Shock as medical registration fees up by 600pc

Patients here will now pay six times more in charges at mid-level public hospitals as the authorities move to decongest Muhimbili National Hospital, which serves more than 1,000 people every day.

Mwananyamala hospital, in Kinondoni district, has hiked the registration fee from Sh1,000 to Sh6,000 for out-patients beginning December 1.

The Citizen on Sunday has learnt that Temeke and Amana hospitals will also announce new fees soon as the government seeks to turn them into regional referral hospitals. The move has caught many city dwellers unawares and concerns have been raised over the state of affairs at health centres and dispensaries, which face acute shortage of medicine and personnel.

Many of the over four million city residents who are poor will struggle to raise the new fees at the designated referral facilities. They are expected to throng the lower facilities that still maintain their registration fees at Sh1,000.

In a spot check at Mwananyamala, The Citizen on Sunday met patients protesting the rise in the fees. They lamented that the new charge was way too much for a government hospital. A notice pinned at the hospital announced the new fees and change in status. Patients with referral letters from public health centres will pay Sh3,000 in registration fees.

Those without such documents will pay double the amount, according to the notice. On Wednesday, brothers Mohammed and Abdalah Mwinjuma from Makumbusho left without treatment when confronted with the changes. They claimed they had neither the information nor the money demanded. The brothers have over the years relied on Mwananyamala as it is the health centre nearest to their home. “My brother (Abdalah) is ill and I have brought him straight here,” said Mohammed as they walked out. “Now I am told I have to pay Sh6,000 because we don’t have a referral letter. We have not been attended to.”

Lucy Charles had a referral, though, and had been cleared to see a doctor after paying Sh3,000. But she still complained that the amount was too much: “We used to pay Sh1,000, which is affordable for the common mwananchi like me, but what is the difference with the private hospitals? We don’t see any improvement in services, just the pricing.”

But an official at Mwananyamala defended the new fees, saying they were within the official cost-sharing policy. Mr Edwin Bisakala, the Health Secretary, said the earlier payment of Sh1,000 was only for registration while the current amount covers a medical card, consultations and initials lab tests. “Formerly, the patients were either bringing an exercise book that we used to keep their medical records but the new A4 card remains in the patient’s file at the hospital and the patient is given a card number for reference. On top of that, the patient will get consultation and some initial tests.”

He added: “We are just implementing the national cost-sharing policy that says we should raise the fees by 50 per cent if the cost of operation has risen.  Secondly, it is now a regional referral hospital requiring that the people make use of the health centres in their wards.”

The new charge is expected to help raise internal hospital revenue so that even when the national medical subsidy is delayed or insufficient, they can still maintain required operational levels without disrupting services. “The hospital therapeutic committee proposed the new price and sent the proposal to the hospital board which is the representative of the citizens, who approved it,” he said.

The new charge at Mwananyamala hospital and impending ones at Temeke and Amana means that ward public dispensaries will now receive more patients. But inquiries at the health centres and dispensaries indicate that the current situation in terms of medical supplies and staffing will likely remain the same.

A tour of several of these health centres and dispensaries established that little has changed and staff have not been made aware of their new role. Sources at Makuburi dispensary, who spoke on condition of anonymity, said they were taken by surprise at the sudden surge in patients. The source added: “We were taken aback at first as Mwananyamala did not involve or inform us of the consequences of their move. We now attend to about 200 patients, up from an average of 100 every day.”  An officer at Sinza health centre said they did not know if help would come, and in what form, if they were to handle the new challenges. “We were not informed of the changes but the patients have increased. We have not been given additional funding or more staff and medicine. “

At Makuburi, the facility has only two doctors while the third is on leave. “The government or the administration of Mwananyamala hospital should have first considered the situation in these centres because now we will have a big burden using the same inadequate resources,” said one worker.  Ministry of health officials were unavailable for comment.

How Dar can curb corruption

Tanzania has to pull up its socks and back words with commitment if the country wants to triumph against corruption, says Transparency International (TI).

The organisation recently ranked Tanzania at 111 out of 177 countries on its 2013 Corruption Perceptions Index, nine places down from the 2013 index.

Since the publication of the 1996 Warioba report assessing the state of corruption in Tanzania, the country has established a comprehensive body of regulations, laws and oversight institutions aimed at preventing, investigating and sanctioning corrupt practices, including the Prevention of Corruption Bureau (PCB) to Prevention and Combating of Corruption Bureau (PCCB), and the Ethics Inspectorate Department. 

However, anti-corruption institutions suffering from lack of staff, resources and coordination, enforcement of the laws and regulations remaining limited, which some view as the reasons behind the stalling of the fight against corruption.

“Despite 2013 being a year in which governments around the world passed new laws and forged fresh commitments to end corruption, people are not seeing the results of these promises”, said Transparency International.

According to the organisation, anti-corruption is an increasingly attractive platform for politicians, with many incorporating anti-corruption pledges into their election campaigns. The danger, however, is that these anti-corruption promises fail to materialise.

 “Government guarantees of greater accountability do not always bring about tangible results at the local level. Protests in Brazil this summer showed public exasperation at the continuation of political scandals in spite of governmental assurances of a zero-tolerance policy on corruption,” claimed the organisation .

Borrow a leaf

Tanzania and the Sub-Saharan region as a whole once again shows the highest perceived levels of public sector corruption, averaging a score of 33.

According to TI, there are however success stories which showed action in executing anti-corruption strategies. Estonia established a new anti-corruption strategy centring on increasing transparency in state institutions by creation of online database accessible to all, where people can find who in their municipal council won a tender and what can be done with taxpayer money.  The effort, among others, saw the country climbing four places in the index, from 32 in 2012 to 28 this year.

According to the latest corruption studies in the country, 18 per cent of Estonians said they had been offered bribes and four per cent had given bribes. The strategy is not dealing with crimes directly, but rather focusing on prevention and education.

In Spain, after a period blighted by political scandals indicating a lack of accountability and fading public trust, the country has dropped ten places in the index from 30 last year to 40 this year. Spain tried to remedy its corruption troubles with a new Transparency Law passed by a congress in September and awaits Senate’s approval .

DC announces city’s cleaning schedule

The district commissioner here, Halima Dendego, has announced plans by the local government to undertake an improvement on the current public cleanliness exercise in Tanga popularly known as “Kalembo Day,” conducted every first Saturday of the month to ensure that it does not become a nuisance to businessmen.

Announcing plans at the first inaugural meeting of the Tanga District Business Council (TDBC), Dendego said that under the new plans to be effective starting next year, businesses would not be closed on ‘Kalembo Day’ as it was the case in the past.

Closure of businesses has caused quite a stir and has been a nuisance to businessmen who have complained of losing profits through the exercise. Contributing to a general discussion on the state of business in Tanga City, a member of the council, Sadik Shembilu, said people were not treating the day with mockery, with businessmen closing businesses as usual but staying inside their houses without doing any kind of cleanliness.

“It does not serve the original purpose of cleaning the city. We thank authorities for establishing the cleanliness drive but I think we should change our tactics,” said Shembilu.

He suggested the use of youth brigades to clean many areas using payments from households instead of using the current system.

The district commissioner said that the city would be divided into zones where cleaning would be done by different sectors of the society.

“The first zone would be where the city council is able to conduct cleanliness without any problem. The second zone would be left to the private sector and would include a plan to establish youth groups to do the cleanliness for a fee,” Dendego pointed out.

She said the other zone would involve areas where the public would do cleanliness collectively (msalagambo).

“Cleanliness in Tanga would be a 24-hour affair and the health department is expected to take charge of the situation to ensure that everybody takes part in the exercise.

Meanwhile, a health department official, Joseph Mbati, said that registration of youth groups to undertake cleaning tenders has already started and eight groups have already been registered.

Dar’s $500bn gas boom and Africa’s richest tribe

The discovery of natural gas reserves, apart from elevating Tanzania’s economic status, has also triggered heated debate, putting the country’s future at a crossroads. While the government has maintained that its policy aims to create what it calls ‘a win-win situation’, some observers believe Tanzanians have been locked out of the $500 billion gas bonanza.

Energy and Minerals minister Sospeter Muhongo did not take kindly to the debate initiated by Tanzania Private Sector Foundation chairman Reginald Mengi. Prof Muhongo believes Mr Mengi harbours selfish interests, and does not speak on behalf of the masses as he claims.

But even before Mr Mengi’s outcry against the exclusion of locals from the lucrative natural gas sector, Mtwara and Lindi residents had rioted against what they claim is their sidelining from the imminent boom. The government’s response was to fire tear gas and bullets at them and deploy the military to calm the situation. Countrywide, the nation is divided on how gas revenues should be distributed and spent. Amid the heated debate between Prof Muhongo and Mr Mengi, The Citizen asks in a special news analysis whether Tanzania could learn a lesson from Africa’s richest community.

Kikwete in tough cabinet choice

 In re-crafting the Cabinet,  the engine of  running government affairs,  President Jakaya Kikwete  faces a two-in-one challenge: filling  vacant posts, and determining whether the current governance systems are, or aren’t  good enough to enable even the best brains and dedicated individuals to operate efficiently.

That, some analysts, say, is apparent, in the wake of four ministers being sacked, and a looming reshuffle that could see more heads rolling, amid heightened concerns at levels ranging from the grassroots to Parliament, that the government is a let-down, in its public service mission.

On Friday,  the president,  as top appointing authority,  fired four ministers implicated by a parliamentary select committee with gross human rights abuse during an operation to tackle poaching, dubbed ‘Operation Tokomeza’. 

Chairman of the committee James Lembeli revealed shocking incidences of crimes, including murder, rape and torture committed by soldiers deployed to execute  the operation that triggered much alarm and criticism. He then proposed that the four minister-- Dr Emmanuel Nchimbi (Home Affairs), Mr Khamis Kagasheki (Tourism and Natural Resources), Mr Shamsi Vuai Nahodha (Defence and the National Service) and Dr David Mathayo (Livestock and Fisheries Development)--take responsibility by resigning.

Shedding political party affiliations often typical on issues of a relatively mild nature, MPs supported the proposal, culminating in President Kikwete endorsing the plea by blessing the sacking of the ministers.

Commentators who spoke to The Citizen on Sunday pointed out that, whereas departure from the Cabinet via resignation of,  or expulsion  by ministers deemed inefficient or irresponsible was a positive trend, it wasn’t a wholesome solutions to operational problems.

The Head must  probe  the extent to which the governance systems were a stumbling block to  the performance of  even ministers who would be exemplary performers in an ideal environment.

What’s more, they noted, restricting punitive measures to ministers was unfair and wouldn’t have long-term positive bearings if  subordinate, but nonetheless key  executives such as permanent secretaries and top political officers  implicated in the atrocities are not sent packing.

Political scientist Bashiru Ali, says the whole governance system in the government was in  such a shambles  that even potentially capable ministers wouldn’t be helpful and whose tenure could consequently be short-lived.

“The same would happen even if we bring in angels…have you asked yourself how many ministers have served in the energy and tourism ministries since Kikwete came to power?” the University of Dar es Salaam lecturer asked. The ministry  of energy has seen three ministers on the wheel since President Kikwete came to power in 2005 while that of tourism will be having its fourth head after the next reshuffle. He said President Kikwete’s administration lacked clear administrative discipline, making even new ministers vulnerable to failure.

“The system is exhausted…it is ungovernable; this parliament will be investigating one scandal after another because the system is failing…it needs a major overhaul,” said Mr Bashiru.

To show failings in the country’s governance system, the academic said the parliament itself  was suffering from similar accountability problems, making even the Lembeli’s report questionable.

He queried: “We heard of raping  and killings in Mtwara during gas-related chaos; have you seen any report on those atrocities?”

Leader of the opposition Civic United Front (CUF) Prof Ibrahim Lipumba asked President Kikwete to constantly review performance of his ministers before things get out of hand.

Chadema’s Chairman Freeman Mbowe said we would be committing  serious political mistakes to pour too much blame on alleged underperforming ministers without critically reviewing how the current governance systems work.

“Contributions in parliament by mostly CCM MPs indicate that the ruling party was losing grip,” said the Hai MP. Mr Mbowe said he expected the President  to weed out more unsuitable ministers, citing the Education sector as an example.

Why women have sharper memory than men

If you are a man, perhaps you have wondered why your wife, girlfriend, mother, sister and even a female friend remembers everything you said to her or promised. You also may have been surprised why women are better than men when it comes to memory tests.

If you are female, chances are you have also wondered why men tend to outperform women in spatial tasks and motor skills—such as map reading or driving. Wonder no more.  Scientists have found the answer.

A pioneering study has shown, for the first time, that the brains of men and women are wired differently—which could explain some of the stereotypical differences in male and female behaviour, the United Kingdom’s The Independent newspaper reported yesterday, quoting research by scientists.

According to the newspaper, researchers found that many of the connections in a typical male brain run between the front and the back of the same side of the brain, whereas in women the connections are more likely to run from side to side between the left and right hemispheres of the brain.

This difference in the way the nerve connections in the brain are “hardwired” occurs during adolescence when many of the secondary sexual characteristics such as facial hair in men and breasts in women develop under the influence of sex hormones, the study found.

The researchers believe the physical differences between the two sexes in the way the brain is hardwired could play an important role in understanding why men are in general better at spatial tasks involving muscle control while women are better at verbal tasks involving memory and intuition.

Psychological testing has consistently indicated a significant difference between the sexes in the ability to perform various mental tasks, with men outperforming women in some tests and women outperforming men in others. Now there seems to be a physical explanation, according to scientists.

The UK newspaper said, quoting Ragini Verma, a professor of psychology at the University of Pennsylvania in Philadelphia: “These maps show us a stark difference—and complementarity—in  the architecture of the human brain that helps provide a potential neural basis as to why men excel at certain tasks and women at others.

“What we’ve identified is that, when looked at in groups, there are connections in the brain that are hardwired differently in men and women. Functional tests have already shown than when they carry out certain tasks, men and women engage different parts of the brain.”

The research was carried out on 949 individuals—521 females and 428 males—aged between eight and 22. The brain differences between the sexes became apparent only after adolescence, the study found.

A special brain-scanning technique called diffusion tensor imaging, which can measure the flow of water along a nerve pathway, established the level of connectivity between nearly 100 regions of the brain, creating a neural map of the brain called the “connectome”, Prof Verma said.

“It tells you whether one region of the brain is physically connected to another part of the brain and you can get significant differences between two populations,” Prof Verma said. “In women, most of the connections go between left and right across the two hemispheres while in men most of the connections go between the front and the back of the brain.”

Because the female connections link the left hemisphere, which is associated with logical thinking, with the right, which is linked with intuition, this could help to explain why women tend to do better than men at intuitive tasks.

Prof Verma added: “Intuition is thinking without thinking. It’s what people call gut feelings. Women tend to be better than men at these kinds of skill which are linked with being good mothers.”

Many previous psychological studies have revealed significant differences between the sexes in the ability to perform various cognitive tests.

Men tend to outperform women in tasks involving spatial tasks and motor skills—such as map reading—while women tend to do better in memory tests, such as remembering words and faces, and social cognition tests, which try to measure empathy and “emotional intelligence”.

HomeNewsEast Africa News EAST AFRICA NEWS S.Sudan bid to join EAC in jeopardy

The ongoing civil unrest in South Sudan may shatter the country’s dream of joining the East African Community (EAC),The Citizen has learnt.

Right from the outset, the newly independent South Sudan cultivated warm relations with its southern neighbours within the EAC.

Motivated by economic pragmatism, and perhaps seeking a sense of belonging, South Sudan, Africa’s youngest nation, submitted an application to join the regional economic bloc in November 2012, just months after gaining independence.

The five partner states – Tanzania, Kenya, Uganda, Rwanda and Burundi – were more than eager to bring the oil-rich country into the fold of the EAC. A verification team was sent to Juba in July 2012 and a timetable for negotiations has since been drawn up.

However, the ongoing political chaos in South Sudan may see these plans crumble swiftly. The Treaty for the Establishment of the EAC sets out stability and good governance as one of the requirements for membership. An attempted coup and political chaos mean that South Sudan is now far from meeting this prerequisite.

“The current internal crisis in South Sudan does not augur well with its bid for membership in the Community,” noted EAC Secretary-General Richard Sezibera in a statement.

The EAC Charter, Dr Sezibera observes, requires that a country meet standards on “universally accepted principles of good governance, democracy, the rule of law, observance of human rights and social justice.”

Clashes broke out in Juba on December 15, following what the presidency claims was an attempted coup. They have since escalated, with reports indicating that violence has spread to other cities. The United Nations has put the death toll so far at about 500 people.

Following a meeting of the EAC Council of Ministers in November, the secretariat had scheduled the first round of negotiations with South Sudan for January 13 to January 22, 2014.

A decision on South Sudan’s membership in the Community was expected from the heads of state in April 2014.

With Juba in a shambles, it is doubtful whether President Salva Kiir’s government will make this date with the EAC, let alone meet the standards required set out by partner states.

“We pray that this programme will not be jeopardised by the ongoing internal conflict in the country,” reads part of Dr Sezibera’s statement.

Prof Macharia Munene, an international relations scholar at the United States International University, noted in a telephone interview that the current crisis in Juba should not have come as a surprise to the EAC partner states since South Sudan has struggled for stability since independence.

President Salva Kiir has blamed soldiers loyal to former Vice-President Riek Machar, whom he sacked with the rest of the Cabinet in July.

Prof Munene reckons that the speed with which the conflict is resolved could be key in determining whether the timeline for South Sudan’s integration into the EAC will be interrupted.

“The question now is how the government will handle the situation. If it is resolved quickly and is seen as no more than a hiccup, then the schedule might not be dramatically interrupted. If it is a prolonged crisis, then there might be problem,” he said.

Even in the early stages of verification of South Sudan’s EAC membership application, there were cracks. A team sent to Juba last year noted that the government was divided over what the timetable would be for joining the EAC.

The verification committee also raised concerns about the “highly militarised society.”

“Proliferation of illicit arms and light weapons is a threat to national and regional security and stability,” read the team’s report.

Was it an attempted coup d’état? That is neither fully established nor highly important, pretty much like the question as to whether this is a Nuer-Dinka clash.

There has been incessant violence in different parts of South Sudan, but not to the military, humanitarian and political scales of the clashes between factions of the Sudan People’s Liberation Army (SPLA) last Sunday and the civilian killings that followed.

The arrest of ten or more senior figures of the Sudan People’s Liberation Movement (SPLM) and the search for others is also unprecedented.

The violence has extended from Juba to Jonglei State and could spread further.

It has retained the form of clashes within the military with civilian casualties. Similarly, government clamp down on suspected dissidents has also gone beyond the capital city.

There are reports that local SPLM officials in Warrap State have been arrested for questioning over their roles in the alleged coup attempt. These developments are unfortunate but not surprising.

Signs of growing disunity in SPLM and the possibility of a potentially violent conflict between two rival groups under President Kiir and Dr Machar Teny have only been getting clearer by the day.

Historical antecedents to the current crisis, especially the more recent ‘catalysts’ are fairly well known.

The dismissal of Dr Machar as vice-president, coupled with the sacking of several ministers following dissolution of the Cabinet and the suspension of SPLM secretary-general Pagan Amum in July this year, gave the strongest indication that SPLM was at war with itself.

Before then, the president had issued decrees sacking the governors of Lake and Unity states at different times this year and appointing office holders in interim capacities.