SoC04 A Concept Paper on the Establishment of Medical Train Services in Tanzania by 2027

[Mzee Mwanakijiji]

M. M. Mwanakijiji

UANZISHAJI WA TRENI YA KITABIBU IFIKAPO 2027

Introduction:

Tanzania, like many developing countries, faces significant challenges in providing adequate healthcare services to its population, particularly in remote and inaccessible areas. In response to this need, we propose the establishment of Medical Tran Services (MTS) in Tanzania, leveraging the country's newly inaugurated Standard Gauge Railway (SGR) network. The fact that the SGR is connected to a specific electricity grid makes the establishment of MTS not only inevitable but necessary.

Objective:

The primary objective of the MTS is to bring emergency medical facilities, with capabilities of up to Level IV trauma care, to the unreachable parts of Tanzania especially those along the SGR line. By utilizing the railway infrastructure, we aim to overcome the geographical barriers that hinder the delivery of timely medical assistance to remote communities. While not in use the MTS can be utilized for providing services to communities across the country, and training of medical staff.

Overview

The proposal outlines a phased approach towards implementing the MTS, with the goal of full implementation by the year 2027. The three phases are designed to ensure systematic development, gradual scaling, and sustainability of the program.

Phase 1: Planning and Preparation (2024-2025)

• Conduct Feasibility Study: The initial phase will involve conducting a comprehensive feasibility study to assess the viability, logistical challenges, and potential impact of MTS.
• Identify Railway Routes: Evaluate existing railway routes and identify key locations where the medical train units can be stationed to maximize coverage and accessibility to remote areas.
• Develop Infrastructure: Retrofit existing railway cars into medical units equipped with necessary medical equipment, supplies, and personnel to provide Level 4 trauma care.
• Training and Capacity Building: Train medical staff, including doctors, nurses, and paramedics, in emergency response procedures and onboard medical care.

While the concept of MTS may be unique to Tanzania, there are existing or similar initiatives around the world that can provide valuable insights and lessons for the implementation of this program. By studying these examples, Tanzania can learn from best practices, identify potential challenges, and adapt strategies to suit its own context. The nation can draw lessons from similar projects in terms of emergency response protocols, telemedicine integration, and efficient resource allocation.

1. Lifeline Express, India: India's Lifeline Express, also known as the 'Hospital on Wheels', is a train equipped with medical facilities that travels to remote rural areas to provide healthcare services. It offers surgeries, consultations, and treatments for conditions like cataracts and polio. Tanzania can learn from the Lifeline Express model in terms of logistics management, medical service provision, and community engagement strategies.

2. Mobile Clinics, United States: In the United States where I have been residing for the past 26 years mobile clinics are deployed to provide healthcare services to underserved communities, including rural areas and urban neighborhoods with limited access to medical facilities.

4. Health Train Initiative, South Africa: South Africa's Phelophepa Health Train Initiative operates two trains that travel to remote areas, offering primary healthcare, dental services, eye care, and health education. Tanzania can take inspiration from the Health Train Initiative in terms of comprehensive healthcare provision and community involvement.

Cost Analysis

Projected Initial Costs for Phase 1:

1. Feasibility Study: $100,000
2. Infrastructure Development: $500,000
3. Training and Capacity Building: $200,000
4. Retrofitting of Cars: $300,000
5. Miscellaneous Expenses: $100,000

Total Initial Costs: $1,200,000

Recurrent Projected Expenditure:

1. Personnel Salaries: $300,000 annually
2. Maintenance: $100,000 annually
3. Medical Supplies and Equipment: $200,000 annually
4. Operational Costs: $150,000 annually

Total Recurrent Expenditure: $750,000 annually

Phase 2: Pilot Implementation (2026)

• Launch Pilot Service: Initiate the MTS on selected routes to test operational efficiency, assess patient response, and identify areas for improvement. The first route from Dar to Dodoma can be initiated along the completed SGR line.
• Monitor and Evaluate: Collect data on patient outcomes, response times, and service utilization to evaluate the effectiveness of the pilot program.
• Community Outreach: Conduct awareness campaigns in remote communities to inform residents about the availability and benefits of the MTS.

Projected Initial Costs for Phase 2:

1. Pilot Implementation Costs: $500,000
2. Data Collection and Evaluation: $100,000
3. Community Outreach Campaign: $50,000

Total Initial Costs: $650,000

Recurrent Projected Expenditure:

1. Personnel Salaries: $300,000 annually
2. Maintenance and Upkeep of Medical Units: $100,000 annually
3. Medical Supplies and Equipment: $200,000 annually
4. Fuel and Operational Costs: $150,000 annually

Total Recurrent Expenditure: $750,000 annually

Phase 3: Full-Scale Implementation (2027)

• Expand Coverage: Based on the findings from the pilot phase, scale up the MTS to cover additional routes and reach more remote communities. Areas within fifty miles of the train line can be easily coordinated to bring patients to the Medical Train during non-emergency tours.
• Strengthen Infrastructure: Invest in upgrading railway infrastructure and facilities to support the expanded scope of the MTS. Other services such as optical, dental, and ENT can be added either to the current cars or by adding specialized cars.
• Continuous Improvement: Implement feedback mechanisms and quality improvement processes to continuously enhance the quality and efficiency of medical care provided onboard the trains.

Projected Initial Costs for Phase 3:

1. Expansion of Services: $1,000,000
2. Infrastructure Upgrades: $500,000
3. Quality Improvement Initiatives: $200,000

Total Initial Costs: $1,700,000

Recurrent Projected Expenditure:

1. Personnel Salaries: $500,000 annually
2. Maintenance and Upkeep of Medical Units: $150,000 annually
3. Medical Supplies and Equipment: $300,000 annually
4. Fuel and Operational Costs: $200,000 annually

Total Recurrent Expenditure: $1,150,000 annually

Conclusion:

The establishment of MTS in Tanzania represents an innovative approach to addressing the healthcare needs of remote communities. By leveraging the country's railway infrastructure especially, the SGR and the Meter Gauge Railway, we can overcome geographical barriers and ensure timely access to emergency medical care. Through a phased approach, we aim to systematically implement and scale up the program, ultimately improving health outcomes and saving lives across Tanzania. While there are initial costs and recurrent expenditures associated with the project, the long-term benefits in terms of improved healthcare access and outcomes justify the investment.

 

[Uhakika Bro]

the unreachable parts of Tanzania especially those along the SGR line. By utilizing the railway infrastructure, we aim to overcome the geographical barriers that hinder the delivery of timely medical assistance to remote communities

Ooooh! Is it like making a mobile clinic train!! Or an ambulance train? Woow! This is new to most of us.

Total Recurrent Expenditure: $750,000 annually

Ill read this, because the maths is mind bogling🤯.

New ideas everyday. The Tz we want.

 

[Mzee Mwanakijiji]

Ooooh! Is it like making a mobile clinic train!! Or an ambulance train? Woow! This is new to most of us.


Ill read this, because the maths is mind bogling🤯.

New ideas everyday. The Tz we want.

Makisio yanaweza kubadilika baada ya upembuzi yakinifu.

 

[Mzee Mwanakijiji]

Ooooh! Is it like making a mobile clinic train!! Or an ambulance train? Woow! This is new to most of us.


Ill read this, because the maths is mind bogling🤯.

New ideas everyday. The Tz we want.

Swali ni Je SGR na njia yake ni bora zaidi au mradi kama huu ufanyike kupitia reli ya Kati ambayo tayari ina mtandao mkubwa lakini ina changamoto ya umeme wa kuaminika?

 

[Proved]

Swali ni Je SGR na njia yake ni bora zaidi au mradi kama huu ufanyike kupitia reli ya Kati ambayo tayari ina mtandao mkubwa lakini ina changamoto ya umeme wa kuaminika?

Hiyo treni itasimamiwa na nani Sasa?.....au TRC ?

 

[Mzee Mwanakijiji]

Hiyo treni itasimamiwa na nani Sasa?.....au TRC ?

Kuna namna mbalimbali. Mwanzoni ni ushirikiano Kati ya Wizara za Ujenzi na Afya katika kuandaa mabehewa hayo ya tiba. Uendeshaji wake utafanywa na Afya kwa kubadilishabadilisha madaktari na wauguzi katika mazingira ya kawaida. Wakati wa dharura (janga kubwa kama ajali, mafuriko, tetemeko la ardhi nk) wizard inaongeza madaktari Bingwa kulingana na mahitaji.

Chukulia kwa mfano tetemeko la ardhi limepiga Dodoma, mabweni mawili yamewaangukia wanafunzi. Hospitali zilizopo zimechukua majeruhi kadhaa lakini hazitoshi. Treni inatumwa toka Dar ndani ya masaa matatu madaktari bingwa wanaanza kuokoa maisha ya watoto bila kusubiria ndege au magari kuwakimbiza Muhimbili. Hapo hujasema wabunge walioangukiwa na ukumbi wakati huohuo....