APPMG Delegation Trip to Tanzania 2019- Report

APPMG Delegation to Tanzania

16-20th September 2019

(Based on report from TAPAMA NTDs and feedback from the delegation)

 

Delegation included: Jeremy Lefroy MP- Chair of the APPMG, Dr Paul Williams MP and Volkmar Klein- German MP and they were supported by Alex Simpson

From September 16th to 20th 2019, members of the APPMG as well as a member of Parliament from Germany visited Tanzania hosted by the Tanzanian Parliamentary Group against Malaria and NTDs (TAPAMA NTDs). The delegation was invited by TAPAMA NTDs Chairperson Hon. Riziki Lulida MP and TAPAMA Secretary General Hon. Dr Raphael Chegeni MP of Busega Constituency.

 

The delegation comprised of Jeremy Lefroy MP for Stafford, Chair of the APPMG, Dr Paul Williams MP for Stockton South, member of the APPMG and Volkmar Klein MP for North Rhine- Westphalia in Germany. Mr. Klein MP is also a Member of the German Committee on Economic Cooperation and Development and the Subcommittee on International Health which is concerned with malaria and NTDs. The delegation was supported by Alex Simpson and Dr Hermengild Mayunga of TAPAMA NTDs secretariat and coordinated by Nicole Vecchio, the coordinator of the APPMG. The delegation was accompanied by Dr Janet Lefroy and Ms Vicki Holt who are both medical professionals with considerable experience working in East Africa.

 

A goal of the visit was to provide the opportunity and forum for the APPMG members to visit Tanzania and meet members of TAPAMA NTDs to discuss Parliamentary initiatives to end malaria in Tanzania by 2030. The delegation also aimed to provide the opportunity for UK and German MPs to see the lived experience for those at risk of and suffering from malaria and NTDs and the important work being done by their respective governments to fight these diseases on the ground. The APPMG highly values the opportunity to bring MPs to endemic countries where they can see the direct impact of UK aid to those in need in order to create Parliamentary champions to ensure that the UK government continues to support initiatives to fight these diseases.

 

The trip was planned with input from DFID UK, DFID Tanzania, TAPAMA NTDs, various NGOs working in Tanzania on malaria and NTDs as well as the British High Commission and the Global Fund.

 

Day 1: Kilimanjaro Region

On the first day of the visit, the delegates were welcomed by Dr Hermengild Mayunga, the Programme Director for TAPAMA NTDs Secretariat. The visit began with a courtesy visit to the Kilimanjaro Medical Office where the delegation received a brief report on Medical Health Projects for Kilimanjaro Region from the Regional Medical Officer, Dr Mwako. The group then paid a courtesy visit to the Kilimanjaro Regional Commissioner, Hon. Anna Mghwira.

 

The delegation then divided into two groups, one group which visited a trachoma outreach surgical camp in the district of Rombo. This group included Jeremy Lefroy MP and Dr Paul Williams MP and they were supported by representatives of the different NGOs working on this project- Sightsavers and Helen Keller International as well as Kilimanjaro Centre for Community Ophthalmology (KCCO). The programme that the MPs visited was funded by DFID under the project “Contributing towards the Elimination of Blinding Trachoma in the Commonwealth”. This is also part funded through the Conflict, Stability and Security Fund (CSSF) as part of the commitment made by the Commonwealth Heads of Government Meeting (CHOGM) 2018. The group was impressed by the reach of this programme which corrects trachomatous trichiasis, a neglected tropical disease which is a leading cause of blindness. The group also felt that this programme was a great example of reaching the most vulnerable in terms of rural location and in providing the surgery to all who needed it, including up to age 90 years old.

 

(Dr Paul Williams MP observes a sight-restoring trachoma trichiasis surgery)

 

The second group comprised of Volkmar Klein MP, Dr Mayunga and Alex Simpson and they visited Kilimanjaro Christian Medical Centre (KCMC) Hospital. This hospital is mainly an eye-hospital and a teaching hospital for eye-surgeons but also treats other NTDs and malaria and is one of the largest referral hospitals in Tanzania. The group was welcomed by the KCMC director and heard presentations about the different work going on in the hospital including an overview of the eye- health services, the NTD strategic plan and the research programmes for malaria and trachoma. The delegates also had an opportunity to visit the hospital building structures and eye theatre operational room.

 

(Representatives from KCMC Hospital, CBM and the APPMG delegation including Volkmar Klein MP, Alex Simpson and Dr Janet Lefroy)

 

Day 2: Makunyi

 

Visit to Maasai Community Development and Sustainable Health Initiatives Programme:

On the second day of the visit, the delegation was joined by their host from TAPAMA NTDs, Hon. Dr Raphael Chegeni MP, on the journey to visit a Maasai community at Makuyuni – Mswakini area in Monduli District, Arusha Region. The purpose of the visit was to learn about the programmes to fight and prevent malaria and NTDs under the local NGO Maasai Community Development and Sustainable Health Initiatives – (MCD-SHI).

 

The delegation was welcomed by the MCD-SHI Chairperson Ms. Edna Kivuyo and the community with traditional song and dance by the Maasai warriors and given a short history of Maasai culture with the leaders. Dr Mayunga spoke about the Awareness Campaign against Malaria and NTDs in the Maasai region and Tanzania as a whole and how TAPAMA NTDs collaborates with MCD-SHI on this initiative. Jeremy Lefroy MP spoke to the group about his experience living in Tanzania in the past and how malaria has impacted his family while living there. Mr. Lefroy stressed we must continue to fight this disease and that by joining the efforts together of the Tanzania government, the UK government, TAPAMA NTDs and MCD-SHI and others, it is possible to eradicate this disease. Mr. Volkmar Klein MP also added the support of the German government to work in conjunction with the UK government and the Tanzania government, TAPAMA NTDs, and MCD-SHI to eradicate poverty and malaria in the Maasai community and Tanzania at large.

 

The Secretary General of MCD-SHI, Ms. Edina Kivuyo then identified the key challenges and needs of the Maasai communities which were the lack of clean water and the increase of malaria prevalence in women and children. The lack of access to clean water means that the people are at risk of many NTDs and communicable diseases and they stressed trachoma as a main concern. This also impacts the women having to travel for long periods of time looking for clean water and the men looking for water for their livestock. The time spent gathering water takes away opportunities for economic activity and further contributes to poverty in the community.  The MCD-SHI team then asked the Parliamentarians present to use their voices in the UK and Germany and on the APPMG to help support access to clean water for the Maasai people in the Mswakini Ward area with the provision of a well to every ward in the district.

 

The delegation has asked the MCD-SHI team and community to work with the local water engineers to prepare a budget for this request and the delegation hope to be able to help find the funding needed to enable the community to find access to clean water. The group also agreed that it was essential to provide mosquito nets to the community’s pregnant women and children and hope to be able to help the community to be provided with these nets. The delegation offered a donation to the Maasai community to buy some mosquito nets or malaria medication while they were there.

 

 (Jeremy Lefroy MP receives a gift and blessing from the Maasai leader)

 

At the end of the visit, the delegation was offered kind remarks by the District Medical Officer and appreciative handicraft gifts by the Maasai community along with their wishes for these products to be promoted in Germany and the UK as a means of bringing economic growth to the community. The delegation also presented gifts from the UK to the community leaders and offered their thanks for the hospitality of the community through Hon. Dr Chegeni.

 

Day 3: Dodoma

 

Ministry of Health and Members of Parliament:

On the third day of the trip, the delegation was in the country’s capital, Dodoma, where they were welcomed by the Regional Commissioner of Dodoma, Hon. Dr. Binilith Mahenge and also the Regional Medical Officer, Dr Best Richard Magoma.

 

The delegation then met with representatives of the Ministry of Health to receive official reports on the status of malaria and NTDs in Tanzania including the major successes and challenges/gaps. This meeting was attended by: The Permanent Secretary of the Ministry of Health, Dr Zainabu Chaula and the Permanent Secretary of the Officer of the President Local Government Authority, Dr Dorothy Gwajima as well as the National Malaria Control Programme Manager, Dr Ally Mohamed and the Acting National NTD Programme Manager, Dr Oscar Kaitaba members of Parliament who are members of TAPAMA NTDs, Hon Riziki Lulida, Hon Dr. Raphael Chegeni, Hon. Dr. Immaculate Sware and Hon. Magreth Sitta and the Director of the African Leaders Malaria Alliance (ALMA), Ms. Joyce Kafanabo.

 

The Permanent Secretaries recognised the generous support that Tanzania is receiving from UK and German governments and requested that the MPs present maintain enthusiasm and encourage the mobilization of more funds to support malaria prevention (as opposed to diagnostics and disease management) in order to achieve the national goal to end malaria and NTDs by 2030. TAPAMA NTDs discussed the original aims of the group which was to create an accountability mechanism to see how money was being spent on these diseases at the local and national level. Investments into health systems are crucial to fighting these diseases and the group has been successful in influencing budget lines and raising awareness to other MPs about how they can champion budget lines for malaria and NTDs.

 

(APPMG delegation including Dr Paul Williams MP, Volkmar Klein MP and Jeremy Lefroy MP take part in discussions with the Tanzanian Ministry of Health and Parliamentarians)

ALMA shared how their malaria and NTD scorecard has been used at a country level as an accountability mechanism, scorecard and action tracker to help reach malaria eradication goals. The next stage of this scorecard in Tanzania is to take it to a regional level and to develop an app which will be updated quarterly to be used by MPs to follow progress in their constituencies and to be notified if there are any red flags where action is needed.

 

The Acting NTD Programme Manager shared that the national programme focused on 5 NTDs and included national television education campaigns regarding preventative measures as well as teacher training to encourage better WASH practices by children and national mass drug administration (MDA) programmes. DFID and Commonwealth funding have been critical to NTD operations carried out and also NTD research programmes.

 

Dr Paul Williams MP summarised that resources and coordination are needed in order for the strategic plan to be successful in bringing malaria to zero and reaching the eradication target by 2030 in line with the SDGs goals. Dr Williams emphasised that the British, German and Tanzanian Parliamentarians were there as equal partners and that this should not be a top-down approach to support led by donors. Rather, the delegation were there to hear what Tanzania needed in terms of their malaria and NTD programmes. The delegation congratulated the Tanzania National Malaria Team for the initiatives and success achieved in reducing malaria from a prevalence of 14.8% in 2015 to 7.3% by 2018 and agreed to discuss with their respective countries UK (DFID) and the German government to continue supporting Tanzania with the Malaria Eradication Campaign.

(The delegation outside of Tanzania Houses of Parliament)

 

A planned meeting with the Speaker of the Assembly had to be cancelled due to an emergency task that took the Speaker’s availability so the delegation spoke in length with Hon. Dr Chegeni about how the APPMG may support TAPAMA NTDs. The delegation shared their experience to support with capacity building for TAPAMA NTDs and monitoring of the action and accountability of malaria programmes in Tanzania. The group reflected on ways in which TAPAMA NTDs can mobilize resources for their administration costs. Discussions also focussed on how to learn from success achieved in Zanzibar which has come from IRS and bednet use and the need to ensure that people not become complacent otherwise there will be a resurgence of malaria.

 

Mvumi Hospital Visit (Chamwino District):

The delegation visited Mvumi Hospital later in the afternoon of the third day where they first were greeted by the Chamwino District Council Director- Mr Athuman Masasi, the District Medical Officer- Dr. Euseby Kessy as well as Dr Andrew Barclay and Dr Gill Barclay of Mvumi Hospital. The District Medical Officer reported on the hospital as well as malaria eradication efforts in the district. New infections have been greatly reduced in the area due to simultaneous interventions such as proper use of LLINs and early diagnosis, prompt treatment and cleaning of mosquito breeding sites. This has brought prevalence in the area to 1.2% in 2018. The hospital has good medication stocks and rapid diagnostic tests and regularly provides pregnant women with IPT drugs to prevent malaria and provides pregnant women and children under 5 with bednets. The District Medical Officer highlighted that their major needs were regarding vector control and cleaning the mosquito breeding sites.

 

The hospital also commented on its NTD programmes which includes MDA with between 88-92% coverage in children and also the SAFE strategy for trachoma control. Major improvements have been made in recent years with WASH facilities and practices which are essential to reducing NTDs. WASH improvements include an increase in household toilets from 5% in 2015 to 62% in 2019 and improved handwashing facilities. After a tour of the hospital, the delegation commended the hospital directors for their achievements in reducing malaria and offered their support to help find funds for equipment to destroy mosquito breeding grounds.

 

Day 4: Dar Es Salaam

 

Members of Parliament and Minister of Health:

The delegation met with the Deputy Minister of Health, the Hon. Dr Faustine Ndugulile, Tanzanian Members of Parliament who are members of TAPAMA NTDs including Chairperson Hon. Riziki Lulida MP, Hon. Dr Raphael Chegeni MP, Hon. Immaculate Sware MP, Hon. Venance Mwamoto MP and Hon Esther Matiko MP as well as representatives from international and local organisations in the fight against malaria and NTDs at the Parliamentary Office in Dar Es Salaam.

 

Representatives commented on the status of malaria and NTDs in Tanzania and the work that their respective organizations are doing to fight these diseases. TAPAMA NTDs presented the National Malaria Report and members of the APPMG delegation had the opportunity to respond about what they have seen so far in Tanzania. The APPMG delegation commended the country on their efforts and success in reducing malaria to date and the importance of maintaining support and efforts until this disease is eradicated. CBM is an NGO working in Tanzania mainly on supporting people with disabilities, many of which are caused by NTDs. CBM Tanzania director, Nesia Mahenge, spoke about the work they are doing focused on empowering these people and ensuring that those living with disabilities have equal access to healthcare, including NTD and malaria programmes.

 

Mr. Lefroy observed the need to scale up efforts to establish a network or coalition of inter-regional APPG groups. This will enable the groups to share interventions, strategies, and a common plan to enhance the political will among members of Parliament from different countries. The suggestion was made for TAPAMA NTDs to coordinate the first Summit of an inter-regional group of APPGs (similar to the Global TB Caucus) to take place in Tanzania in April or May 2020. TAPAMA NTDs already has  made connections to the Parliamentarians working on malaria and NTDs in Uganda, Germany and the UK. This Summit shall provide a platform for members of various Parliaments and other stakeholders including academia and NGOs working in malaria and NTDs to meet and share interventions and strategies to end malaria globally.

 

(Jeremy Lefroy MP and Dr Paul Williams MP speaking with Tanzanian Members of Parliament about malaria and neglected tropical diseases)

 

Ilala Hospital:

The delegation was able to visit a maternity hospital in Dar Es Salaam accompanied by the District Medical Officer in charge of the hospital. The delegation distributed treated bednets to pregnant women and mothers of newborns at the hospital to support the prevention of malaria in these vulnerable populations.

 

British High Commission and DFID Tanzania:

The delegation met with Sarah Cooke, the High Commissioner of the UK to Tanzania at the British High Commission and representatives of DFID Tanzania Ms Gloria Ngaiza, Miss Gertrude Mapunda Kihunrwa,  Mr Rick Shearn – Deputy High Commissioner, Miss Beth Arthy – Head of Office, DFID on the final day in Dar Es Salaam. Hon. Dr Chegeni requested the financial support of DFID for TAPAMA NTDs activities including the secretariat administration running costs.

 

The APPMG would like to stress their congratulations to the government of Tanzania and the Ministry of Health for reducing malaria prevalence from 14% to 7% but there is still much to be done in order to reach elimination targets. The APPMG has heard that the government has recently reduced the tax on bednets to make them more affordable and introduced a national insurance scheme which are both efforts to be applauded. In order to maintain efficacy of bednets, solutions must be found to ensure that they are re-impregnated when required. The APPMG would also like to encourage the government to focus on long-term sustainability plans for a transition to these programmes being managed and funded by the Tanzania government when aid is no longer available. The National strategies for malaria and NTDs and the political will are promising for Tanzania, but resources are still limited and as we approach elimination surveillance mechanisms will need to be greatly improved. The APPMG has found this visit to Tanzania has left them encouraged by the progress and the brave Parliamentarians taking up this fight for the people in their constituencies. The delegation are now more determined to continue the fight in the UK and across borders with other Parliamentarians in both donor and endemic countries. The collaboration between British, German and Tanzanian Parliamentarians was a highlight for all members involved in this delegation.

PDF Version of the trip report can be downloaded here: Tanzania 2019 trip report