MEDICAL SERVICES' RESPONDERS IN TANZANIA (MSRT)

There are many autoimmune diseases,women are more affected than men and in both cases the burden to manage is more expensive than even compared to cancer.These diseases lead to morbidity,suffering and deaths.In most female population,it is a number one killer in women, above 64 years.

There are estimated more than 120 autoimmune diseases with more than 63% being rare diseases, For example Evans Syndrome.Little is known about their management and it normally take more than 4 physicians to diagnose the disease.

For the available data from research sources, there are estimated to be more than 52 million patients of autoimmune diseases in United State of America.

We have been pointing out many cases of rare autoimmune disease in  three Regions of Tanzania.These are Kigoma,Katavi,and Rukwa, both are at the shore of Lake Tanganyika.

Both Regions  have population of more than 4 Million people.

Example of some rare autoimmune diseases we have been diagnosing are 

  Eosinophilic granulomatosis with polyangiitis (EGPA) ...   

• Guillain-Barre syndrome. ...
• Kawasaki disease. ...
• Mixed connective tissue disease (MCTD) ...
• Myasthenia gravis. ...
• Paroxysmal nocturnal hemoglobinuria (PNH) ...
• POEMS syndrome. ...
• Retroperitoneal fibrosis

There are 434 patients pointed out in both Regions,384 are women and 50 men.How ever there are many more cases  not diagnosed in the community.Much have not been done.

Factors contributing to the problem.

-Autoimmune diseases are caused by genetic factors when comes across to the environment factors, called Triggers or Ignators.

 A person who is genetically susceptible comes across these factors may developer the disease. The environment factors can be a chemical,micro organism etc.

-There is very low awareness in the community about these diseases.

-There is very little knowledge on diagnosis,investigation and treatment among Clinicians.Most of them,  more than 96% are not medical doctors,but clinical officers with very little training about general Medicine.

-There is no specialist Doctors available.In both three Regions with over 4 million people there is no single Rheumatologist.

-There are no initiatives at preventive or curative level to deal with diseases,at both community and facility level.

-The autoimmune diseases are not well taught at medical schools at satisfactory level, like other infectious Diseases.In our sorting test to 50 clinical officers, only 2 could mention 5 auto immune diseases.

-Population habit of not seeking medical services due to poverty,bad taboos,and in believing in witch craft.

Data.

-A new scientific paper published in European Journo of human genetic,confirmed that,the number of people worldwide, living with rare diseases are estimated to be 300 million.(www.orpha.net)

The solution is to impose initiatives that will reverse the situation and manage the condition.These are 

1.) Raising community awareness about rare diseases/provision of education via Radio sessions and mobile phones in natives languages,making communities part of the fights.

2.) Making Out patient and in patients clinics part of the program by exposing new cases of rare diseases,and link them to proper management.

3.) Creating special clinics benches,that will treat and ensure proper follow of patients.Follow up can be archived through digital health services such as the uses of mobile phones(Smart phones).Where patient can access medical advises and action in 24 hours.

4.) Provision of well understood education of rare diseases to the patients themselves,making them number one doctor.For example they must know how to abide with both pharmacological and non pharmacological rule.

Most rare diseases need you to

-Know what to eat and what not to eat.

-Stay away from stress.

-Physical exercise,involving in exercise is helpful as it reduces inflammation.

-Drug adherence rules and consulting their doctors,physically or via digital health services, when ever they think there is a need.

5.) Provision of quality education to the family members and care takers, about rare diseases and the rules to their management.Counselling must be an important package in this case,as most of these patients are frequently in a suffering mood.This will eliminate stigma and create a spirit of unity in the fight against  rare diseases.

6.) Capacity building programs on rare diseases must given to the primary consultants.For example in Africa, particularly in Tanzania,the target consultants are clinical officers, Assistant Medical officers,Nurses and Medical officer.The big number in this category are clinical officers.

The training should base on the crucial set up,such as

- Emphasis on raising ability to diagnose rare diseases.This is very difficult task especially when it comes to autoimmune diseases.

-Proper and accuracy investigations methods in low income set up.

- A wide range of management,from Pharmacological to Non pharmacological approaches,counselling and palliative care.

7.) Since there are no Rare diseases specialists such as Rheumatologists for autoimmune diseases.The organization should find a way to consult them,in America or Europe.This will be useful in the followings

-Enhancing specialty consultation via digital health services.

-Arrange periodic physical visitations of these specialists for patients,consultation and  technical capacity buildings to front line health staff.

-This will enable availability of some important medication availability.These medication are not found in our Areas. These are like, strong immune modulators,Biologic etc.

8.Proposing policies to our Ministry of Health that will lead to increase in initiatives for approaching rare disease.

For example ensuring,The teaching syllabus in Medical Schools,Clinical officers,Nursing and laboratory Technicians colleges are well equipped with the Rare diseases topics.They must ensure they are well taught in all aspects, so as to have better impact in the population of concern.

-They are people with low income in  the forgotten part of Tanzania.The three Regions are at the show of lake Tanganyika with little access to health services.There is no access at all to rare diseases services.

In what ways are they undeserved?

1.) There is no system on place to find and expose new cases,and place them in special clinics for proper management.

2.) There is no initiatives on place, to educate the community about rare diseases.

3.) There is no program on place to activate, technical  health staff,to create special clinics, for patients with rare disease.To treat,follow up , and  close monitoring via digital health services and access to specialist Doctors. 

4.)In most rural parts of these regions,people are still caught in the jungle,of witch craft belief.They believe the causes of diseases are witch craft by origin.In Tanzania it is only 40%, who go to health facilities when they are sick.60% are still attending to local healers/traditional healers.These is not only a threat to people's lives,but also the primary cause of many deaths.People with rare diseases are being attended by non professional healers,while they need well trained, Medical personnel.

By the way 80% of Tanzanians are living in rural areas,where there is very limited access to health services,or no services at all.In the case of rare diseases,it is no access to services at all.

How will the solution address their needs?

1.) It will create the proper health services access,which will be impact fully to their health condition.

2.) It will raise community awareness on rare diseases by 80%.This will eliminate misconception and stigma in relation to rare disease in very high extent.

3.)It will expose more new  un diagnosed cases and link them to the proper facilities.

4.)It will reduce deaths by 58% and lengthen lives.

5.)It will reduce morbidity by 54%.

6.) It will increase the degree of community participation in the fights against rare diseases.

7.)It will draw much attention to the government participation on rare diseases.

8.) It will ensure maximum quality of services to the patients.Due to capacity buildings' program to health staff.

9.)It will cover  more than 85% of the population of concern,in access to health services,education,medical consultations, free access to medical consultations,advises and linkages. 

1.) Our organization is a nonprofit it gives health's' services for free,to the low income communities in demanded area in Tanzania.Most people in low income areas like this, need support with treatment's access and cost.

2.) Our organization has a policy of involving communities in its program,and receives communities' opinions, digest and work on them for the betterment of the program.We will create a system of full community engagement,accountability and feed back.

3.)We are led by humanitarianism' values through,

-Volunteerism

-Unity

-Self motivations.

4.) Our organization is authorized to operate at national level,we also capable of making partnership with, Government and non Government health facilities.

5.) Our services are much base on the followings

-Raising community awareness, in health education and promotions in both physical approaches and digital health services.Also communities diseases surveillance.

-Capacity buildings program to health staff and special groups in the communities.We also offer supportive supervisions,mentor-ship and monitoring and evaluation.

-We also intervene in provision of health services, in curative and preventive services.

What do we do to understand the needs of these people?

Through needy assessment on the demanded area,involving the communities,via interviews and questioning.Also through assessment to available data regarding the problem.

In general we take, a cross cut study on studying communities' problems. 

How do we engage the communities on developing solutions?

-Through presenting to them the exposed problems and proposed solutions,and allow them to in put their views.

-By involving them in decision making stages,basing on important factors like gender basing and equities.

-Involving the community in needy assessment and on addressing the problems.

How our design and implementation of our solutions guided by communities' inputs?

The formulation of our design and implementation is basing on, what was pointed out by the community and proposed solutions, which can easily be adopted and produce good,specific and measurable impacts within the community of concern.

We normally collect the best from communities and work upon them.

We face barriers in finance to implement the project in the followings packages.

1.)Raising community awareness via digital health services,data collections and community surveillance services.

2.) Capacity buildings to the technical staff and communities

3.)Establishing special clinics for more cases findings and interventions,and concrete follow up.

4.)Establishing special clinics with specialties visitations and consultations.

If the Challenge offer us fund,it will solve these barriers.

The project will be implemented  by covering  cost like.

-Program expenses.

-Personnel expenses

1.) It uses digital health services under the modern technology,the first to be applied in our area.This will ensure maximum coverage to the population of concern,especially in rural areas,where distance,bad roads have been hindrance on reaching the majority.

2.) It will provide high quality health services for free,to the people of high demand.

3.)The solutions applied can be easily implemented and sustained' not only globally,but also to the areas with low resources,like in low income part of Africa.

4.)It combines communities and technical staff on a jointly fight to the problem.This will ensure maximum measurable impacts.

5.)The solutions will provide  long term impacts to the people of concern.

6.) The solution is catalytic,as it will stimulate the communities via education to grasp,knowledge and pass it to the next stage.This will stimulate the community to be part of solution.

7.)It will create confidence in people with rare diseases,by knowing that,having these problem does not means end of life.Meaning there are lot of things to be done,to ensure long and happy lives.They just need to be part of the solution.

Broader impacts.

-will reduce mortality,morbidity and Disability rates.

-I will increase access to health's services in high extent.

-It will raise communities' understanding and make communities part of solution.

1.) It will create the proper health services access,which will be impact fully to their health condition.

2.) It will raise community awareness on rare diseases by 80%.This will eliminate misconception and stigma in relation to rare disease in very high extent.

3.)It will expose more new un diagnosed cases and link them to the proper facilities.

4.)It will reduce deaths by 58% and lengthen lives.

5.)It will reduce morbidity by 54%,It will also reduce Disability rate by 60%.

6.) It will increase the degree of community participation in the fights against rare diseases.

7.)It will draw much attention to the government participation on rare diseases.

8.) It will ensure maximum quality of services to the patients.Due to capacity buildings' program to health staff.

9.)It will cover  more than 85% of the population of concern,in access to health services,education,medical consultations, free access to medical consultations,advises and linkages.

Path to Achievement.

• Clearly defined and target-driven initiatives
• Employ quality and experienced people coordinated with managers and support personnel
• Well introduced services to these new communities one by one on a foot to pavement platform to ensure our services are well known.
• Creating a well committed team, through the encouragement of education, compassion, work ethic and professionalism.
• Technical high risk case sharing meetings to be held weekly or prn.
• Ensuring monthly foot to pavement field visits done by team leads and supervisors 
• Evaluations, with a specific emphasis on internal health audits (ie. are we achieving our goals?) to be performed twice a year.

1.) MORTALITY RATE INDICATOR- with its specific  components which are

-Crude Mortality rate.

-Expectancy of life.

-Age specific Death Rates.

-Child Mortality Rate.

-Case fatality Rate.

-Neonatal Mortality Rate.

-Maternal Mortality Rate.

2.) MORBIDITY INDICATOR.-with its specific components which, are

-Prevalence and incidence Rates,where by in incidence Rate, we will use 

attack and secondary attack Rate.

3.)DISABILITY RATE.

Our initiatives will ensure  all these Indicators are reduced and maintained at the required threshold,as per WHO  AND OUR MINISTRY OF HEALTH Standards.

We will also ensure the followings

1.) Activities that impact on good health and well being.This will increase decent work and economic growth in the population of concern.

2.) Activities that impact on Gender equality  with no classes,Reduced inequalities..

3.) Ensuring,Partnership with various health facilities and authorities with meaningfully impacts.

On top of these we will ensure maximum performance of the followings.

-Frequently field visits.

-Supportive supervision to the partners' facilities and community.

-Offering impact fully on job training.

-Providing high quality mentor ship programs.

-Encouraging volunteerism,self esteemed and ''patient first'' policy in our routinely activities. 

Activities  linkage with immediate outputs and longer term outcomes to the target population.(With how and why?)

Activities

1. Provision of education via radio sessions and mobile phones programs.

Immediate out puts

-Raise community awareness on the problem.

-Making a community engage fully and become a part of solution.

-Reduce extent of stigma.

-Promote gender equality on participation.

-Increase  an extent of new cases' exposing and linkages.

-Create an access to the proper health services.

Long term outcomes

-Improved health of the population of concern

-The community will be passing knowledge to next stage.(Children,relatives etc)

2. Training to the health staff and communities Leader.

Immediate output

-Availability of high quality services.

-Reduce the rates of avoidable deaths

-Availability of sensitive and reliable data for decision makings.

-Increase community sensitivity and engagement,due to communities Leaders sensitization

Long term outcomes.

-Reduction in number of deaths and new cases at maintained level.

-Increased number of well trained health staff due to,on job training mentor ship and supportive supervision.

3.Digital health services clinics.

Immediate out put.

-Reduction in mortality and morbidity rates.

-Reduce the degree of disability

Long term outputs.

-Reduction of sufferings.

-Availability of specialty services.

-Reduce extent of morbidity

-High extent of motivated communities, to seek right medical services.

DIGITAL HEALTH SERVICES,VIA USES OF

-Radio sessions

-Mobile phone including smart phones.Mass texting)

-Uses of apps

-Soft wares.

For Diversity.

-Our rule of provision of services is non discriminating on basis.We do not discriminate people,by their tribes,religion,races groups or any other social factor.

-We widen our services through uniting and equal caring for all.

For  Equity.

-We ensure equal access and opportunities to all in our daily activities.

-Every one in the group or community has equal chance and opportunity  in access to our services,with regardless to any hindrance factor,such as Disability.We have policies of abiding to this on daily program.

For Inclusive.

-Every one from any group is welcomed,and will be given any support at glance,has all rights to be respected and well valued.

We have created rules in our constitution in which inclusive is one of our package.

Medical Services' Reponders in Tanzania, will ensure all these rules are well observed and valued,as the foundation of our organization is lied in the humanitarian principles.

-We provide curative and preventive health services to the low incomes population,following needy assessment.These are communities which need support as in most cases they can not afford to cope with financial challenges.

-We provide health education,health promotions,diseases surveillance and clinics via digital services.The services are to cover the gaps left by the current health system.

-The gaps and demand for provision of these services, were justified followings a needy assessment,which was conducted in the proposed project area.Revealed the need for intervention.

Through seeking of donation and grants via

-Proposal writings.

-Finding and joining fund raising platforms.

-Membership fees.

-Making community of concern part of the solution.

-We have raised 20000 USD

-We have never received any grant

-We  make 10000 USD per year as membership fees,and donations from members,and friends.