Overview
Like most countries in Africa, Tanzania has a public and private health care sector. The public health care system is run by the Ministry of Health and Social Welfare. There is a lot of aid that flows through the country, yet the public facilities leave a lot to be desired, so people turn to the private sector which is unaffordable to many. Those who can often travel abroad to Kenya for their medical care. People are quite aware of diabetes in general, due to the catastrophic rise in Type 2 diabetes here. People refer to the types as "low" (Type 1) and "high"(Type 2) diabetes. They make reference to the two types in this way, but anything beyond this understanding is limited.

What happens if you need to see a doctor?
The process for seeing a doctor or healthcare worker varies considerably depending on location and socio-economic factors. There are hospitals and clinics that cost around $15 to see a doctor, but you usually have to wait in long queues, often for the entire day, before you are seen, particularly if trying to see a specialist. Even with appointments and referrals, there are long waits, which usually means time taken off work and loss of income. Then there are the costs of tests on top of the doctor fees. Public facilities are cheaper but often do not have the required treatments and tests. Due to costs involved, many people wait for free clinics provided by charitable organisations or individuals. There is a flying service that visits remote areas, and waiting for these flights remains the only option for some people living in those areas. That said, many people believe only in traditional medicine so will not ever attend clinics.

Who decides what medicines the doctor prescribes?
The Tanzanian Food and Drug Authority in collaboration with the Tanzania pharmacist’s council regulate prescription medicines. Acterapid, Lente and Mixtard are the most commonly used insulins. Newer generation of insulins are available to order from overseas, but these are unaffordable for most.

Practically, what's it like to live with Type 1 diabetes in Tanzania?
Type 1 diabetes is bitterly referred to as a "rich-mans disease." Most people cannot afford a glucometer or test strips, so rely on clinics to check blood sugar. Education is challenging and the diet is carb-based, which makes blood-sugar targets difficult to achieve, particularly for those from low-income families. Many people rely on free-medical camps provided by volunteer doctors coming from abroad, donors or on charitable organisations. The Tanzanian Diabetes Association works with the charities to help support people, mainly children, with Type 1 diabetes. However, even for people who can afford private health-care and treatment, access to Western standard care is not possible within the country.

How does healthcare vary across Tanzania?
Health care varies significantly with location and socio-economic factors. Many people live in remote areas and are from low-income families, so travel costs are an issue. Clinics may be poorly attended as many families in remote areas are nomadic. This makes advocacy, awareness and management challenging. Many cases in remote areas likely go undiagnosed and are treated through traditional and herbal methods. In urban areas diagnosis is more likely, yet general education levels can make safe blood-sugar difficult to achieve.

A huge thanks to Elisabeth Fraser of The 4Ts – Travel, Teaching, Tanzania and Type 1 for sharing this information.