Testing her blood sugar each morning is an ingrained, if not always welcome, part of Elisaria Matau’s daily routine.
The 70-year-old retired Tanzanian businesswoman from Dar es Salaam has been living with type 2 diabetes for decades. Her late husband, a soldier, died of complications from diabetes, and she is one of six members of her extended family with the chronic disease.
His family’s health situation is not unusual. Government health sector reports show that non-communicable diseases (NCDs) such as diabetes are on the rise and now account for around 40% of Tanzania’s disease burden.
The country has one of the best in the world fastest growing populations, and UN projections suggest that it will be one of eight countries responsible for more than half of the increase in world population by 2050.
People are also living longer: life expectancy is 66 for men and 71 for women by 2025, and the UN expects the number of Tanzanians aged 60 and over to be more than double over the next three decades. Even with its current population, Tanzania is struggling to meet its health needs.
Older Tanzanians are disproportionately affected by NCDs, but almost 90% of people over the age of 50 do not have health insurance and have little access to medical services. The state health insurance plan can cost between £70 and £350 a year, and healthcare costs are prohibitive for many. Authorities estimate that more than three quarters of people do not visit hospitals until they are seriously ill.
Matau lives alone in the Kawe neighborhood of the capital. She is one of the few Tanzanians who can afford private medical care and visits a nearby clinic every few weeks. But Matau’s health insurance only covers a part of her medical expenses; her children help pay the rest.
“It is very difficult for them because they also have a family to take care of,” says Matau, sitting outside her house. She has had to change her diet because of her diabetes, which means spending more on food.
Victoria Matutu, 35, is bearing a double burden. diagnosed with Diabetes type 1 Two years ago, Matutu was spending around £35 a month on insulin and the same amount on clinic visits every two months. Her mother also has her condition, so Matutu has to help her with the medical bills. She earns the equivalent of £140 a month, which is not enough to pay for the government scheme. “We’ve really had to dig in our pockets,” she says.
Mary Mayige, coordinator of the National Survey of Noncommunicable Diseases, says that conditions that previously affected mainly older adults now affect people in their 30s who are “the engine of production for the country.”
Health care has always been thought of in terms of expense, he says. “It is about time that countries start to see the situation as a threat to the economy and the development of human capital.”
She wants the government to broaden its approach by making targeted investments and increasing social and economic incentives for healthier lifestyles.
Tanzania allocates Less than 5% of its GDP to health, which is below the international threshold for the provision of basic services. Donor funding contributes to approximately 60% of total public spendingbut Health programs that pays are heavily biased towards infectious diseases such as malaria and tuberculosis, despite the fact that data suggesting that infectious disease cases are declining, while NCDs are increasing and account for almost half of the country’s deaths.
The government’s healthcare strategy for 2021 to 2026 recognizes the need to increase its focus on NCDs. “The government will encourage preventive measures that address risk factors related to lifestyle and mental health, as well as environmental factors,” the strategy says. “Where necessary, laws and regulations will be implemented to reduce exposure to risk factors. There will be early detection of chronic diseases through the early detection and treatment of noncommunicable conditions of public health importance.”
“We need to reorient the health system to respond to the growing burden of NCDs,” says James Kiologwe, deputy director for NCDs at the Ministry of Health.
A universal health insurance plan will be launched next year, offering lower premiums to large families and providing specific support for the elderly or those with chronic illnesses. But NCD experts say much more needs to be done, or tailored solutions found, to address the country’s growing NCD burden.