied on NGOs to provide protective services (2015)

targeted by traffickers moving hashish, Afghan heroin, and South American cocaine transported down the East African coastline, through airports, or overland through Central Africa; Zanzibar likely used by traffickers for drug smuggling; traffickers in the past have recruited Tanzanian couriers to move drugs through Iran into East Asia

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What Does COVID-19 Still Have in Store for Africa? | World Economic Forum

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What Does COVID-19 Still Have in Store for Africa? | World Economic Forum

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What Does COVID-19 Still Have in Store for Africa?

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Coronavirus hasn't had the same the sort of devastating impact on Africa as it has elsewhere, according to official statistics. That may not last.

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All the latest news about Tanzania from the BBC

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Tanzania: Spread of COVID-19 could be devastating to refugees and host communities

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Doctors Without Borders/Médecins Sans Frontières (MSF) teams in Tanzania are concerned about the threat posed by the spread of the new coronavirus disease, known as COVID-19. Hundreds of thousands of people living in refugee camps here are highly vulnerable to infectious diseases and have limited access to health care services.

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"Coronavirus is a devil. It cannot live in the body of Christ. It will burn instantly. This is a time to build our faith."

These were the words of Tanzania's President John Magufuli.

While many countries around the world are closing their borders and implementing lockdowns and curfews to curb the spread of Covid-19, Tanzanians were instead urged by their president to congregate in places of worship to combat the deadly disease and to continue with all economic activities.

Many Tanzanians have expressed shock at the president's response to the arrival of the virus in the country, and are demanding the government take more drastic measures to ensure the disease does not spread.

"This disease is literally spreading all over the world," said 25-year-old Deogratias Mahinyila, a student at the Law School of Tanzania in Dar es Salaam, the country's commercial capital. "He should be banning people from congregating in churches - or anywhere else, not encouraging them."

"There seems to be a lack of seriousness [in the government]," he added. "We've seen that many countries in Africa are taking very serious measures. But in Tanzania, the government is taking this disease very lightly. They haven't even closed the borders yet."

Related article:

Critics say the Tanzanian government needs to ensure the safety of its 57 million citizens amid the global pandemic, which has seen more than 700 000 people infected with the highly contagious disease. On 30 March, the Tanzanian health ministry confirmed the total number of confirmed Covid-19 cases in the country had increased to 19. But the actual number is believed to be much higher. On 31 March, the health ministry reported the country's first death from coronavirus, a 49-year-old Tanzanian man in Dar es Salaam.

In Africa, more than 4 000 Covid-19 cases have been reported and there have been 135 deaths in at least 46 countries. Tedros Adhanom Ghebreyesus, head of the World Health Organization (WHO), told African countries to "wake up" and "prepare for the worst" during a news conference in Geneva.

Recently, Matshidiso Moeti, the WHO Africa head, said that about half the countries in sub-Saharan Africa still have a "narrowing" opportunity to curb the spread of coronavirus. She urged African governments to invest their efforts into aggressively tracing all contacts of imported cases, while "preparing for a possible, broader expansion of the virus".

Dangerous words

After the first Covid-19 case was confirmed in the small northern city of Arusha on 16 March 2020, the government announced the closure of all schools, including universities, and a ban on public gatherings - excluding religious activities.

Splitting with their East African neighbours Kenya, Rwanda and Uganda, which have sealed their borders and implemented strict measures to fight the disease, Tanzania has left its borders open and announced a mandatory 14-day quarantine for arrivals coming from countries "most affected" by coronavirus.

Zitto Kabwe, the leader of the ACT-Wazalendo opposition party, said the president's words were "dangerous".

"The population of our people is such that probably 50% of the people will believe what he says because we are very faith-oriented in Tanzania," he said. "And we have evidence that there are areas where [the coronavirus] has spread owing to religious gatherings."

A Muslim gathering held at a mosque on the outskirts of Malaysia's capital Kuala Lumpur, for instance, is the source of hundreds of new coronavirus infections across Southeast Asia. Meanwhile, in South Africa, the worst-hit African country with more than 1 300 confirmed Covid-19 cases, a church gathering in the Free State has been connected to a cluster of positive cases.

20 March 2020: A man sells face masks on the streets of Arusha a few days after the first reported Covid-19 case in Tanzania. (Photograph by Jaclynn Ashly)

"It's making our citizens believe that the virus is not as contagious as it is," Kabwe said. "So it has made it so people have been going on with their normal life activities. With the exception of more hand washing and using more hand sanitiser, people are continuing to live as normal."

Fatma Karume, a lawyer and former president of the Tanganyika Law Society (TLS), said the government's response was "strange and disheartening" because "it implies that the only way out for us is prayers as opposed to any other measures based on modern scientific knowledge".

Karume, however, said she was "past the point of surprise".

Since Magufuli was elected in 2015, he has been the target of scathing criticisms for eroding freedoms of speech in the country, cracking down on civil society and journalists, and muffling democracy by banning political gatherings and routinely arresting opposition figures.

"It has been years of this," she said. "I would be insane after seeing the manner in which this government conducts itself to expect any better from them. You only get disappointed if you have expectations. I don't have any expectations of my government."

Not adequately prepared

For Freeman Mbowe, the chairperson of Tanzania's main opposition party Chadema, the government's policies hit close to home. His son, 26-year-old Dudley Mbowe tested positive for Covid-19 on 20 March. He was sick for about a week before he was tested. He picked up the virus in Dar es Salaam, where the Mbowe family lives. He had not recently travelled.

"He was living with the family. He interacted with his parents, brothers, sisters and friends - and no one knew he had coronavirus," Mbowe, who is now self-isolating at his home in Tanzania's capital Dodoma, said. "But once he was diagnosed you would have expected that the whole family and everyone who had been in direct contact with him would have been quarantined to make sure the disease doesn't spread."

But Mbowe said most of the individuals who had been in contact with Dudley were not provided "any kind of supportive engagement" from the government to ensure the virus was controlled. They decided on their own to take precautions, with Mbowe self-isolating in Dodoma and the rest of the family quarantining themselves at their home in Dar es Salaam.

Related article:

According to Mbowe, it took about a week for him and his family to be tested after Dudley's test came back positive. It then took several days for Mbowe to receive the results, which have since confirmed that Mbowe and his other family members are negative for the virus; however they will all continue isolating as an added precaution.

Dudley has remained in the isolation ward of the Temeke Hospital in Dar es Salaam since testing positive. According to Dudley, there are less than 30 beds in the isolation ward and there is a clear lack of medical equipment.

"My son has been sick now for the last 10 days," Mbowe said. "He's coughing constantly, and he hasn't been able to get a chest X-ray because they don't have mobile X-rays at Temeke."

"I've been constantly complaining - and, mind you, I'm the leader of the opposition in this country - and I still have not been able to get my son an X-ray. Besides the beds, there doesn't seem to be much else there [in the isolation ward]."

Mbowe said he did not think the government was "adequately prepared" for a potential outbreak. "Now we're dealing with a few patients, but in the next few weeks we could be dealing with many patients. If that becomes a reality, it will be a huge crisis for this country because we're simply not prepared."

Tanzania already suffers from a shortage of medical equipment and trained personnel. Experts have warned that countries with weak healthcare systems and infrastructure, like Tanzania, could become quickly overwhelmed by the virus.

Meanwhile, policies put in place by the Tanzanian government have been marred by shortcomings. For instance, arrivals in the country have complained that the hotels the government has designated for mandatory two-week quarantines are too expensive.

In one video shared widely on social media, a woman at the Peacock Hotel in Dar es Salaam, where a single room costs $55 (just under R1 000) per night - the cheapest of the options available - said government officials escorted her to the hotel and then just left.

Related article:

Ummy Mwalimu, Tanzania's health minister, has since ordered regional commissioners in the country to identify more affordable facilities for those being quarantined.

Atiya Sumar, the head of programmes and business partnerships at the British Council in Tanzania, posted on her Twitter account that last week her son returned to Tanzania from the UK, which has reported almost 20 000 coronavirus cases and more than 1 000 deaths, and went straight to one of the designated hotels for quarantine. But many people arriving on the same flight skipped the quarantine and went home.

Comprehensive national plan

Mbowe, along with other opposition leaders, activists and intellectuals, has urged the Tanzanian government to immediately seal the country's borders and be clear and transparent about its national plan to prepare for a potential outbreak in Tanzania.

Besides erecting more hand-washing stations outside business and offices, announcing the formation of cabinet committees and posting photos of government officials visiting hospitals that will be treating coronavirus patients, very little has been revealed about the specifics of the government's plans to combat the pandemic.

"It's not just about providing some equipment at the isolation wards for patients who are already diagnosed," Mbowe said. "We need to have a comprehensive national plan and it must be shared in detail with the public. We need to act quickly. For instance, we could be converting the dorms of now empty university buildings into makeshift hospitals."

Such preparations for a Covid-19 outbreak are already under way in other countries. For instance, Brazil, which now has thousands of confirmed cases, is transforming more than half of its football stadiums into field hospitals to prepare for an inevitable surge of coronavirus-related hospitalisations.

Related article:

"Tanzania is part of the global community," Mbowe told New Frame. "Corona has no borders. It has no race. It can attack anyone. Therefore, Tanzania cannot live in isolation. For our country to be able to face the challenges that will come along with this virus, our government must accept reality."

"But unfortunately, it doesn't seem like our president understands the gravity of the situation and is refusing to adopt the serious policies that all other countries are doing to protect their citizens."

Mbowe also underscored the importance of developing testing centres in each administrative region of Tanzania, noting that the country's testing capabilities at the moment are extremely limited since all samples must be sent to one lab in Dar es Salaam.

"Your preparations cannot be based on the belief it won't get bad," Mbowe added. "If you prepare adequately and then it doesn't happen in the way it happened in Italy or Spain, then lucky you. But if it does happen, at least you're somewhat prepared."

Kabwe recently published an open letter to the president, in which the opposition figure urged the government to be more transparent on data related to Covid-19 patients, to enhance the government's communication with the public on issues related to the pandemic, to suspend all government meetings, including parliament and the courts, to release bailable and vulnerable prisoners, and to close the borders.

Deep mistrust

New Frame asked the offices of the prime minister and health ministry for comment many times, but did not receive a response.

When New Frame requested a comment from Hassan Abbas, the government's chief spokesperson who is in charge of channelling all information related to the government's Covid-19 response, he replied: "I don't know what you are referring to as government [sic] not taking serious measures. Who measures other country's measures? What set of measures should be taken to say the government is serious? That's why we have no time to engage in such uninformed debates."

Abbas refused an interview with New Frame and would not provide more information on the equipment and beds available for Covid-19 patients at the Temeke Hospital in Dar es Salaam.

Semi-autonomous Zanzibar, meanwhile, has decided to follow the global trend, splitting with the central government's policies and closing its borders to curb the spread of the virus.

Many Tanzanians have criticised the central government for their slow pace when sharing information related to Covid-19 with the public. Others do not trust the government's numbers at all. As neighbouring countries have continued to report a steady increase in positive cases, Tanzania's numbers have climbed slowly, despite the government taking a much less aggressive approach to containing the virus, which has sparked suspicions among some.

Related article:

Karume said this public distrust stems from the "government's need to control statistics". In 2018, the Tanzanian parliament amended the Statistics Act of 2015, which had already made it a crime for Tanzanians to disseminate "false official statistics," to make it a jailable offense to publish statistics without the approval of the National Bureau of Statistics. However, last year the Tanzanian parliament removed this amendment, which would have threatened civil society groups with prison terms for publishing independent statistics.

"[Magufuli] pushed this narrative and agenda and made it so people were scared to even discuss alternative figures or statistics to those put out by the government," she said. "When you try and give yourself legitimacy not through open discussions, but through force, you're creating a society that can no longer trust you."

This would not be the first time the Tanzanian government has been criticised over its handling of deadly diseases and its lack of transparency. Last year, the WHO issued a rare public rebuke against the Tanzanian government for its failure to provide detailed information on suspected Ebola cases in the country - an allegation the government has denied.

In 2016, Magufuli also fired Mwele Malecela, then director-general of the National Institute of Medical Research, for going public with a report that detailed findings of the Zika virus among the Tanzanian population. Malecela now heads the department of control of neglected tropical diseases at the WHO.

Last year, during a political rally, Magufuli admitted to firing Malecela because she was sent by "imperialists" to "announce we have the disease so that tourists would not come to our country".

For Mbowe, he feels lucky that his son was one of the first to contract the virus - before the hospitals become overwhelmed with patients.

"In the near future, the magnitude of patients that will start flowing into the hospitals will be so big that we're not going to be able to cope," Mbowe said. "How many unlucky families out there are going to become the victims of this?"

"The rest of the world is locking down. But in Tanzania the bars and restaurants are open. We're functioning as if nothing is happening. Our preparedness is hoping that God protects us. But God will not protect people who cannot protect themselves."

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Tanzania's state response to Covid-19 under fire

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"Coronavirus is a devil. It cannot live in the body of Christ. It will burn instantly. This is a time to build our faith." These were the words of Tanzania's President John Magufuli.

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Regardless of race, culture or status, people around the world are suffering in the shadow of the COVID-19 pandemic. Hardships range from the most debilitating - such as hunger and homelessness - to crippling psychological effects such as fear, loneliness and anxiety. Despite this new reality, all around us we see the very best of humanity coming to the fore. From simple acts of neighbourly kindness to extraordinary corporate and health innovations; in societies across the world we are witnessing more care than indifference, more steadfastness than despair.

We are also each called upon as individuals to contribute to relief efforts, wherever possible. This includes South Africa's Solidarity Fund, to which I am personally proud to make a contribution over the coming months. I would like to appeal to all fellow South Africans who are fortunate enough to be able to assist in the fight against the pandemic, to do so in whatever way they can.

Naturally, with people now increasingly physically isolated in various state lockdowns, mobile and fixed networks become even more critical to keep societies functioning. Vodacom's numerous teams in countries across the African continent are working hard and in testing conditions - during these unprecedented times - in order to keep communities, businesses and governments connected. We are also seeing the development of some exciting innovations which harness the power of technology to help fight the virus.

Maintaining Network service quality

Vodacom's operations in South Africa, Tanzania, Lesotho, the DRC and Mozambique have all recently experienced extraordinary growth in network traffic. We have undertaken various measures to ensure that our network quality across the continent will not be compromised in the coming months. In South Africa, Vodacom will spend over R500 million within the space of two months to add network capacity during the national emergency lockdown period, to ensure customers continue to enjoy a seamless experience as more people work from home and use online platforms for schooling their children and for entertainment. Both Vodacom Tanzania and the DRC are prioritising network optimisation for areas that need improvement as well as network resilience. In Lesotho, equipment is being purchased to increase capacity in identified hotspots and, in Mozambique, plans have been initiated to provide additional support to all critical sites.

Support services for e-Learning

With many children unable to attend school in person, e-Learning becomes even more important during the COVID-19 pandemic. Vodacom e-School in South Africa, a free curriculum-aligned service for subscribers, has seen user registrations on the platform increase to over 1 million. In March alone, we saw over 100 000 new registrations, a four-fold increase in the number of new registrations on the platform compared with February. In addition to providing special bundles to universities so that students can access e-learning platforms, we have expanded our zero-rated offering to all public schools, universities and T-Vet colleges across the country to ensure that students enrolled into these institutions will be able to access relevant information for free via these portals.

Vodacom Tanzania continues to promote its free education platform for students and Vodacom DRC offers VodaEduc, a zero-rated learning platform. Vodacom Mozambique is working on providing free internet for the government's e-learning portal and free access to university portals with the Minister of Science and Technology. Finally, Vodacom Lesotho is providing free data access to 101 schools, with plans to connect an additional 59 schools by July 2020.

Providing support to African governments

There have been various initiatives across our operations to support African governments in combating the spread of the virus. Some of these examples include:

In South Africa, Vodacom Group will donate 20 000 smartphones plus 100 terabytes of data and 10 million voice call minutes to the National Department of Health to collect and transmit data in real time for resource planning purposes as government accelerates its COVID-19 testing campaign. Vodacom South Africa recently entered into a partnership with Discovery Health, the country's largest administrator of medical schemes, to offer free virtual consultations with doctors to the general public to alleviate pressure on the country's healthcare system by assisting in diagnosing COVID-19 as well as treating it. We have also zero rated a number of critical websites such as www.sacoronavirus.co.za , the South African Unemployment Fund (UIF) as well as public hospital and clinic websites through the ConnectU platform. In partnership with the National Department of Health, we have sent out numerous text messages to our 44 million customer base to raise awareness around hygiene etiquette as well as the official COVID-19 WhatsApp line.

In Tanzania, we recently made a donation of $1 million both to the Central Government committee driving National Response Plans on COVID-19 and the Government of Zanzibar to be used towards purchasing medical equipment. Through the Vodacom Tanzania Foundation, Vodacom is providing the Ministry of Health and ICT Departments with 10 Mobile Routers and bundles to assist them in their response efforts.Vodacom Tanzania has also provided a zero rated data link to the country's government COVID-19 team to assist with communication and provide free data access to the National Institute of Medical Research. This is in addition to zero rating access to several government websites with awareness campaign content and other information on COVID-19. Vodacom Tanzania has also partnered with the Ministry of Health on an awareness campaign utilizing various its channels of communication including SMS, IVR, Video in addition to zero rating education portals of higher learning institutions.

In the DRC, Vodacom is providing an SMS broadcast to its entire customer base with information and updates from Government around the pandemic. Vodacom DRC is also building a zero-rated ConnectU platform which will include the provision of COVID-19 info. Vodacom DRC is also offering the government a zero rated short code that allows the general public to call into specialised Ministry of Health agents to ask about COVID-19 symptoms and guidance. It has also zero rated all government websites and applications that inform the public about the pandemic.

In Mozambique, Vodacom is providing free connectivity to ministries, airports and NGOs. In addition to this, Vodacom Mozambique is in discussions with the Ministry of Health to offer support around geo-data tracking and big data analytics.

In Lesotho, Vodacom has sponsored a toll-free call centre and WhatsApp line for information and guidance around the pandemic. Vodacom Lesotho has further donated 1,000 mobile phones to Government for use in efforts to track and contain the pandemic. Vodacom Lesotho is also allocating data and voice call minutes to 6,000 health workers to enable easy communication and access to crucial COVID-19 related information. Additionally, Vodacom has zero rated access to educational and health websites in order to enable easy access to information by citizens and continued digital access to education during the national lockdown and beyond. Vodacom is also sponsoring radio communication from the Ministry of Health to update the general public as well as answer questions about COVID-19. In order to facilitate easy access to mobile financial services, Vodacom has implemented zero fees for merchant transactions of up to M50.00 and zero transaction fees for person to person money transfers of up to M100.00.

Some of Vodacom's operations use big data analytics to provide aggregated data to governments to help track the spread of the disease, as well as to monitor population movements. In South Africa, Vodacom continues to offer its support to government, including national and provincial departments of health, in helping to prevent the spread of Coronavirus through providing population movement insights. This includes offering the use of location services, which is based on aggregated and anonymised information. These insights can assist decision makers in understanding how people are responding to various COVID-19 interventions, such as the national state of disaster lockdown. This data is aggregated to municipality, district and province level and the information may be used to improve the speed and precision of resource allocation, where needed.

Supporting Small and Micro Businesses

It is critical that small and micro businesses across the continent remain supported during the pandemic. In South Africa, Vodacom is extending loans to SMEs to assist them with cash flow challenges. Vodacom Tanzania is currently assessing the risk of SMEs shutting down, and a payment plan will be put in place for customers who need support. In the DRC, additional data allocations have been provided to SMEs and work from home services have been extended to all Vodacom enterprise customers in the region. Vodacom Mozambique is looking to introduce special work at home packages for SMEs. Vodacom Lesotho has identified vulnerable sectors for special assistance and is also considering providing a combination of payment holidays or discounts to SMEs over a four month period.

Maintaining M-PESA platform, enabling cashless payments and financial services

Vodacom's operations in Lesotho, Mozambique, DRC and Tanzania have introduced various changes to make it easier to use the M-PESA service during state lockdowns. These include increasing daily wallet limits, waiving some of the P2P fees and merchant payments fees paid by customer, reducing transaction fees and promoting the use of M-PESA over in-shop purchases to limit interactions between people and curb the spread of the virus. As an example, Vodacom Lesotho has implemented zero fees for merchant transactions up to the value of M50.

Vodacom: supporting you through this crisis

Vodacom is proud of the various innovations and public private partnerships which pool the best talent and technology to find new ways to flatten the curve of the virus. As a leading African telco, we have a clear duty as part of our social contract to provide access to essential services to as many people as possible. We remain determined to keep the continent confidently connected during the coming months as we make every effort to offer support to our customers and staff during this once in a lifetime event.

Vodacom South Africa has already experienced a notable increase in fixed and mobile traffic during the lockdown. Maintaining our network service quality remains our top priority and we will continue to increase our network investment spend to manage the extraordinary traffic increases in the short term. We will continue to do everything in our power to support all governments throughout our African operations in whatever way we can.

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Vodacom helps to flatten the COVID-19 curve through technological innovation

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Regardless of race, culture or status, people around the world are suffering in the shadow of the COVID-19 pandemic. Hardships range from the most debilitating - such as hunger and homelessness - to crippling psychological effects such as fear, loneliness and anxiety.

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ARUSHA, Tanzania

"Corona!" one man hollered, laughing and pointing at the white mask tied around my face as I weaved through the traffic on a motorbike taxi last week in Arusha, a small city in northern Tanzania.

"Vipi corona (How's the corona)?" another man yelled from his car window, throwing a thumbs up and flashing a wide smile.

Jackson, the motorbike taxi or boda boda driver, shook his head. "They are laughing. But in reality everyone is scared. But no one knows what they should do about it," he told The New Humanitarian. "We're just hoping it doesn't make it here."

About an hour later, on Monday, 16 March, the Tanzanian health ministry confirmed the country's first case of COVID-19 at the government-run Mt. Meru Hospital in the centre of Arusha, a city of 463,000 people at the base of Mount Meru, not far from Kilimanjaro.

Discussions overheard on the streets, bars, and restaurants became sprinkled with the word "coronavirus". Friends running into each other skipped over usual greetings, replacing them with: "Umesikia? Corona imefika (Have you heard? Corona has arrived)."

Within an hour of the announcement, more and more Tanzanians were crowding the pharmacies and purchasing protective masks, hand sanitiser, and plastic gloves. Bottles of hand sanitiser doubled in price and then quickly sold out.

COVID-19, which the World Health Organisation has declared a global pandemic, had not only arrived in Tanzania, but had landed in Arusha, its tourist capital.

Ummy Mwalimu, Tanzania's minister of health, held a press conference and urged Tanzanians to keep calm. But panic, for many, had already set in.

'Prepare for the worst'

Frank Massawe, known locally by his nickname "Dikteta", is a boda boda driver in Arusha - a cosmopolitan city and diplomatic hub. He began taking precautions when the first COVID-19 case was reported in Nairobi, about a five-hour bus ride from Arusha, on 13 March. Kenya now has 25 confirmed coronavirus cases.

"I knew that if it was already in Kenya it was only a matter of time before it got here," Massawe told TNH as he pulled his blue surgical mask down to his chin so he could speak more easily. "I began buying masks, disposable gloves, and speaking to people on the streets to understand the best ways I could be protecting myself."

Massawe has watched in dismay as the death toll has continued to rise by hundreds each day in Italy, with COVID-19 killing thousands across Europe and North America.

First declared in the Chinese city of Wuhan in December, the virus has up until recently spared African countries. But in the last few weeks it has spread rapidly across the continent. More than 2,000 COVID-19 cases have now been confirmed in Africa in more than 40 countries, with South Africa being the worst hit in the sub-Saharan region.

More than 425,000 people around the world are now known to have been infected (the real number is thought to be much higher), and almost 20,000 people have died.

Tedros Adhanom Ghebreyesus, director-general of the WHO, urged African countries last week to "wake up" and "prepare for the worst" during a news conference in Geneva, warning of undetected and unreported cases across the continent.

'This isn't like malaria'

On Tuesday, the day after the announcement of the first COVID-19 case - a 46-year-old Tanzanian national who had arrived in Arusha from Belgium - hand sanitiser continued to be out of stock in most shops and pharmacies in the city. Men appeared on the streets hawking protective masks, while some people could be seen wearing full-on gas masks.

Abduli Hissa, a bajaji (or tuk tuk) driver in Arusha, now sells face masks on the side. He buys the masks in bulk, paying $43 for 20, and then sells each one for $4, a tidy profit.

Tanzanian Prime Minister Kassim Majaliwa announced the closure of all schools (extending this to universities the following day) and banned all public gatherings, excluding prayer activities. Arusha's Regional Commissioner Mrisho Gambo warned that anyone hiking the prices of hand sanitiser would face consequences.

Despite the bans and warnings, the bars in Arusha were still packed over the weekend, and the price of hand sanitiser was still stratospheric, with 500 millilitre bottles being sold for around $22 - an unaffordable price for many residents of the city.

Handwashing stations quickly appeared outside many hotels, businesses, and shops. Pharmacists showed customers how to mix methylated spirits with glycerin when their stock of hand sanitiser ran out, or for customers who couldn't afford the jump in prices.

But not every Tanzanian was taking the disease seriously. One man, seated next to Massawe, said: "If you die, you die. But this is a white people flu. We Africans will be fine. Malaria kills more people than corona."

More than one million people do die each year from malaria - the overwhelming majority under the age of five in sub-Saharan Africa.

However, there is a demand for the government to do more to prevent the spread of coronavirus, and to more adequately inform the public. "They need to take more precautions," Massawe said. "This is something new, and it's something very big. This isn't like malaria."

"We won't be able to stock up on food and hide in our homes for a month like they do in Europe," he said. "We need a real plan to prevent its spread."

'I'm freaked out'

Hassan Mohammad, 46, lives in a small room with his 27-year-old girlfriend Irene Abdulrahman, who cradled Zamzam, their three-month-old baby, in her arms when TNH visited. The couple live in a shared compound with more than a dozen other people in Kaloleni, a densely populated area of the city.

Mohammad intermittently peeked into his younger brother's room, located next to his, to watch the TV and catch more news on the COVID-19 case in Arusha, as several children laughed and rolled a tyre around the communal, open-air area.

On Wednesday, 18 March, two more COVID-19 cases were confirmed - in the commercial capital, Dar es Salaam, and semi-autonomous Zanzibar. Both were foreign nationals, from the United States and Germany. Both countries have reported tens of thousands of cases of the deadly virus, while almost 800 people have died in the United States.

"Frankly speaking, I'm totally scared. I'm freaked out," Mohammad said. "Any human being who is mentally okay has to be worried about this. If it's this contagious and it spreads this quickly, we all have to be worried."

However, Mohammad said he hadn't received any information from the government before the announcement of the first COVID-19 case, except for a commercial that appeared on the TV once every few hours showing Tanzanians how to properly wash their hands.

Abdulrahman, Mohammad's girlfriend, told TNH: "I have seen the news on TV. I've seen that it has been killing many people in Europe. I have no idea what else to do except wash my hands. I'm very frightened, but I have to believe the government will be able to handle this."

But, in Arusha, frustrations with the government were palpable.

"Many people are scared and we feel like the government is moving too slowly. It seems like they are just dragging [their feet]," Mohammad said. "I have about 30 percent trust in the government to handle this. The other 70 percent will just depend on us and what we decide to do as common Tanzanians."

This sentiment was prevalent among residents in Arusha. Juma, an employee at a safari airline who asked TNH to use a pseudonym to protect his identity, said he didn't believe the government had been prepared for a possible outbreak and wasn't taking the crisis seriously.

He referred to an earlier press conference - in response to the first COVID-19 case being reported in South Africa - when Mwalimu, the health minister, said: "I believe that God is going to protect us during this tragedy."

"Can you imagine a government saying this? I was so frustrated by this," Juma said. "This isn't right. We've had a more than two-month headstart on this. It was bound to come to Tanzania. We should have been preparing and creating awareness and making sure everyone had the information and education they needed so that they would know exactly what to do when the virus arrives."

Janneth Mghamba, assistant director of the epidemiology and disease control section of the health ministry, told TNH that "misinformation broadcasted by various media" was the cause of the population believing the government wasn't prepared.

"We've been preparing for this even before the WHO called this a pandemic," Mghamba said, citing a preparedness system the government put in place in 2015 in response to the Ebola outbreak in West Africa. "We also strengthened the ports of entry because we thought we would get an imported case," she said.

Mghamba said Tanzania had been using thermal scanners as an "initial screening mechanism" and walk-through thermal scanners at the airports, while passengers from high-risk regions had been asked to fill out surveillance forms upon arrival so that authorities could quickly follow up with them.

However, experts have warned that temperature checks at airports are insufficient, as it can take two to 14 days for those infected with the coronavirus to develop symptoms. Infected passengers can easily pass through airports undetected - as was the case for several of the patients who tested positive for COVID-19 in Tanzania.

Mghamba said the government had released funds for the hospitals to begin procuring more equipment, such as ventilators. At Mt. Meru Hospital, there is an eight-room isolation building that was constructed in 2015 during the country's Ebola preparations, and a quarantine tent area has been erected inside the hospital grounds with a capacity of 20 to 30 beds, she said.

"I want to assure the community that we are on track, according to the WHO standards and assessments," Mghamba added.

'I was sent into a panic'

On the day the government announced the country's first COVID-19 case, Francis Kembo, a 52-year-old tour guide, was on his six-hour drive home to Arusha from Mwiba Lodge in the Serengeti when he received a call from his wife, who works as a nurse at Mt. Meru Hospital.

"She told me that there was a problem at the hospital and that she needed to stay later to answer some questions and run some tests," he recounted, sitting on a chair in a small work shed beside his house. "Right when she said that, it immediately clicked. I heard about the COVID-19 case in Arusha, but I wasn't even thinking about her being on duty that day."

"All of us have been watching the news and seeing what's happening in Europe," Kembo said. "And then suddenly it was here, and right in front of us. It sent me into a panic."

According to Kembo, Isabella Mwambapa, Tanzania's first COVID-19 patient, had come to the hospital on Sunday asking to be tested for the disease. When her test came back positive the following day, Kembo's wife and other medical staff were asked questions about their contact with the patient and given a COVID-19 test. Kembo's wife was allowed to go home that night.

In a panic, Kembo, still en route home, called his daughter - one of his five children aged between four and 24 - and told them all to stay inside and not interact with anyone. He also told his children to keep track of every person they had been in contact with over the last day.

"My wife was around the coronavirus patient, and then she went home and interacted with the family," he said. "I was shocked that the hospital was not more concerned about the possibility of my family contracting it."

Kembo did not have any information on how to handle the situation, and sent around a frantic WhatsApp message to various groups, pleading for help or advice on what to do now that his family may have been infected with the virus.

Someone sent him two emergency hotline numbers set up in preparation for a possible COVID-19 outbreak. However, according to Kembo, one of the lines didn't work and the other remained busy for four hours. He was unable to get through to anyone.

Kembo had considered bringing his children to the hospital to be tested, but was too worried he would infect others on the way if it turned out they were carrying the virus.

His wife, along with 27 others who were quarantined in Arusha after having contact with Mwambapa, tested negative for COVID-19. But Kembo is keeping his family in semi-quarantine for 14 days as an added precaution - despite his wife continuing to go to and from work at the hospital.

Kembo has since calmed down from the initial shock of being in such close proximity to the virus.

Mghamba, at the health ministry, told TNH that there are different guidelines applied to different contacts, depending on the risk factors, and that "you can't just come to the hospital and say you want to be tested".

"You get tested only after you're assessed by an expert," she added. Mghamba also assured TNH that the government has since expanded the emergency call centre.

Tanzania has only limited testing capabilities. All tests for COVID-19 are sent to a lab in Dar es Salaam, and it takes at least 24 hours to get the results.

While Kembo believes the government should be doing more, he doesn't blame them either. "We're an inexperienced nation in this kind of situation," he said. "But we need to do everything possible to prevent the spread of this disease."

"For instance, someone from the government should have come to speak to my family or at least listened to our concerns," he continued. "What if my wife did have the virus? And then it was spread to us? And then my children spread it to others? We're just giving it time to spread. But we should be doing every single thing we possibly can to prevent it from spreading."

"Once it spreads, we will have no way of containing it. We don't have the resources," he added. "We can't put whole cities under quarantine like they are doing in Europe. Most people here live hand to mouth. We would end up having to choose which death we prefer: coronavirus or hunger."

But Kembo urged Tanzanians to trust the authorities. "I'm sure the government will do everything they can to keep the situation under control," he said. "I don't think there's any government in the world that wants to see their people die."

Hundreds of millions of people around the world are now living under lockdowns to curb the spread of the virus. For many in Tanzania, however, the effects of such measures would cause economic devastation.

While other governments, including neighbouring Kenya, have mobilised resources to assist those who have lost their jobs or who have been adversely impacted by the closure of borders and businesses, the Tanzanian government has not announced any plans to cushion an economic collapse if the virus were to spread.

"In Tanzania, people work to live for just one day," Juma, the safari airline employee, said. "So people are really scared. If someone loses their job for just two days, that would have a massive impact on a person's life. People wouldn't be able to survive anymore and this is causing even more fear."

"We know from the rest of the world how quickly this virus can get out of control," he added. "So the fact that the government is not planning anything ahead of what's right in front of them is causing all of us a lot of worry."

'There's not much I can do'

Despite several days having passed since the virus arrived in Tanzania, Marta Munuo has never heard of hand sanitiser. The 72-year-old owns a small shop in Moshono, near the centre of Arusha. She sells basic products, such as sugar, soda, cigarettes, and eggs.

Munuo heard about the virus through the radio and was told by one of her customers that boiling hot water and mixing lemon together would prevent people from contracting COVID-19. Despite the Tanzanian ministry's claims that it has worked diligently to inform its citizens about coronavirus and the precautions to take, misinformation is still rampant. Others have said ginger and drinking plenty of water can ward off COVID-19.

"I get most of my information from the customers who come to my shop," said Munuo. She, like many impoverished Tanzanians, doesn't own a phone that can check the health ministry's website for information. "I get very little information from the government itself. I've only heard that I should be washing my hands."

However, Munuo's shop, where she also sleeps, has no running water. She must fetch water from other people's homes and carry the buckets back to the shop. Three 20-litre buckets last her about five days. One bucket is used for drinking, while the others are used for washing dishes and cleaning the toilet.

Asked what else she knew about COVID-19, Munuo replied: "I know that the main symptom is a cough. And I know that if you're infected, the blue part of the mask should be outside, and if you're not infected the blue part of the mask should be on the inside."

If she begins to feel symptoms, Munuo said she believes she needs to travel to a hospital in Dar es Salaam, more than 10 hours by bus from Arusha.

In reality, the health ministry has said those showing symptoms can go to any hospital. However, government hospitals in Tanzania are often overcrowded, and if an infected person is not educated on how to protect others, they could easily spread the disease - whether at the hospital or en route on public transport.

Mghamba assured TNH that the emergency hotlines would explain how to best handle each situation based on the caller's symptoms.

Munuo, however, said she didn't know what precautions she should take if she believed she had contracted the virus and had still not been made aware of any emergency hotline numbers.

"There's not much I can do," she said. "I will drink plenty of lemon water and pray to God it will go away."

Not a single person TNH spoke to was aware that testing and treatment for COVID-19 would be free in Tanzania, despite the health ministry confirming these details.

Azizi, an Arusha resident who requested that TNH not use his real name for fear of reprisal, said the government must do more to inform its citizens of the seriousness of the virus and what precautions they should take.

"I will drink plenty of lemon water and pray to God it will go away."

"You cannot just keep telling people to wash their hands or practise social distancing," he said. "Maybe these things work in the West, but here we have people with no water and we have people who don't have the ability to practise social distancing."

They are "too poor to order a private taxi each time they need to leave the house," he said. "They have no choice but to get on congested buses."

Azizi noted that the information the government was disseminating was too general to put Tanzanians at ease.

"We need people from the government out on the streets and teaching people how to keep them safe," he said. "They should be teaching the dala dala drivers how to sanitise their vehicles. We need them to take decisive action against this disease.

"And they should have been doing this a month ago."

'We need the government to take more drastic measures'

On Sunday, during a live address to the nation, Tanzanian President John Magufuli confirmed that the COVID-19 cases in the country had doubled to 12 within a few days - four were foreign nationals and the rest Tanzanians.

"I believe if Tanzanians follow the advice of the specialists and stick to it, we will defeat coronavirus like other enemies," the president said.

He also encouraged Tanzanians to continue to gather at their places of worship. "These holy places are where God is. My fellow Tanzanians, let us not be afraid of going to praise him," he said, adding that COVID-19 cannot survive in the "body of Christ".

To the confusion of many Tanzanians who believed Magufuli would follow the example of their East African neighbours and announce strict measures to control the spread of the virus, Magufuli instead said that any arrivals from the most affected countries would be quarantined for 14 days at designated locations at their own expense. However, it was unclear if measures were being implemented to enforce the quarantines.

For many Tanzanians, this was not enough.

"If this thing continues to spread here, many of us are going to die."

In Kaloleni, Mohammad chain smoked cigarettes by the door, taking long drags, tilting his head, and blowing the smoke outside, while his girlfriend breastfed their newborn baby on the bed.

"It's scary that our government seems even less worried than European governments," said Mohammad, his eyes wide and anxious.

"We need the government to take more drastic measures. They need to completely shut the border. They cannot afford to let this get out of control. Europe has an advanced healthcare system, while we don't even have enough doctors as it is."

"We're not rich like Europe, and they can't even control this virus," he continued. "Imagine what would happen to us here in a country like Tanzania?"

"The government tells us not to panic. But they seem so relaxed about this, and it's making us panic even more. If this thing continues to spread here, many of us are going to die."

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ARUSHA, Tanzania "Corona!" one man hollered, laughing and pointing at the white mask tied around my face as I weaved through the traffic on a motorbike taxi last week in Arusha, a small city in northern Tanzania. "Vipi corona (How's the corona)?" another man yelled from his car window, throwing a thumbs up and flashing a wide smile.

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Tanzania Needs to Urgently Invest in the Health and Education of its Youth – New World Bank Report

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Tanzania Needs to Urgently Invest in the Health and Education of its Youth – New World Bank Report

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DAR ES SALAAM, July 18, 2019 - Tanzania needs to undertake important and urgent investments to accelerate progress in the health and education of its citizens, especially the youth, if the country is to improve its human capital for sustainable development, according to the latest Economic Update published by the World Bank.

In recent years, Tanzania has made gains in human development, with reduced under-five mortality, an increase in the average number of years of schooling for its youth, and improved adult survival. However, its human capital index (HCI) of 0.40 means that children born today in Tanzania may reach only 40 percent of the earnings that they could have attained with full health and education.

"Tanzania's wealth has increased by 45 percent since 1995 and this is an important achievement, but the country's population has also grown, leading to a decreasing of per capita wealth which is not sustainable," says Bella Bird, World Bank Country Director for Tanzania. "For the country to achieve sustained and inclusive growth, it needs to make a concerted investment in its people, as human capital is the most important asset of any country."

The World Bank launched the HCI in October 2018, as part of the new Human Capital Project to encourage countries to invest more and better in their people. The index focuses on five factors that have an important bearing for future earnings: the survival rate of children past age five; the expected number of years of education completed by youth; the quality of learning in school; how long workers will remain in the workforce, as measured by adult survival past 60; and prevention of stunting in young children.

There is a lot to for Tanzania and other countries to learn from the four countries that top the HCI ranking-Singapore, South Korea, Japan, and Hong Kong-whose success is explained by the fact that they made investing in youth a top priority, focusing on education and skills development at all stages of their progress," says Quentin Wodon, World Bank Lead Economist and co-author of the 12th Tanzania Economic Update.

Given its level of development, Tanzania performs especially poorly in the number of years of schooling that children complete and the risk that children under the age of five will be stunted. In addition, the report finds that gender inequality in earnings is also affecting the country's ability to increase its human capital wealth and thereby its total wealth per capita.

To tackle the country's barriers to human capital development requires boosting investments in multiple areas using a "whole of government" approach to providing quality services. A special emphasis should be placed on reaching vulnerable adolescent girls' sectors and targeting areas of the country that are lagging behind. In addition, to narrow the gender earnings gap, the authors recommend reducing the time women spend in unpaid work and redistributing care responsibilities to enable them to spend more time in the labor market; giving women more access to and control of productive assets; and addressing market and institutional failures that limit opportunities for women.

The latest Economic Update also provides a snapshot of recent economic developments and the outlook over the next few years. The external environment for trade and investment in Sub-Saharan Africa remains challenging, and there has been softening on both fronts in Tanzania. However, it is the pace of domestic policy reform implementation that will remain most critical for the country's growth outlook. Government action to improve the business environment and fiscal management should be top priorities, including lowering the costs of regulatory compliance, reducing domestic arrears (VAT refunds and payments to suppliers), preventing new arrears, and ensuring a prioritization of investment projects based on sound criteria and growth-enhancing prospects as well as securing adequate and affordable financing to complete these projects on schedule.

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Tanzania Needs to Urgently Invest in the Health and Education of its Youth - New World Bank Report

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DAR ES SALAAM, July 18, 2019 - Tanzania needs to undertake important and urgent investments to accelerate progress in the health and education of its citizens, especially the youth, if the country is to improve its human capital for sustainable development, according to the latest Economic Update published by the World Bank.

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Tanzania | Institute for Health Metrics and Evaluation

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Tanzania | Institute for Health Metrics and Evaluation

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Institute for Health Metrics and Evaluation

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Congenital heart disease is a large, rapidly emerging global problem in child health. Without the ability to substantially alter the prevalence of congenital heart disease, interventions and...

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UNESCO outreach and interventions aim to support solidarity, counter misinformation, hate speech and myths, tackle racism, promote resources for education and distance learning, protection of journalists, and support quality, gender-responsive and accurate programming by media, particularly the community radios.

In preventing the spread of the pandemic, access to quality, gender-responsive and accurate information is key to dispel myths, curb the spread of fear and ensure that the public has the facts to keep themselves and others safe from acquiring and/or spreading the disease. Media can also play a key role in curtailing hate speech and racism at this time. In Tanzania, reports from foreigners have shown experiences of name-calling on the streets and the general fear of contracting the disease from foreigners is noticeable. Public information on health and sanitation is imperative at this time, particularly to rural and hard to reach communities mainly reached by community radios, which UNESCO supports.

On 17 March, the government banned all public gatherings and closed schools from pre-school to tertiary level. UNESCO's experience and expertise in convening stakeholders and resources in online and distance education is extremely relevant at this time. Resources for education are relevant to teachers/ guardians/instructors on developing and conducting online learning sessions for students at all levels to ensure that learning does not stop. In immediate response to this, UNESCO has updated an online guide with links to distance apps and other resources for supplementary learning accessible on https://en.unesco.org/themes/education-emergencies/coronavirus-school-closures/solutions.

Free access to UNESCO resources for actions to support media, enhance access to information and leverage digital technologies in the fight against the corona pandemic are also available on https://en.unesco.org/themes/communication-and-information/covid19-informationsharing-counteringdisinformation/resource-center.

Policymakers, media and the public also have free access to global and national news updates on emerging trends related to COVID19.through an online monitoring platform developed by UNESCO and the International Research Centre on Artificial Intelligence on http://coronaviruswatch.ircai.org/.

Tanzania is among the 13 high-risk countries for COVID-19 as classified by WHO AFRO. This communications plan fulfills the requirement for a robust and multi-sector preparedness and response plan to ensure readiness and agency-led action for any outbreak. In all outreach and interventions, content, programming and broadcasting adequately incorporate and address considerations for gender and human rights unique to this crisis.

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Campaign for education and information in COVID-19 crisis in Tanzania

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UNESCO outreach and interventions aim to support solidarity, counter misinformation, hate speech and myths, tackle racism, promote resources for education and distance learning, protection of journalists, and support quality, gender-responsive and accurate programming by media, particularly the community radios.

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Ada Health Launches World’s First AI-Powered Health App In Swahili

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Ada Health Launches World’s First AI-Powered Health App In Swahili

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The Ada app has 8 million users and has completed 15 million health assessments
Ada Health

Ada Health, a free, symptom-checking app created by Berlin-based healthtech company, has become the first health app to be launched in Swahili, a language spoken by over 100 million people across East Africa in countries such as Tanzania, Kenya and Uganda. Harnessing the power of artificial intelligence, Swahili-speaking patients will be able to use the Ada app, a CE-marked and ISO-certified medical device, to input their symptoms in a chatbot-style format and receive a recommended next step in their medical care.

The newest, Swahili version has been developed as part of Ada's Global Health Initiative (GHI), a series of projects with partners such as the Bill and Melinda Gates Foundation focused on improving the availability and delivery of primary care in underserved populations around the world. By working with partners to deploy in Swahili-speaking regions, Ada Health aims to improve access to quality health information and advice, particularly for young people and families, as well as to empower patients to make more informed health decisions.

One of the partners in the GHI and Swahili version of Ada is the Muhimbili University of Health and Allied Sciences in Dar Es Salaam in Tanzania. Dr. Nahya Salim is head of pediatrics and has ground-floor experience of treating patients in the Tanzanian system. She believes Ada will equip people with more information and enable them to make better healthcare decisions:

"Ada will strongly support access to appropriate health care, thus improving health seeking behaviours. The health system of Tanzania is like a pyramid, on top of which the lower levels are overwhelmed with a significant number of patients and minimal resources. Accessibility, weak communication and not being able to pay are key contributors to the delay in seeking health care. Ensuring a functional Ada health app in Swahili, the language widely spoken all over Tanzania, will accelerate appropriate and timely health seeking behaviour, maximizing access to health care."

Another of Ada Health's partners is Fondation Botnar, a Swiss foundation focused on improving the health and wellbeing of young people in low- and-middle-income countries. CEO Stefan Germann emphasises the responsibility to democratise access to good healthcare through technology:

"AI has huge potential to help improve the efficiency and quality of our healthcare systems through more personalised and predictive care; we believe it is vital that these benefits are available to everyone, globally. Apps like Ada can make patients, especially young people, informed stakeholders in their own health; building digital health tools specifically for the demands and local requirements in low- and middle-income countries is therefore essential to achieving health equity. We are proud to be launching the Swahili version of the Ada app and look forward to further collaboration to deliver on our shared vision of using technology to support patients, no matter where they live."

Adapting Ada's AI to East Africa's unique healthcare challenges was a complex process that went beyond a simple translation. To ensure that the app would correctly factor in the conditions and symptoms that are more common in Tanzania and East Africa, 160 disease models were optimised, including many maternal and child health issues, cardiac conditions, mental health-related problems and infectious diseases like malaria, HIV, diphtheria and pertussis.

To ensure that the Ada app would correctly factor in the conditions and symptoms that are more ... [+]
Ada Health

Solving end-to-end problems
Dr Vincent Grasso is a U.S.-based physician who explores and implements AI applications in healthcare systems. He is currently global practice lead in healthcare and life sciences at IPsoft and has taught telemedicine and laparoscopic surgery in Uganda. He believes in solutions like Ada but cautions that healthtech companies must think of the bigger picture:

"In general, applications providing diagnostic support, such as that provided by Ada Health, certainly meet the clinical demands of the East African market. These demands are driven by a shortage of clinical professionals distributed relevant to populations. However, in my opinion, apps such as Ada need to be part of a comprehensive digital and clinical ecosystem that utilizes other assets."

Any healthtech startup with a technology that, in some way, involves patients must appreciate that healthcare is not a product nor a collection of products, rather it's a service that must look after people end-to-end. Companies that either solve only a small part of a big problem, or don't properly look after patients either side of their solution, rarely provide enough value to health systems or the patients being served by them to justify their procurement. Therefore, any solution must be considered within the context of the bigger picture to analyse whether it truly solves a problem, or whether the system as a whole could suffer.

For those going direct-to-consumer, it is often the responsibility of the company themselves to make this judgement and this cannot be done lightly when, for example, 100 million people are newly equipped with a means of assessing their own health and could descend upon the health system that is not sufficiently resourced to manage for the influx. Similarly, a stretched health system could be relieved as patients are more confidently assessing and treating their own minor health conditions.

So far, Ada have worked with expert partners in the East African area as part of their GHI to analyse the potential impact, and, going forwards, they say they are working closely with communities and health workers on the ground, with the eventual aim of integrating Ada into the local health ecosystem.

... Read More

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Ada Health Launches World's First AI-Powered Health App In Swahili

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Ada, a free, symptom-checking app created by Berlin-based healthtech company, Ada Health, has become the first health app to be launched in Swahili, a language spoken by over 100 million people across East Africa in countries such as Tanzania, Kenya and Uganda.

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Drawing on Ebola readiness to tackle COVID-19

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Like many African countries now making use of Ebola and Influenza preparedness to step up their COVID-19 response, Tanzania is tapping into the skills of health workers already knowledgeable in infectious disease control, established influenza sentinel surveillance system and repurposing facilities to tackle the new virus.

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The coronavirus disease (COVID-19) pandemic has swept the globe at an unprecedented rate, flooding hospitals and revealing the vulnerabilities of finite supplies and providers. Neurosurgeons have restricted operations to emergency and essential interventions. Some are being deployed to new intradepartmental roles, others lateralized to provide care for coronavirus patients. The reassignment of staff is a common, often temporary, response to expand coverage in a crisis. However, the coronavirus situation is unique. With the novelty of COVID-19, not even infectious disease and critical care experts are exempt from the learning curve, and individual risk of infection breeds further discomfort. Understandably, these conditions can evoke feelings of fear and powerlessness for patients, families, and providers. In this challenging time, strategic health systems approaches can facilitate timely access to safe and affordable care and transform untoward sentiments into a collective strength.

Task shifting and task sharing are workforce strategies that involve duty redistribution. Task shifting is transference of clinical autonomy from highly qualified healthcare workers to those with shorter training and fewer qualifications. In contrast, task sharing uses tiered staffing models with collaborative teams of specialists and less-qualified cadres who share clinical responsibility and rely on iterative communication and training to preserve high-quality outcomes. The application of task shifting and task sharing for medical, surgical, and neurosurgical specialties in low-resource settings has shown that task sharing is preferred to task shifting to maintain safety. An ideal task-sharing model can be evaluated in 3 phases: training, practice, and maintenance ().

For the first phase-training-the principal step is identifying providers and redistributing in a manner that minimizes "things to be learned" in order to satisfy the "job to be done." One must ensure adequate reserves of those with setting-specific expertise. In the COVID-19 pandemic, the most experienced neurosurgeons are also from the most vulnerable age groups, so their wisdom and skills may be best used via telemedicine encounters, guiding ethical decisions on appropriate neurosurgical interventions, or preserved for neurosurgery-specific cases. Attendings with critical care experience may need to oversee medical ICU care. Residents adept in neurocritical care and placing central lines can undergo intensive skills training to bolster competence and confidence in intubation and ventilator management. Residents staffing neurosurgery services can work remotely when possible to place orders, write notes, call consults, and conduct virtual visits with patients, to provide a buffer in case onsite residents become ill and/or require quarantine. Many centers are assigning "contaminated" and "clean" teams to respective wards. Meanwhile, the reduction in neurosurgical patient censuses permits redeployment of remaining faculty, residents, and advanced-practice providers to support COVID-19-specific care. Hospitals can further benefit from medical student engagement. In the United States, final-year medical students are being issued emergency 90-day limited licenses for early promotion. More junior students can assist with supervision. Comprehensively, many can be mobilized.

The subsequent question is what to teach. Training in technical skills requires shorter time intervals than clinical decision-making capacity, so procedures can be offloaded in a task-sharing model with oversight from experienced persons. Throughout Europe, when the gravity of intensive care demand was realized, hospitals halted elective procedures and implemented skills workshops for non-ICU personnel regarding noninvasive ventilation and advanced monitoring, as well as abbreviated courses on relevant care, such as testing guidelines and pulmonary optimization. Many national and international societies have released open-source webinars and podcasts on high-yield COVID-19-specific management. Departments, neurosurgery included, may benefit from designating personal protective equipment (PPE) "coaches" to oversee proper donning and doffing practices across teams. Concurrent efforts can empower outpatient testing to reduce the burden on hospital centers. Universally, it is essential to ensure adequate governance for standardized curricula, appropriate oversight, and competency-based evaluation before graduating individuals to more independent stages. The escalation of the COVID-19 pandemic means that training phases will be brief, and providers will rapidly advance into the practice phase.

In the practice phase, job scope should be clearly defined to facilitate transitioning into the COVID-19 workforce, seeking consultation for complex cases, and prevention of "task creep," acting beyond permissible guidelines. Within neurosurgical departments, teams can consider dedicating providers for patients at risk for COVID-19 ("contaminated" team). As neurosurgical staff are lateralized to medicine services, we should prepare to humbly engage in working models that involve multidisciplinary teams, supervised in branch models under internal medicine residents and attendings. Again, where to seek help when needed should be clear; preventing task creep protects providers, patients, and the healthcare system. As patient burden exceeds provider capacity, there will be greater pressures to use a task-shifting approach with less oversight, but task sharing is preferred when possible.

The duration of the maintenance phase has yet to be determined. Short-term priorities include ensuring that the newly trained staff thrive for as long as needed, with an adequate supply of PPE and timely dissemination of new information. Addressing the impact of physical, emotional, and moral stress on providers given isolation and care rationing should be incorporated. The longer-term strategy is contingent on multiple factors. If the virus is not seasonal and there is geographic recurrence, control methods may extend into 2022. If so, our community will need to reassess which cases can truly be delayed. We may need to establish "green zones," as Switzerland neurosurgery is doing, where urgent or elective cases are performed in a separate location, and providers and patients require negative COVID-19 tests and chest radiographs prior to entry. Furthermore, there would be a greater demand for rapid data analysis and iterative systems research to ensure best neurosurgical practices.

While the wrath of coronavirus has caused tremendous disruption in global health already, many cities and countries have yet to experience the virus at its peak. We cannot lie idle, anticipating the storm. In geographic locations currently facing or anticipating the wave of COVID-19 patients, neurosurgeons can begin task sharing to strengthen workforce systems, while continuing to triage operative cases and invest in contingency plans if the pandemic is prolonged. In this arms race between humanity and a virus, we must venture forward with humility, patience, flexibility, and persistence to conquer this challenge together.

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Editorial. Task shifting and task sharing for neurosurgeons amidst the COVID-19 pandemic

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The coronavirus disease (COVID-19) pandemic has swept the globe at an unprecedented rate, flooding hospitals and revealing the vulnerabilities of finite supplies and providers. Neurosurgeons have restricted operations to emergency and essential interventions. Some are being deployed to new intradepartmental roles, others lateralized to provide care for coronavirus patients.

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After a wave of digital health initiatives in the late 1990s and early 2000s, national digital health strategies are a critical tool to help the sector mature from siloed initiatives to aligned systems. They help countries use resources more efficiently, while avoiding fragmentation and facilitating information sharing for better and faster decision-making. As the use of technology in health systems surges and investments pour into the sector, a national health strategy offers guidance and a clear path forward.

"With our new Digital Health Strategy we will coordinate all partners and stakeholders," explained Tumaniel Macha, the Director of Monitoring and Evaluation (M&E) for Tanzania's Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC). "We'll have one platform where we discuss, plan, and mobilize resources together to achieve better [health] outcomes."

Tanzania's new strategy will play an essential role in guiding the implementation of digital health initiatives, enabling a health system that is patient centric, data driven, and more equitable as a result. It reflects ten high-priority areas that will guide the next five years of digital innovation in the country. These priorities range from strengthening disease surveillance, reporting, and response, to the use of telehealth to build health worker capacity in a changing digital landscape, while providing specialized care to the country's most remote corners.

The strategy also clearly lays out an implementation plan and develops several governing structures that will oversee activities. These range from a National Digital Health Steering Committee composed of voting members, to health facility digital health committees that will coordinate activities, provide mentorship, and create awareness about digital health.

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New strategy and systems cement Tanzania's digital health leadership

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After a wave of digital health initiatives in the late 1990s and early 2000s, national digital health strategies are a critical tool to help the sector mature from siloed initiatives to aligned systems. They help countries use resources more efficiently, while avoiding fragmentation and facilitating information sharing for better and faster decision-making.

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Preventing and controlling the spread of infectious diseases is key to protecting the health of both patients and health care workers (HCWs). This is an urgent need in Tanzania, and not only because of the threat of COVID-19, but also to make the country vigilant about stopping the spread of HIV, tuberculosis, and antimicrobial-resistant infections. From a 2011 WHO meta-analysis, 15 in 100 people who receive health care services in Tanzania will acquire a infection while doing so.

Tanzania already has infection prevention and control (IPC) guidelines and standards for HCWs. However, there is still poor adherence to them because of inadequate knowledge and skills among HCWs on IPC basics; shortages of IPC supplies, including personal protective equipment; and inadequate supportive supervision.

For example, HCWs often fail to comply with hand-washing protocols because they lack an adequate supply of clean water, liquid soap, or elbow-operated dispensers. In several facilities, linens are not cleaned per standard operating procedures and are stained. Hospitals lack equipment to transfer both clean and dirty linens and to properly disinfect them, both of which make HCWs susceptible to infections. Meanwhile, the country already has an HCW shortage, running at only 44% of its required staffing capacity.

I am a medical doctor and public health specialist with over 15 years of experience working to improve the health of Tanzanians. I've seen the devastation health care-acquired infections (HIAs) can bring, such as a burst abdomen at a surgical site. Currently, I am working as an MTaPS senior technical advisor overseeing the IPC component of the program, building the capacity of frontline HCWs through trainings and mentorship on current IPC practices. So far, we have managed to impart IPC knowledge and skills to 350 HCWs so they can protect themselves and patients from getting HIAs. We also educate the community, especially caregivers, on how to protect themselves with good hand hygiene and housekeeping. The trained HCWs have acknowledged the life-saving knowledge and skills they received during mentorship, things like practical skills on how to correctly prepare chlorine solution for disinfection.

MTaPS and MOH staff, and other stakeholders reviewing IPC standards. Photo credit: Christina Mchau

In addition, MTaPS has revised the IPC curriculum to include the latest WHO recommendations, so that trainers demonstrate current practices to new HCWs before they even begin their jobs. During one training session, an IPC trainer thanked MTaPS for providing opportunities to orient them on the new IPC guidelines, saying that tutors were often overlooked when it came to updating knowledge and skills, particularly when new guidelines were issued. "Our students learn slightly old practices, so they need to spend time to articulate the practices while they are on the job," said one train.er MTaPS is also working with the government to develop IPC e-learning courses, enabling trainees to have convenient access to modern training techniques.

I'm confident that our efforts to strengthen IPC programs in Tanzania will help protect these service providers and patients from health care-acquired infections and protect their communities from infectious disease outbreaks, including the current COVID-19 pandemic.

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Helping Health Care Workers Protect Patients-and Themselves-from Infection

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Preventing and controlling the spread of infectious diseases is key to protecting the health of both patients and health care workers (HCWs). This is an urgent need in Tanzania, and not only because of the threat of COVID-19, but also to make the country vigilant about stopping the spread of HIV, tuberculosis, and antimicrobial-resistant infections.