I: I just wanted to know with your position as DMO, what are your responsibilities?

R: briefly, is to manage, implement and to supervise implementation of all responsibilities

concerning with heath, so this cut across managing human resources, financial issues,
infrastructures and all other staff used to provide services
I: okay
R: when I say staffs, I mean accommodates and other stakeholders who provide service in this
municipal so briefly those are my responsibilities rather than going through every detail of my
responsibilities
I: anha….
R: but also, am a doctor so I have to participate in treatment, to cooperate with others to decide
what kind of treatment a patient should get, so despite being in management also am a doctor
I: I just wanted to know eeh…. We are evaluating the non- communicable diseases, what are
non-communicable diseases affecting people here at lindi
R: I have met many cases concerning with diabetes and hypertension, yeah those are common
diseases
I: aanha…
R: those are non-communicable diseases that I meet though I don’t have the exactly figure in my
head. Whenever I attend most of the patient concerning with non-communicable diseases I just
find out it is either diabetes or hypertension but sometimes they stick together
I: okay, so with that reference why are those diseases common in this kind of environment?
R: I can say these are diseases which depend in our lifestyle, these are lifestyle diseases in so
many cases the source is due the results of the life we live
I: yeah
R: and this is due to the food we eat, we have a tendency of ignoring food and eating things
sometime we shouldn’t be eating without considering the benefits of such foods in our bodies, so
I can say the high source of these diseases is the food we eat
R: okay
I: another reason is the all system of our lives, the way we use our bodies either to do exercise or
not so we eat wrong food or excessive food then we can give it out by doing body exercise, so I
can say with the rate, our life system contribute much to the diseases
I: okay, I would like to know the situation of cancer and TB in this district
R: TB exists but I have not met many cases concerning with cancer to be honest but TB exists up
to now we have 16 patients but I can compare these figure with other place but due to our
population the rates are high but I have met so small case of cancer especially cervical cancer is
the most case that I have met
I: okay, I just wanted to know the plan you have as a district to control these non-communicable
diseases
R: aah we have tried to…… especially when you speak about non-communicable diseases
ehhh….. we have seen it’s so important to educate the mass because these diseases can be
controlled so we try to educate the mass especially… the patient I met I just expose her to the
community especially people that she depends because some of these diseases can be inherited,
so if you find the victim in the family, their life style may be the same or she can transfer those
genes to the children
I: okay
R: so if I find out the victim I just advise him/her before the conditions becoming worse there are
steps that can be taken to change the whole lifestyle and also another challenge we face is about
cure some of us still believe that diabetes can be cured as malaria by just using drugs for few
days, so we just advise them after starting this medicine you should not stop even after changing
the lifestyle because when you stop, you end up getting stroke
I: okay
R: to these who have reached that stage we advise them to continue using medicine and those
who have got stroke already just ask for the family support but apart from cute I just spend most
time with the victim to give them knowledge and that’s our goal
I: so, your coverage stops from here to the patients that come to the hospital, you don’t have a
program to reach other people at their home
R: no, we don’t have, but I had that plan also, we can start with this coverage of employee just to
do screening and teach them about these diseases though I have ever done this before but not in
this region
I: what about TB because before you told me the rate of TB is higher comparing with cancer
R: we have the team that discover the victim in the society and bring them to the hospital so we
give them cure and, in that process, we minimize the probability of being spread among others
and we have gone deep that every patient coughing we just take TB screening so that is the
system we have implemented to discover and cure TB victim
I: okay, is your team having enough training concerning with TB?
R: yeah, they are trained but in this coverage am not sure because I have not stayed for so long
but I remember where I was before they were trained and I hope most of the parts in this country
benefited these training
I: apart from these patients who come to the hospital for checkup, do you have other program of
community sensitization you do in TV
R: aaaah! There are few to be honest, I don’t remember any program done in my mind more than
the initiative of HIV screening program as we know the relationship between TB and HIV then
we put a person for sensitization of HIV but it’s not the regular basis, so we have done it and we
will continue doing it
I: what about cancer
R: we have never done
I: because you participate in the decision-making meeting, do have any arrangement of doing it?
R: we have not arranged because now all the budget is directed to the health center so we have
not arranged any program concerning with cancer screening
I: can you remember if there is any success concerning with the strategies you set to address
these diseases
R: I don’t have deep information concerning with the success but before the end of this year we
will do evaluation to determine successfulness but to honest now we don’t have data that can
conclude the success
I: okay, for how long have you been in this position?
R: since form 2009 with different coverages
I: and here?
R: since from last year
I: so, you don’t know whether the rates are increasing or declining
R: it doesn’t stop me from knowing because I could recall the history but I have not bothered
I: are there strategies as the district or municipal to the dispensary or health centres to help
medical attendant and patients to detect the victim concerning with non-communicable diseases
R:no we don’t have any plan but it’s a gap also we have seen attendants giving drugs for
example hypertension victim not permanently but in temporary basis so it’s a gap we know but
we don’t have any plan to transfer this knowledge to attendants how to discover the victim but it
should be given priority because you find most of the victim have been in treatment before so
when she meets the doctor with knowledge you find the condition are worse which could be
controlled before
I:is there any reason behind this
R: to be honest it’s because of shortage funds, such kind of program needs money to run and we
have so many programs but at the end we have to get priority of things to start and end with but
it’s a sensitive issue
I: what about these attendants in the wards and village, do they have knowledge about these
diseases?
R: not all of them but some of them know but I can’t conclude how many firstly it is taught in
every course concerning with health but it becomes different in implementation, they have
knowledge and they understand
I: knowledge and facilities are different, someone can understand may be its diabetes but what
will I do to know if it’s diabetes? So are there facilities that can help…….
R: yeah, they are there, there facilities that can-do initial diagnosis of diabetes and hypertension
even once, and here the big issue is what steps are taken after discovering the victim……
I: I wanted to know how many attendants who get the opportunity for trainings in your
coverage?
R: not less than five, six to ten
I: per year or?
R: year per year
I: out of how many?
R: 117, they go in shift to avoid gaps but we take it very importance for people to go training
I: so is it all diseases in general or for these diseases we are addressing
R: in general, like MD CE but we believe when they upgrade they add also knowledge
concerning non-communicable diseases
I: so how many specialists do you have?
R: we don’t have any specialist and am not sure about sokoine but here the upper position is
medical doctor
I: I just wanted to know if you have any outreach services of general disease and specific
diseases
R: we don’t have any outreach of non-communicable diseases basically when we are supervising
you can check figures then you can capture problem concerning non-communicable diseases
then you can give them ideas how to handle them so we don’t have any outreach service
concerning non-communicable diseases so we have HIV, TB and VICCINE outreach
I: so what factors do you consider when arranging the outreaches?
R: sometime there are many factors but we have indicators we use for example TB HIV and
Vaccine, there are indicators you should meet different from non-communicable diseases so
indicators lead us what to do to meet a certain goal so from there that’s where you can find
outreach to a certain requirement
I: are there specific days of doing outreach services or you just decide the day of doing
R: for vaccine there are specific day of doing but HIV and TB it depends most on the reliability
of money, we have to request funds who are the at site and sometime we have to do assessment
where to strengthen but many times when we ask they just provide and we also have malaria
services so the donor supports these three area of support we also have family planning services
so they fall under their support, so when we need to meet or when we see lagging in a certain
area we just communicate for the support, so those are scheduled not in a regular basis different
from vaccine, which are scheduled routinely monthly throughout the year
I: how many outreach services have you done this year concerning with HIV and TB?
R: for HIV there are 5 or 6 which are combine with TB but for malaria it is so many times even I
can’t recall the figures
I: okay, who are the stakeholder that help to plan and fulfil those outreach service?
R: for Vaccine we use the fund of the government but HIV and TB we just cooperate with
America grow charity
I: what about family planning?
R: for family planning we have psi……..
I: in those outreach services, do you go with experts in those particular areas or in general?
R: it doesn’t limit us, it depends if we are supportive in a certain area we can put our person, let
say we have six people who wants to go, may be five are dealing with HIV and TB and your
given fund for fuel and driver then it doesn’t limit us to pay another person according to
particular task, that’s the way we operate so, I can’t conclude the number of people but it
depends on the objectives of the out reach
I: can I ask the last question?
R: it’s okay
I: when we consider the lifestyle of people at Lindi, what things that play role as benefits to
minimize some diseases equivalence to other and what things that play a role of increasing a
certain disease?
R: here at Lindi the big challenge is the environment sanitation, I mean surround area and
personal, here at Lindi we have shortage of water I mean tap treated water so many people use
weal water which does not meet the requirement also toilets are problems and there are
personality issues……………..
Respondent speaking on phone……………
R: and this goes too deep up to food handling, it goes beyond, when you speak about
environmental and personal agene it doesn’t stop from cloth wearing, bathing……. It goes up to
the things we take in our bodies so the main source of problems here relates to the personal
agene and environmental sanitation
I: okay
R:so, you find that we use much time and resources on weal sanitation and supervision places for
food service because we know the consequences also it takes big role in malaria because of
environmental sanitation so we just emphasis to spread drugs to the mosquito sources also to
make sure people clean their surrounding areas I think those are area that needs to be emphasized
I: okay
R: according to the history it has never happened for a full year to pass without spreading of
cholera but now we have maintained two years without cholera and it’s because of monitoring
and constant supervision
I: you told me before that you have met few cases of cancer do you think the lifestyle of people
at here Lindi contribute to have low rate of cancer comparing with other places?
R: I can’t verify, I need the evaluation to confirm because here the population is high, I cannot
compare the victim I have met with past 3-10 years but I have seen many victims of hypertension
more than diabetes so I don’t have enough data to verify that cancer has the low rates comparing
with other diseases no I need more time to do research and verify
I: okay
R: but here at Lindi people do exercise, when you go to the beach in the morning you find a lot
of people doing exercise so in another way I helps to reduce aaah…………... but I can’t come up
with any conclusion
I: okay thank you! But let me ask you the last question
R: don’t worry just ask
I: we have come here to evaluate non-communicable diseases like cancer, diabetes and TB, what
are things that I did not ask about but you see it’s important to inform in the health programs
R: I think we should stream line, we have good guidance because when we look at health
ministry or us who are in management, the order used to provide service I think it’s the best
I: okay
R: the big challenge, I think we should have integrated policy not stand alone policies for
example this issue of ncd I think is bigger than infectious diseases because I have worked at
Meru it grows, I have worked at Simangiro NCD is bigger than infectious in the top ten and here
I have found the same trend so think we should continue pushing because NCD can cost much in
providing services than infectious diseases also the mode of prevention of these is easier than
infectious diseases
I: okay
R: so, should not focus more on treatment because we can buy cure but ultimate cure, the
ultimate cure is to prevent, I think we should have order to emphasis that thing sold at
somewhere doesn’t meet the standards and It should not be in the local market, we should have
evidence beside decision making because these things are sold randomly for example cooking oil
can cause hypertension
I: okay
R: I think this issue of NCD doesn’t come on treatment only, it doesn’t come with absence of
cure in the hospital, it should start from prevention and it is multisector, people supervising the
standard of imported good, they should supervise with the quality with high charges in case of
fake goods but we should be sure enough to meet the standards. I have many things but I think if
we can solve this, think it will help to solve problems for the generation to come
I: oky thank you very much for your time and information
R: okay don’t worry