Democratic aspect of governmental and private health care facilities : the case of Ifakara - Kilombero district

The problem of malaria in Tanzania has been and continues to be the most challenging of health problems. It is the major cause of morbidity; it is also one of the top causes of deaths. Efforts have been undertaken to curb malaria in the country from as early as the beginning of this century. However, regardless of the great efforts administered to curb malaria, the problem still persists and malaria is still the leading killer disease. It has been hypothesised in this study that the above scenario is a manifestation of the manner in which the anti- malaria campaigns have been carried out. They have not been open and democratic enough to allow full participation by the communities involved. From the study, it was observed that there is availability of good expertise in the control of malaria at the top and research levels, but less at the intermediate and little at the lower levels of health services. In spite of the great contribution offered by the governmental and private health care service, there is evidence suggesting that a large proportion of the targeted population actually do not utilise these facilities. They prefer traditional and self-medication it was further noted that there exists a general lack of full community participation in the campaigns especially where crucial matters such as decision-making is concerned. The study concludes by voicing a plea to the concerned bodies to revise their way of looking at this problem. Information which is used basis for planning by Ministry of Health is based on findings from the patients using hospitals and dispensaries as well as routine administrative data. However this does not portray the real situation since a large proportion of the populations living in areas where malaria is endemic receive their health care outside formal health care services. The study thus calls upon more transparency and openness among the campaign strategies which take into consideration local health knowledge and the most affected of community members women and children as hence giving the special attention.