In Tanzania, the WHO World Health Report (2004) indicates an adult mortality⁴³ rate per 1000 population of 561 for males and 512 for females. Life expectancy for males is 45.5; for females 47.5. Healthy life expectancy is 40.0 for males; 40.7 for females.⁴⁴

There is a perceived epidemiological shift from acute and infectious diseases towards chronic diseases. Prior to the AIDS epidemic Mark Jacobson saw that age cohorts were growing older. For the first time in his experience there were large numbers of cancers, congestive heart failure, chronic diseases, diabetes, hypertension, and pulmonary artery disease. This shift away from acute illnesses and trauma towards an ageing population experiencing chronic illnesses created the need for palliative care.

There appear to be marked variations in cancer prevalence patterns in different parts of the country. In the Arusha region, “probably the most common female cancer is cervical…then oesophageal cancer is quite common.”⁴⁵ Although liver cancer is common in the west of the country it is less so around Arusha. AIDS related tuberculosis is the number one opportunistic infection at Selian Lutheran Hospital in Arusha yet this is rare around the Kilimanjaro region where cryptoccal meningitis is more common. Clinicians at Selian Lutheran Hospital have yet to diagnose one such case. A condition likely to be toxoplasmosis is common both in Arusha and Kilimanjaro. There are however, diagnostic limitations in this country and clinical diagnoses are often all that are available.

ORCI reports that up to 70% of their patients present with advanced cancer of the cervix. Cervical screening was only introduced in 2002. AIDS related Kaposis Sarcoma is now the next most common cancer, closely followed by cancer of the breast. There are high prevalence rates of head and neck cancers, cancer of the oesophagus and stomach cancer. Types of cancer relating to geographical location have been noted here too. Burkitt’s lymphoma is a common paediatric cancer.

Approximately 2,500 cancer patients per year are attended to at ORCI. This is assumed to be only 20% of the estimated people living with cancer in the country.

HIV/AIDS is a huge burden for Sub-Saharan Africa. Throughout the region in 2003, an estimated 23-27 million people were thought to be living with the disease which also caused up to 2.5 million deaths. This represents a huge loss and impacts significantly on health systems and social and family structures.

Tanzania is one of the worst HIV/AIDS affected countries in Eastern Africa. Estimates suggest that in Tanzania, approximately 1,600,000 people were living with HIV/AIDS at the end of 2003. In the same year, up to 230,000 adults and children are thought to have died from the disease (Table 8).

Table 8 Country HIV and AIDS estimates, end 2003

Source: 2004 Report of the global AIDS epidemic

UNAIDS reports:

HIV prevalence is far higher in the mainland than in the island territory of Zanzibar, which has about 1 million inhabitants and a prevalence rate estimated at 0.6% in 2002. Women are significantly more affected than men; accounting for 60% of the new infections reported among youth aged 15 –24 years. The net effect and impact of the epidemic on per capita GNP growth is substantial and increasingly being felt by many families. Although HIV/AIDS awareness among the population is high (above 80%), behaviour change is very slow with new infections being contracted.

In 2000 the President of the United Republic of Tanzania declared HIV/AIDS a national disaster, which led to the establishment of the National AIDS Commission (TACAIDS) in Tanzania mainland and the Zanzibar AIDS Commission (ZAC) in Zanzibar. These multisectoral bodies are responsible for guiding national efforts to fight HIV/AIDS. Both commissions have successfully formulated a Multisectoral Strategic Framework to fight HIV/AIDS for the period 2003–2007. TACAIDS has developed its three-year Midterm Expenditure Framework (MTEF), action plan and budget. The prime minister launched the National AIDS Policy in November 2001 and the National Multisectoral Strategic Framework (2003–2007) was launched in May 2003. Zanzibar has not yet developed its AIDS policy and MTEF. In the mainland multisectoral HIV/AIDS committees have been set up at local government council level and at ward and village level. Zanzibar is adapting existing DACOMS and SHACOMS to assume a similar role, but extensive capacity building will be required to enable them to function more efficiently and effectively.⁴⁶