The Volleyball Match

The Health Team faced the match of their lives. A match that would determine whether Afya Yetu, their project for the summer, could be implemented or not. PSI, Afya Yetu’s main product supplier were only willing to negotiate product orders when the Health Team convincingly won all five sets. The health of the population of Vingunguti was at stake.

But their opposition, various governing authorities with the power to grant business licenses stood in the way. We weren’t willing to step aside. It was time for the Health Team to dig, set and slam their way to a win.

The first set was against the TIN (Tax Identification Number). Some strong rallies ensued, but we clearly maintained control until we came through with a win (25-10 if you want to know the score). However, we were well aware that the TIN weren’t our strongest opposition as they were never going to put up much of a fight.

The second opponent we faced was the VAT (Value-Added Tax). However, we weren’t allowed to step onto the court until we had proof that we had paid our taxes. And unfortunately, as we were in the process of doing so, the set had to be postponed until we proved our eligibility to play.

The Business License stepped onto the court for set three. They promptly handed us some forms to fill out before leaving the court again. Again, we needed to sort out some paperwork before they were willing to play some ball, the second of three sets delayed. We had known the match was going to experience some interruptions, so we continued on, keeping morale high.

By this point, we were desperately keen to get back on the court and play a set. TFDA (Tanzanian Food and Drug Authority) provided a good opportunity for us to do so, our fourth opponent. Rhys and Ocheck, our key play makers moved to the front. Before we had a chance to rally for serve however, the TFDA declared they were the ‘wrong team’ for us to play as they were the central team, and we needed the zonal TFDA team. A quick team change followed and we were ready to play again.

The first few rallies were contested evenly by both teams, until the TFDA managed a lovely set and smash combination, with the ball flying into our half of the court. Unfortunately, Rhys’ stomach was on the receiving end of the ball, knocking the wind out of him. The TFDA were unable to fit our model into their existing models for licenses and consequently, we would need to register as a pharmacy. This would require the renovation of our current premises to fit the physical requirements of a pharmacy, which would be both expensive and likely delay the business opening. We took a time-out for Rhys to recover, and to change our game plan. We drew out some alternatives to the renovation plan the TFDA had provided us with, alternatives that would meet the TFDA’s pharmacy requirements, but that would require fewer physical alterations to the premises.

Before re-entering the court, we wanted to get some advice from the central TFDA office, the team we were to originally play. After looking into our case further, they began to question whether our set with the zonal TFDA office should have been played at all as they concluded that we didn’t need a TFDA license.

We then approached the TFDA zonal office with many questions as to why they stepped onto the court in the first place. We knew it wasn’t a good sign when each of the six team members gave a different response, and left the court more confused than when we began.

Our prearranged set five against the Pharmacy Council was placed on hold when their team didn’t show – we instead gave their representative a letter asking for a match in the next week. We finished the match having won one set out of the five (TIN), one set suspended mid-set (TFDA), and with three sets delayed (VAT, Business License and Pharmacy Council).

After an intensive team chat, we decided that we would not pursue a rematch with the TFDA as we believed we did not need a TFDA license. However, our relationship with PSI was dependent on us winning all five sets, including the set against the TFDA, which would ultimately provide us with all the licenses we needed to operate.

With the results from our volleyball match in our pockets, we approached the PSI offices with trepidation, uncertain as to whether they would pursue a partnership with Afya Yetu without the TFDA license. We were greeted by a big grin, courtesy of Mzee, our contact at PSI, and all began to relax a little.

The meeting began with a rather significant backward step in that we discovered that our community health workers would be unable to sell the oral contraceptive pill and delivery kits for Afya Yetu as they need to be prescribed by a pharmacist. However, our mood was quickly turned around when we discovered that this meant that we no longer required the TFDA and Pharmacy Council licenses. Although our current product portfolio had been reduced, we left with the knowledge that PSI were both keen to work with us and happy to allow us to order the remaining products when we wanted to.

We continue to pursue rematches with the VAT and Business License. Our prospects are looking strong as we look forward to getting all the licenses required for the opening of Afya Yetu.

In other news; the health team also continues to dominate CDI-wide volleyball. Natalie is learning to not close her eyes when the ball comes to her, Sam can now dig the ball towards the net instead of outside the court, Fran has begun to understand that you can play volleyball tactfully instead of using brute violence, Jack continues to up his sledging game and Rhys is slowly but surely becoming a little less competitive, which everyone appreciates.

Dar Week 2! (Health Team)

Monday dawned bright and early, with us eager to start our pre-project survey. After working on this in the UK, then improving it and translating it with our Tanzanian counterparts, I was excited to finally get it started and see how well it worked. For once the Tanzanian traffic was on our side with our journey to Vingunguti taking only twenty minutes (previous trips had taken up to an hour and a half!). This seemed like a good start to the day.

With the help of John (Tanzanian Director of the Engineering Project), we enlisted two enumerators from the community and they along with two of our Tanzanian volunteers began surveying people. Back in our business premises, we began our NGO research, looking into more products to sell and education collaborations we might be able to make.

Our successful first day went a little awry as our bajaji took a ‘shortcut’, instead getting lost and taking us an hour to return to the university. To top it off, I discovered that somewhere along the way our room key had run away… Turns out it was the only key to our room! Luckily, Monday night had some people moving accommodation to nicer rooms, including Fran. Natalie and I moved into one of the vacated rooms (‘Bug Room’ woohoo) and we all managed to scrounge some sheets and nets off the other volunteers.

Tuesday morning we got to watch as our room was broken into, it was surprisingly quick. They even changed the lock straight away so we didn’t have to move rooms. The rest of the week commenced similarly to Monday, with students and enumerators conducting surveys, translating surveys and researching.

Highlights of the week included Jack’s arrival on Tuesday afternoon! The Health Team is now fully complete and to celebrate we went out to eat at Cape Town Fish Market. Wednesday, our bajaji broke down on the way back from Vingunguti! Jack and the driver had to wheel it off the road before our driver went looking for fuel.

Later that night we had karaoke and sang an enthusiastic – if pretty bad – rendition of Adele’s ‘Hello’. Surveys were finally finished on Thursday, with us managing to collect a grand total of 167 responses. On Saturday, Natalie and Jack attended a focus group with our Tanzanian volunteers, and the Community Health Workers, while Rhys ran around trying to sort out our business licenses. (There was a bit of a worry that we would have to knock down walls to swap round the window and the door of our premises). Fran and I helped at the Education Project’s Launch, guiding press and other important people to the venue before sitting and enjoying all the speeches. The morning had involved a slight panic as we realised that we actually had to wear smart clothing, of which the Health Team had brought minimal. And on Sunday we headed out to Bongoyo island for some well-deserved relaxation.

Focus group with the Community Health Workers

Written by Samantha Flint – Volunteer on the Health Project.

Welcome to Dar

After arriving in Dar es Salaam airport we got our first taste of Tanzanian organization with the news that our bags were still in London…Two hours later we had our visas, our bags were tagged ready for collection on Wednesday and we were ready to begin the journey to Ardhi University. The rooms were ready for us when we arrived, complete with mossie nets and our new best friend Oscar the Gecko. After settling down for the night we spent day one exploring the local area and attending the CDI wide induction meeting. This included a fast paced tower building challenge (where we conceded defeat to the Education team by a few centimetres) and an inspiring talk by Ocheck from Bridge For Change. It was also great to meet some of our Tanzanian counterparts for the first time and get to chat to them.

We joined the Engineering team on Wednesday to catch the Dalla Dalla (bus)  to Vingunguti where we will be working for the majority of our time here, and where the business will be based. It put all of our previous work into context to see the streets and people that the Community Health Workers visit as well as our brand new premises which far exceeded our expectations! It was great to be able to sit down as a team and discuss our ideas and visions – it suddenly seems a lot more real now we are here. Collecting our bags from the airport completed a productive day.

Me and Sam joined in with the Engineering team meeting on Thursday to work on including some of their questions in our pre-implementation survey. We hope that the collaboration with them will continue for the rest of our time here to include the training of their Health Ambassadors and water sanitation awareness days within the community. Meanwhile Fran worked on the business model and Rhys met with the NGO TAI to talk about the education side of the project. We came together in the afternoon to work on the survey and discuss our individual goals for the trip.

Friday marked our return to Vingunguti (this time with a not so lucky with a one and a half hour bus journey) where we split up to map out areas of Vingunguti for the survey and visit the local pharmacies. This was a successful trip as we managed to perfect our map without getting lost and confirmed that we would be able to beat the prices for health products in the pharmacies, something which is crucial to the success of the whole project and a key selling point of the products. The day finished with Fran and Rhys meeting Ocheck to discuss our game plan for securing our business licenses over the next couple of weeks.

Visiting pharmacies in Vinginguti

With the business model and survey making good progress it was time for our first whole-team discussion on Saturday with the Tanzanian team too. It was so great to work with the Tanzanian students and explore our ideas with them, especially as they were so enthusiastic and positive about the business. Our aim for the second half of the meeting was to come up with our name and logo and translate the survey into Swahili alongside making any final corrections. Me and Sam each led a section and the whole team worked together to brainstorm ideas. We settled for the name ‘Afya Yetu’ or ‘Our health’ in English along with a slogan and logo- full credit goes to my friend Dima in the UK who turned my less than ideal sketch into a working logo!

Sketch of the business model logo

Bridge For Change held a lovely evening full of chicken-chasing, volleyball and traditional dancing where we could catch up with the other teams and have some fun. We hit the beach on Sunday for our well-earned rest day!

Chicken chasing!

Written by Natalie Fisk – Volunteer on the Health Project.

Day 76/110

I’m writing this as I approach half way through my seven hour layover at Abu Dhabi, all without the comforts of a hotel or shower. But compared to some of my previous flights (or lack of) to Dar this one is reasonably good!

Having been a volunteer last year I feel that I have a fairly unique perspective on this summer’s trip; a position shared amongst only three other committee members.

There is a stark contrast to last year in many different ways. An entirely new team. A different culture. New challenges. More responsibility. More perspective.

However, our motivation and drive to achieve something in these nine weeks is as present as ever.

In my role as Health Project Director, albeit currently located 4645 miles from our project site, my role has evolved from deciding upon a direction for this year’s team (building entirely upon the success of the previous Health Team) to searching for the email addresses of the Masters of Cambridge Colleges for our Annual Launch in January to then recruiting the new Health Team. Whilst that has been incredibly fun and rewarding, the best part is yet to come.

Tomorrow afternoon (it is 4.30AM on Monday 25^th July for me), all of CDI’s volunteers, Tanzania and Cambridge based (minus Jack who arrives in a weeks’ time) will meet for an induction before being let loose on their projects.

For the Health Volunteers, our aim is to implement our Community Enterprise Network (we are brainstorming for a “better” name than this on Saturday – so if you have any ideas email me at health.director@cambridgedevelopment.org) in Vingunguti, Dar Es Salaam. Working with the existing Community Health Workers, we will provide them with formal education on important subjects (thanks to the videos at Medical Aid Films), add structure to their educational role within the communities and incentivise their vital work through the sale of health-related products at an affordable price.

With an implementation date of the 25^th August, the first 5 weeks of this trip will comprise running a comprehensive (150+ household) survey on health in Vingunguti that will form part of our baseline analysis, running focus groups with the Community Health Workers, obtaining business and pharmaceutical licenses and engaging with the community.

Follow this blog to keep up to date with our progress!

Written by Rhys Wenlock – Health Project Director

Reflecting on the Health Project

Sunday 23^rd August.  CDI’s members gather, warily, for what has been billed as a three-hour CDI-wide session.  Charlie Douty, CDI’s Vice-President, asks each CDI project to consider its three principal achievements over the summer, and to act them out in a ‘picture frame’.  The Health Project gathers and considers its response…

Embarking on the Health Entrepreneurship Course

Three students from Harvard have joined us for the next two weeks, to find out more about what we do. Raj reports on the opening of the Health Project Entrepreneurship course.

It was a bright and peaceful morning at Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam as 32 medical students and 12 healthcare professionals from across the region gathered in one of the university’s seminar room for the opening of a two week course on health care entrepreneurship.

As the students and professionals settled in, got their pictures taken, and began introductions, it was inspiring to hear their motivations for applying for the course. For many of them, this would be their first exposure to the subject of entrepreneurship. Eager to learn about the potential of integrating innovative principles of entrepreneurship into the Tanzanian healthcare sector, the students shared an infectious passion and enthusiasm for the course material ahead.

After brief introductions from Dr. Chitama and the course staff and a short presentation by Ewan on the mission and vision of the Cambridge Development Initiative, Japhet Killewo, Professor of Epidemiology at MUHAS, officially kicked off the course with his welcome address. Professor Killewo inspired further passion in the audience by describing the widespread importance of civic responsibility, social justice, and entrepreneurship. He argued that now is the time for everyone, regardless of age, to embrace the spirit of entrepreneurship in solving problems. As soon as individuals and communities share a collective vision of innovation and exploration, the potential for growth is tremendous.

Following Professor Killewo’s speech, the course began with a session guided by Yoshiki on Business Basics – Presentation. Despite the power outage and resultant lack of a projector, Yoshiki charmed and engaged the students and professionals so well. His session focused on principles of public speaking, particularly on how to effectively convey a message to an audience. The course attendants were very receptive to his teachings, actively engaging in his guided exercises and confidently presenting in front of the rest of the class.

Raj taking the session

After the lunch break at the university cafeteria, the participants then reconvened in the seminar room and I started the afternoon session on Strategy and Industrial Analysis. Given the more technical nature of the session material, it was so exciting to see how engaged the attendants were and how well they participated in the various activities. Within 3 hours, they developed a solid foundational understanding of strategic and industrial analysis, applying it to diverse firms and corporations like Bajaj, Coca-Cola, and the emerging Rapid Transit system in Dar es Salaam.

At around 5:00pm, the day eventually came to an end. The attendants all did such a phenomenal job, completing their first day of the rigorous entrepreneurship course. It will be such a joy to see how the rest of the course unfolds.

Raj Vatsa, Health Project Volunteer

One week to go until the Health Entrepreneurship Course

After a somewhat rushed month we are almost ready for the Health Entrepreneurship Course starting on 17 August in Muhimbili University of Health and Allied Sciences (MUHAS).

For two weeks the participants will try to enhance their skills and mind sets which are necessary for future business development through nine subjects: Strategy, Marketing, Financial Management, Operations Management, Human Capital Management, Customer Relationship Management, Business Basics (Presentation, Documentation, and Negotiation), Business Planning, and How to start SME in Tanzania. With integrated methods: lecture, case study, and exercise/action-learning, the attendees would gain not only academic knowledge but also practical ways of application.

CDI Health project gets off the ground

The Health Team have spent their first few weeks immersing themselves in the Tanzanian Healthcare System. Working in the field and shadowing health professionals at Dispensaries, as well as engaging with the surrounding communities has led to rewarding findings that have enabled us to collate together information about the system that has not previously existed in a formal manner. We are now excited to progress by implementing two significant pilot projects to fill existing gaps in the Tanzanian healthcare system. We are also lucky enough to be collaborating, and building the projects with 12 graduating medics from Muhumbili University.

Our primary project is The Community Social Enterprise Network, which attempts to incorporate a number of important community and governmental bodies, and NGOs into a social enterprise system. The main aim of this project is to empower communities to become self-sustaining in order to independently finance essential projects, such as new wells, biogas generators and waste disposal systems.

The model for the initial pilot acts on a system whereby essential health products for preventative measures, such as water filters, home-based first aid kits, and alternative female sanitary products, will be sold throughout a targeted community. Both the sale of affordable home-based healthcare products, as well as the implementation of community-wide projects in the long-term will have a resounding benefit of increasing education and awareness to increase community health. This in turn will mean that fewer people will rely on the dispensary, which currently serves approximately 74,600 people.

The second project focuses on the importance of retaining patients diagnosed with HIV in the long-term. The major challenge to maintaining the well-being of patients is to limit disease progression and transmission in those who do not attend regular appointments to continue their treatment. We hope to tackle this issue by establishing a system of regular automated mobile messages tailored to individuals to act as a reminder service for HIV patients and their supervisory nurses. Through establishing a more effective system of dispensary care, we hope this will contribute to meeting WHO targets for reducing the transmission of, and deaths from HIV/AIDS over the long term.

The Health Team have also gained the exciting opportunity to design, create and be the lecturers for our Health Entrepreneurship Course for leading healthcare professionals from Rwanda, Uganda and Tanzania. The course will also be filmed and added to the Tanzanian curriculum for nurses.

Throughout the next 5 weeks, we will be working hard to implement these exciting pilot schemes for their first trial phases, as well as continuing to work on the Entrepreneurship Course. We recognise the idealistic and ambitious nature of our projects but as members of CDI, we look to emulate our core values and push creative boundaries to the limit.

Millie Foster, Health team volunteer

Dispensaries in Dar

“After our Dispensary Health Board collaborated with us to buy an ambulance through cost-sharing, all the other communities in the district are demanding an ambulance as well.” – Administer, Tabata Hospitali

The first week of the Health Project has reiterated and exceptionally illustrated the misleading and myopic assumption that development is a process of the “first world” aiding the “third world.” Development theories often negotiate the classic debate on aid through the lens of Jeffrey Sach – a proponent of Millennium Villages – and William Easterly – his book “The White Man’s Burden” discusses the harm that Western aid propagated. However, little discussion hinges on what can be learned by developed countries from developing countries. Yes, the patronizing rhetoric of the poor as happy with little is often used to help guide the moral compass of the privileged. Such statements rest of the assumption that developing countries have little to contribute other than their ability to be happy in resource-deprived conditions. A quote from Poor Economics aptly summarizes this notion – “If the poor appear at all, it is usually as the dramatis personae of some uplifting anecdote or tragic episode, to be admired or pitied, but not a source of knowledge, not as people to be consulted about what they think or want or do” (Banerjee and Duflou, 2011).

Last week, the Health Team visited Tabata Hospitali a dispensary in the Ilana Municipality of Dar es Salaam. We learned of their remarkable community-based measures of ensuring not only access to healthcare, but also the monitoring of diseases like HIV/AIDS and tuberculosis. As a resident of the United States, and having worked in inter-city community clinics in Philadelphia, our meeting with Tabata Hospitali was a humble reminder. The United States is a country that provides a significant amount of aid towards healthcare in Tanzania. However, seeing many of Tabata Hospitali’s community-based initiatives, I would definitely argue that the United States could learn from some Tanzanian healthcare practices.

The Health Team learned the intricate community frameworks that are interconnected with nearly half of the dispensaries in Dar es Salaam. Home-based carers, for example, monitor the treatment of HIV/AIDS by tracking drug compliance. Home-based carers then relay this information to public dispensaries, which attempt to minimize patient loss to follow-up. Not only do these carers serve as an essential linkage for compliance, but they also decrease stigma towards HIV/AIDS. These carers, often themselves being survivors, through the narration of personal experiences, encourage community members to seek treatment.

Additionally, a group called the Dispensary Health Board, consisting of community volunteers, advocates for the community to dispensaries and district-level officers. The Dispensary Health Board of the Tabata Hospitali used cost-sharing to build a new facility at the dispensary as well as buy an ambulance! Community driven outcomes like investment in both an ambulance and increased outreach systems is phenomenal. Our team hopes to understand such existing frameworks and collaborate with community partners to co-create new initiatives.

Circling back to the discussion on the necessity for the exchange of knowledge both from designated “developing” and “developed” nations, the Health Team’s experiences at Tabata Hospitali clearly demonstrate the power of national support in community driven infrastructures. The incorporation of such systems in the healthcare system of the United States and other such developed nations could significantly increase preventative practices and community-based advocacy. The ideas for such exchanges are boundless, but for now as the Health Team attempts to learn and co-create in Tanzania, we will remain humble and ensure a true exchange is kept in the forefront of our mind.

Sonya Davey, Health Project Director