Tanzania’s New Health Policy To Recognise Neglected Tropical Diseases

TABORA, Tanzania — At first glance, the village looks quiet and beautiful. Unfortunately, life has not been affirming for dozens of its inhabitants. They have leprosy—a least contagious and curable disease, except for its two worst characteristics — poverty and neglect.

Tanzania First Lady Janeth Magufuli visiting Amani centre, a home for leprosy victims in Tabora region.

Nestled on the wind-swept plains of Ipuli in Tanzania’s western Tabora region, Amani village is a government-run centre and home to hundreds of marginalised elderly people including leprosy sufferers, who had been banished from their families because people believe they are cursed.

This miserable people depend on food handouts donated to the centre to survive.

Sitting on a dusty mattress perched on a makeshift bed made of bamboo poles, her palms twisted by the disease, the 54-year-old Rukia Mzee unflinchingly looks on as a friend pulls a live maggot from one of his disfigured feet.

Like many lepers at Amani village, Mzee, who contracted the disease 14 years ago, has lost the sense of feeling in parts of her body, which prevents her from doing any work.

“I don’t feel anything. Even if I step on fire I won’t feel it, but I would realise later that I am hurt,” she said.

Mzee, who was kicked out of her home after her children accused her of being a witch, had since moved to Amani, and despite the hardship she doesn’t want to return home anytime soon.

“When my skin started peeling off, my children expelled me from home. They thought I would infect them,” said Mzee, who has several missing fingers and facial hair.

However, in what appears to be a glimmer of light at the end of the tunnel, Tanzania has for the first time recognised neglected tropical diseases (NTDs) in its national health policy. This is a move health experts say is a milestone in the fight against leprosy since the government is expected to apportion sufficient budget to tackle the least contageous disease that has pushed many people on the wobbly edge of survival.

Neglected tropical diseases, which are highly communicable but preventable, are poverty-related conditions affecting millions of poor people worldwide. The diseases were in 2015 formally recognised by the United Nations as a target for global action towards the Sustainable Development Goals for the year 2030.

Upendo Mwingira, NTD Programme Manager at the Tanzania Ministry of Health Community Development, Gender, Elderly and Children, said the government will effectively next financial year apportion sufficient budget to combat the diseases.

“We are currently researching to ascertain areas affected by these diseases so that the government can make appropriate decisions in terms of funding allocation,” she told Health Policy Watch.

According to her, Tanzania’s National NTDs Master Plan launched in 2012 will continue to act as a compass for coordinating efforts to eliminate the diseases.

Mwingira believes NTDs, including river blindness, trachoma and lymphatic filariasis, which are prevalent in the east African country, can be eliminated when people have been lifted from the quagmires of poverty.

Worldwide, more than 1.5 billion people are affected by NTDs, and in Africa this figure is thought to be more than 620 million. These diseases cause devastation to the lives of the most vulnerable people, who often live in the hardest to reach communities.

Yunus Mgaya, director general of the National Institute for Medical Research (NIMR), told Health Policy Watch the move to recognise NTDs in Tanzanian health policy is a significant milestone since many people will be lifted from poverty.

“I think it is a very good move,” Mgaya said. “When we have a good health policy that clearly recognises efforts to tackle these diseases, political leaders will certainly prioritize them in annual budgetary estimates.” Leprosy, a chronic infectious disease which affects skin, nerves, upper respiratory tract and causes muscle paralysis, is curable with a combination of multiple antibiotics, however, most poor patients often hide their symptoms to avoid widespread stigma and discrimination, according to WHO.

From Kigoma in the west to Musoma in the north, tales abound of how leprosy sufferers in Tanzania are being abandoned by their families even after showing signs of recovery from the disease—leaving them no choice but to remain in cash-strapped leprosy villages.

While many developing countries boast to have eliminated leprosy, the disease is still wreaking havoc in remote parts of Tanzania.

In the impoverished Tabora region, scientists recently discovered traces of leprosy bacteria in the soil and water, a potential threat for school children who walk barefoot, local health officials said.

While long-term effects of leprosy can be prevented with proper diagnosis and treatment, many victims do not seek medical attention until it’s too late.

“It’s a disease of the poor and the marginalised,” said Ali Mzige, a public health expert based in Dar es Salaam.

According to him, leprosy and other neglected diseases can only be eliminated if the government thinks beyond health-related outcomes in its initiatives. “If people have access to clean water, sanitation and better hygiene, why should they contract NTDs? We need to break the vicious cycle of poverty to win this battle. ”

In remote parts of central Tanzania, where prejudice against lepers is deeply ingrained, human rights activists say local residents often abandon victims in squalid mud huts to starve and die.

“I don’t want to remember how my own children mistreated me, I leave it to God,” said Mzee.

But the change in government policy means that more attention will be given to this and other diseases as Baraka Makona, a Tabora region Social Welfare officer, explained.

“This move has come at a right time. We need political support from the top so that we continue with this noble duty of defending people who are being rejected by their own families,” he said. “We need enough funding to ensure sufficient food and daily operations of the centres.”

In 2012, the world launched an ambitious plan dubbed the London Declaration on NTDs – a joint commitment to control, eliminate or eradicate NTDs in which multiple donors committed funding for medicines worth over US$17 billion.

The donor-funded initiatives to control NTDs, such as schistosomiasis, trachoma, lymphatic filariasis, onchocerciasiasis and soil-transmitted worms, are often embroiled in financial doldrums as donors fail to honor their promises.

“These are not killer diseases, but they have the potential to eat out body strength, destroy their quality of life and disrupt people’s savings,” said Mzige.

In Tanzania, leprosy, river blindness, trachoma and lymphatic filariasis, which are highly prevalent in many regions, are now in the government focus under the new policy whose implementation starts in the next financial year.

Poverty takes many tolls, but in Tanzania, one of the most tragic has been its tight link with neglected tropical diseases. According to WHO data from 2015, more than 60 percent of 1.5 billion people suffering from NTDs, including leprosy and elephantiasis, received treatment.


Image Credits: Issa Michuzi.

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