Phyllis Freeman

Tanzania's health system and workforce crisis

This introduction to Tanzanias health system and acute workforce shortage familiarizes readers with the context in which health professions education takes place. The paper touches on poverty rates, population growth, and characteristics of the health system. The critical shortage of trained health staff is a major challenge facing the health sector, aggravated by low motivation of the few available staff. Other challenges facing the health sector include lack of effective staff supervision, poor transport and communication infrastructure and shortage of drugs and medical equipment. We recommend appropriate action be taken by the government and other stakeholders to provide more financial and human resources for the sector while ensuring their efficient and effective utilization to improve services delivery.

Educating Enough Competent Health Professionals: Advancing Educational Innovation at Muhimbili University of Health and Allied Sciences, Tanzania

Sarah MacFarlane and colleagues share their lessons engaging in educational reform and faculty development with the Muhimbili University of Health and Allied Sciences in Tanzania and the University of California San Francisco.

Teaching and educational scholarship in Tanzania: Faculty initiative to improve performance of health professions’ students

Well-educated and competent health professionals influence the health system in which they work to improve health outcomes, through clinical care and community interventions, and by raising standards of practice and supervision. To prepare these individuals, training institutions must ensure that their faculty members, who design and deliver education, are effective teachers. We describe the experience of the Muhimbili University of Health and Allied Sciences (MUHAS) in encouraging improvements in the teaching capacity of its faculty and postgraduate students triggered by a major institutional transition to competency-based education. We employed a multi-stage process that started by identifying the teaching and learning needs and challenges of MUHAS students and faculty. Collaborating with the University of California San Francisco (UCSF), MUHAS responded to these needs by introducing faculty to competency-based curricula and later to strategies for long term continuing improvement. We demonstrate that teaching faculty members are keen for local institutional support to enable them to enhance their skills as educators, and that they have been able to sustain a program of faculty development for their peers.

International childhood vaccine initiative.

In 1974 as the global smallpox eradication program neared successful completion, the Expanded Program on Immunization (EPI) was launched. The goal of the EPI was global, universal immunization of children against tuberculosis, diphtheria, pertussis, tetanus, polio and measles. By 1990 EPI efforts in surveillance, organization, supply and education resulted in over 500 million contacts per year between EPI workers and children. Because of these efforts 80% of children born in the world today receive the six vaccines mentioned above. The efforts of the EPI are carried out in developing countries with funds contributed by industrialized nations to international agencies like the United Nations and the World Health Organization, as well as monies from local governments. Although the United States is a major supporter of the EPI, there seems to be a lack of awareness of these activities among pediatric health care providers. The purpose of this report is to raise awareness of and gain support for vaccine initiatives worldwide.

The U.S. health data privacy debate. Will there be comprehension before closure

After 25 years of debate about privacy of automated personal health data, the U.S. Congress has set a deadline of August 1999 for enacting health information privacy legislation. The urgency to establish national policy in the United States re-emerges with implementation of a 1996 law mandating a unique identifier for each participant in the U.S. medical care system and the use of a uniform electronic data set for all health information transmitted in financial and administrative transactions. The impact of electronic data storage and transmittal on privacy, health outcomes, and medical care is unclear. A three-step analytic scheme can clarify the issues in the policy debate and for future assessment. The first step is intended to elicit, for the first time, a precise, accurate, and reproducible description of personal health data transactions and chains of transactions, independent of the policy preferences of any interested party. The second step allows the reader to analyze these transactions according to who benefits first and foremost from each. This scrutiny clarifies the reasons why parties to the debate tend to disagree. The third step characterizes how Congress is likely to perceive the policy process and consider its options before enacting any particular set of compromises. Understanding the policy deliberations and potential effects of evolving information technologies and new national privacy rules should aid assessment of results.

An institutional research agenda: Focusing university expertise in Tanzania on national health priorities

A well-articulated institutional health research agenda can assist essential contributors and intended beneficiaries to visualize the link between research and community health needs, systems outcomes, and national development. In 2011, Tanzanias Muhimbili University of Health and Allied Sciences (MUHAS) published a university-wide research agenda. In developing the agenda, MUHAS leadership drew on research expertise in its five health professional schools and two institutes, its own research relevant documents, national development priorities, and published literature. We describe the process the university underwent to form the agenda and present its content. We assess MUHASs research strengths and targets for new development by analyzing faculty publications over a five-year period before setting the agenda. We discuss implementation challenges and lessons for improving the process when updating the agenda. We intend that our description of this agenda-setting process will be useful to other institutions embarking on similar efforts to align research activities and funding with national priorities to improve health and development.

Introduction: vaccine technologies and public health. Why a critical review now?

Since Jenners time, there have always been enthusiasts and skeptics about the role of vaccines in the prevention of disease. This introduction explains why, at this time, it is crucial to assess the historical role vaccines have played in limiting damage caused by infectious diseases, the role they can play in the future, and the technologies that are best suited to achieving optimal gains for public health and development worldwide.

Why health professions education in the Journal of Public Health Policy

I am particularly pleased to introduce this sponsored special issue, Universities in transition to improve population health: A Tanzanian case study, and Guest Editors Sarah Macfarlane (a Professor and Founding Member of Global Health Sciences at the University of California San Francisco) and Ephata Kaaya (a Professor at Muhimbili University of Allied Health Sciences – who has recently been named its Vice Chancellor). Universities in many parts of the world have long been criticized for exclusivity and distance from problems critical to development and well-being of societies. Tanzania’s history, tying independence from colonialism with socialist ideals, is unusual. Having adapted the ‘barefoot doctor’ model from China 50 years ago, Tanzania today depends more than any other country in Africa on middle-level health workers. Trained by the health ministry, they fill most jobs in the health system. As explained elegantly and in more detail by the Guest Editors, the few health professionals, educated at universities, lead the ministry, provide specialty care, and teach; and the government expects the few teachers of health professionals to rapidly and dramatically raise enrollments – while improving the quality of education and student outcomes. The motivation is compelling: in Tanzania devastating consequences of too few professionals are seen, for example, in maternal mortality rates. Experience elsewhere suggests deaths of mothers during pregnancy and childbirth can be dramatically curbed by available interventions – as much as by 80 per cent. The 2010 Tanzania Demographic and Health Survey reported maternal mortality to be 454 deaths per 100 000 live births in Tanzania. Because the focus here is education – one might reasonably ask why JPHP publishes this issue. We welcome its linking of education of health professionals to population health outcomes. Few countries have targeted improving higher education as a strategic element for improving population health. And few development agencies have taken up the challenge to support institutions of higher education to become strategic partners. This

National health care reform minus public health: a formula for failure.

Universal access to medical services will not address all important health needs. Impending health care reform, guided by public health strategies, could achieve many previously unattainable health goals. However, such a public health role seems unlikely. Public health reaches beyond the current popular notion of prevention focused on individual lifestyle, yet attention to public health authority has waned. The history of immunization, a personal health service effective only within a public health strategy, illustrates the dilemma. Britain required 40 years of National Health Service before it invoked a public health strategy to assure effective immunization. Reformed health care must perform certain functions systematically that in the past were optional for medical practitioners or left to health departments by default. Reformers must rebuild public health authority in states, to assure that medical services we will pay for under health care reform accomplish functions critical to the health of the public.

The Role of Vaccine Research and Development in the Scientific Development of Middle-Income Countries

As a new global strategy for improving public health, the Childrens Vaccine Initiative implicitly raises, once again, the question of the role of science in developing countries. If there are to be new and improved vaccines, better delivery systems, and simplified immunization schedules, there must be substantial analysis, laboratory activity, and fieldwork to ensure that the new products are ready for effective use. In the context of these requirements, this paper reviews the possibilities for vaccine research and development in middle-income countries and the benefits in terms of fostering socioeconomic development through integrated scientific health research.