THE CHALLENGE
Zanzibar’s search for a sustainable healthcare system
“At independence, the clove trade in both local and international markets was profitable. This enabled the country to get adequate funds to provide free health care. This is no longer the case. We will have to make smarter decisions.
"In addition, the population has grown about ten-fold, from about 200,000 in 1964 to 1.9 million today, making the delivery of free health care for all more difficult.”
HON. NASSOR AHMED MAZRUI – MINISTER OF HEALTH, ZANZIBAR
Zanzibar in 2019 – the challenges of providing free healthcare
When Zanzibar gained independence in January 1964, the economy was booming and the government declared the provision of free healthcare to all citizens. But by 2019, the Revolutionary Government of Zanzibar was struggling to provide free quality healthcare to its growing population.
Limited funding, lack of quality control, and lack of standard practices led to significant differences in the quality of care between various facilities, both public and private.
Problems patients endured
After a visit to a health facility, a patient may be prescribed medications that are not available at that facility. Patients then need to purchase the medications elsewhere themselves.
At some facilities, laboratory tests may not be possible due to missing reagents. If a patient requires these tests, they need to visit a standalone laboratory (and pay for the tests themselves) before continuing with treatment.
How the project began
2019 conference sparked initial interest
Many prominent healthcare officials were invited to the Future of Healthcare conference in Amsterdam in 2019, including the Director-General for Health Services in Zanzibar.
The potential of mobile technology was a central theme of the conference. After an introduction to SafeCare, the Zanzibar delegation expressed their interest in using its digital model to develop their own quality management program.
Weeks later, the SafeCare team met with Ministry of Health officials in Zanzibar. Together, the teams visited the Cardinal Rugambwa Hospital, a facility on the mainland of Tanzania that successfully participated in SafeCare's stepwise continuous quality improvement program.
A hospital climbing the quality ladder
Proof of concept in Dar es Salaam
The Cardinal Rugambwa Hospital in Dar es Salaam is part of a faith-based organization, the Christian Social Service Commission (CSSC).
The hospital reached SafeCare Level 4 after working its way up from Level 2 in 2019.
For the hospital, SafeCare’s primary advantages were:
- better quality health services that translated into a larger, more satisfied group of visitors,
- a focused approach to quality, and
- clarity on the next steps to improve general health services.
The ambition
The Ministry of Health in Zanzibar was looking for solutions that would help them:
- offer access to consistent, quality care across districts, for all citizens, including the most vulnerable,
- strengthen coordination by obtaining timely information about challenges and the resources needed to provide better health outcomes,
- create a mechanism through which those who can financially contribute, do so in a fair and well-organized way, and
- establish a single quality improvement model for both private and public facilities.