Prof Kaaya: Mloganzila health facility a game changer

Give us a brief history of Muhimbili University of Health and Allied Sciences (MUHAS) and what necessitated the construction of the new campus at Mloganzila?

Muhimbili University of Health and Allied Sciences (MUHAS) was established way back in 1963 as the Dar es Salaam School of Medicine, which was upgraded later on to the Faculty of Medicine of the University of Dar es Salaam in 1968. But at the time of establishment, the faculty could only admit 50 medical students. Then over the years, the population of students grew and until 1997, the population had reached to the stage where the facilities could no longer accommodate all the students.

Therefore, there was the need for expansion of the facilities so that we could also expand enrolment of students. By 1997, the Faculty of Medicine was at that time admitting about 200 students in medicine but also we had other students in School of Public Health, School of Nursing, School of Dentistry and also students from the Allied Health Sciences.

Therefore, we had this idea that in order to be able to increase enrolment, we needed to expand the facilities but the campus at Muhimbili could not expand any further because it had a small area. And therefore the government gave us about 3,800 acres of land at Mloganzila in order to start a second campus which would be the main campus MUHAS, which was accredited to be a full-fledged university in the year 2007.

Where did the government obtain the funding for the construction of MUHAS Academic Medical Centre (MAMC)?

In 2006, negotiations between Tanzanian Government and its South Korean counterpart led to the granting of money as soft loan for construction of the facility. In 2010, the two governments signed a contract. The amount of money for construction of the hospital and installation of medical equipment at that time was $76,500,000 (around Sh171,283,500,000 on current exchange rate). At that time this was enough to construct the building and fully equip the hospital.

However, by the time we started the construction in 2012/2013, inflation had taken its toll and $76.5million could no longer construct the same building. This necessitated the government to top up by $18,040,000 making a total of $94,540,000 to construct the same building which we had planned in 2012/13. The soft loan the government received from South Korea will be paid after the interim period of 16 years and over a period of 45 years.

The completion of the MUHAS Academic Medical Centre (MAMC) will definitely increase enrolment. How many students will MUHAS be able to accommodate?

When the hospital is fully functional and the campus is wholly constructed, MUHAS will be able to enroll about 15,000 students in total.

How would you describe the cooperation between South Korea’s Yonsei University and MUHAS?

Well, immediately after we started the construction of MAMC, we signed a memorandum of understanding between MUHAS and Yonsei University of South Korea through its severance hospital, which is the teaching hospital of the Yonsei University. The agreement between the two universities aims at helping MUHAS train sufficient teaching staff so that they can teach at MAMC and also offer the required health services. The training of staff has been ongoing since 2013 to 2017. We usually send staff from about eight faculties from MUHAS and other institutions like the Muhimbili National Hospital.

How do you allocate the doctors to MAMC as the new facility does not have doctors?

Well, we have already recruited human resource through the government. Some are newly recruited health professionals through the President’s Office, Public Services Management but others have been transferred from other facilities which are the same level as the MAMC. But also we have our own health personnel who are teaching at MUHAS because they are professionals, they have their own rights and therefore they will continue to work at MAMC.

We are going to operationalise the hospital in phases, focusing on critical departments which need to start and then eventually reach maximum functionality whereby we will recruit sufficient numbers of staff which is about 1,300 in total.

Do you have an attractive retention plan taking into consideration most Tanzanian doctors seek greener pasture abroad?

We always have doctors at MUHAS over the years since it was established in 1963. And we haven’t had a problem of migration of doctors to seek greener pastures abroad, because the remuneration packages which are offered at the university are attractive to teach but also the teaching environment attracts doctors and other medical staff to work at MUHAS.

Do you have a succession plan in place?

Yes, the university has a succession plan as required for all government institutions and therefore this is going to be observed and we have already prepared one which will cover not only the current campus but also the new campus including the MUHAS Academic Medical Centre.

To what extent do you think the newly built state-of-art teaching hospital will contribute towards intellectual life in Tanzania?

This is going to be the facility for training health professionals of all types including medical doctors, dentists, nurses allied sciences professionals as well as biomedical engineers. Therefore, the MUHAS and the newly built campus MAMC at Mloganzila is going to contribute significantly to the creation of the required human resource for health which at present is at scarcity.

Do you think the new Mloganzila campus will be a catalyst for research and to what extent?

Certainly it’s going to be a catalyst for research because we as the medical doctors but also as university staff are supposed to do research. The MUHAS Academic Medical Centre is a facility which is well equipped with modern equipment and of high technological advancement and this is going to be a catalyst for state of the art research in all medical fields.

Do you think doctors and medical practitioners teaching at the university would have enough time to engage themselves in research as most of the time they are occupied more with teaching and clinical care issues?

I don’t think there is a problem because most of us here are professors and we have been and we are still providing clinical care. So that is not a deterrent to doing research at all. It is actually a catalyst because you do research while providing care as well teaching.

What are your views on rural –urban disparities in terms of medical care as most medical practitioners are concentrated in urban centres. How do you plan to bridge the gap?

The rural urban disparity is not an easy problem to solve currently, and this is because highly qualified medical professionals will work mostly in the tertiary specialised facilities like Muhimbili National Hospital or MUHAS Academic Medical Centre because this is where they get facilities and job satisfaction.

However, the current training of medical professionals at MUHAS encourages people to go back to work at the periphery, that is in the rural areas. This is what we are doing. We do this through transforming the curriculum, which is relevant to rural areas and will attract people to work in rural areas.

Is there any deliberate plan or special packages as incentives to lure doctors to join and work at MAMC?

Well MUHAS is a government institution and we use a scheme of services, which has been prepared by the government specific for the MUHAS Medical Academic Centre and the Muhimbili University of Health and Allied Sciences. These schemes provide some incentives but they are not very different from the rest of government institutions of this calibre.

On the other hand, usually incentive are created by doctors themselves when they are working and we are planning to be able to create motivation for doctors to join the teaching hospital as they start working own their own. But the scheme of service determines the entry level although it might be better in some of the hospitals but it is not sufficiently and so differently that we can attract all medical personnel from other institutions. After all, this is not the intension. We need to balance the work force across heaths facilities so that everybody has access to the required level of medical care.

Do you have future plans to have such kind of state-of-art teaching facility of the same status as MAMC in other regions in the country?

Certainly, there is that possibility in the future. Already there is the Benjamin Mkapa Hospital in Dodoma, which is also a good teaching hospital and I think more hospitals of that caliber will be built in the future.

However, as MUHAS, I think we need to focus our resources strategically.

We are not rushing to create these very expensive facilities like MAMC or Benjamin Mkapa teaching hospital all over the country. We need to strategically press them so that they can be accessible by all Tanzanians but without straining our resources because these are quite expensive facilities not only to construct but also to maintain.

How do you describe doctor-patient relations in public hospitals as there have been widespread notions that public trust to doctors at public hospitals is very minimal?

I’m not very sure that a public trust to doctors is minimal and I don’t know where such notion comes from. I think it depends on which facilities they are referring to. In most tertiary facilities the public trust is very high as they are offering very high quality services currently as is the case with the Jakaya Kikwete Cardiac Institute, the Muhimbili Orthopedic Institute, the Muhimbili National Hospital. These are reputable health care facilities and the public trust has never been eroded there.

How does the MAMC plan to use technology and ICT in teaching while at the same time providing clinical care to the public?

The new MUHAS Academic Medical Centre is a highly technical facility using modern technology both for teaching and medical care. There will be distant learning facilities which will be installed in various areas which will aim at providing learning even if students are not able to be present for example in operating theater they will be able to access teaching. The technology which has been installed is completely digitalised and this is what we need in a modern teaching facility to provide teaching even to distance remote areas.

Are there any other areas or projects in which MUHAS is working with the Koreans other than the Mloganzila project?

We have been working with Korea Foundation of International Health and the memorandum of understanding which we signed covers more than just the Mloganzila project, which is now completed. We are going to continue working together in exchange of students, exchange of staff and also in teaching and research.

Is MUHAS satisfied with this arrangement?

Well the donor fund we received is a real grant from Exim Bank of Korea, which is the government grant from South Korea. It is a good soft loan in the sense that it is very well managed by the EDCF at EXIM bank of Korea but also the mechanism of paying back is good for the country because we will pay after 16 years and over the period of 45 years, something which I think is good and we will be able to repay the loan.

We have also been working with Korea Foundation of International Health. They have been able to sponsor our specialists to undergo special training in South Korea at the Younsei University teaching hospital, the severance hospital and we are really happy with this arrangement because most of our students have gained quite a lot in terms of skills and competence required to be used in MAMC.

We still have collaboration with the Younsei University and we will continue working with them. We are happy with the arrangement.

Do you have plans to make the MAMC a referral hospital only?

MAMC is a tertiary care facility at referral specialised level and therefore we receive patients who are referred from other district and regional hospitals just like the current Muhimbili National Hospital where you only receive referred patients who have been seen in the regional hospitals. So the hospital is going to take care of conditions which cannot be treated at a referral hospital that is district and regional hospitals.

Will the current entire MUHAS medical school shift to the new Mloganzila campus?

No, the current MUHAS medical campus is not going to be shifted. What we are going to have is the main campus at Mloganzila and the second campus at Muhimbili. So we are going to admit students in both campuses and this will increase the number of students who are going to be admitted to do various health professional studies at MUHAS.

You have been at the helm of the major health university in the country for about five years now. What are the major challenges you have faced?

In life, challenges are always there but you have to be able to solve them. At MUHAS there are several challenges, among them is the number of students we have which is more than what we can accommodate, there is the issue of sponsorship for students and several other challenges. But I’m grateful that we are working closely with the government to address those challenges.

Well, what I can say Is we are happy that the government has been able to assist the construction of this modern health teaching facility at Mloganzila, which is going to be part of MUHAS.

When do you think the hospital will be officially opened?

We are aiming at commissioning the hospital soon. If everything goes well we still have few issues to take care of and that is finalise installations and testing of medical equipment.