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Rural Center of Excellence: Closing a Gap in the Health Care System in Tanzania

Traditionally, if a woman from the Tanzanian town of Ipuli wanted to give birth in a hospital or clinic, she would have to travel 81 kilometers by oxcart and bicycle to the capital city Dar Es Salaam. Although Ipuli isn’t a small settlement by any means—it has a population of more than 100,000 and there are hundreds of thousands more in the surrounding district—until recently it lacked any sort of formal local health care system, particularly for expecting mothers and their children (more than 10 percent of the population is under the age of 5). Like many African nations, Tanzania has a high infant-mortality rate and a low life expectancy, and the health care crisis in Ipuli illustrates part of the reason why this is so.

When social entrepreneur Neema Mgana, the founder of the African Regional Youth Initiative and a nominee for a 2005 Nobel Peace Prize, started planning a new health center for Ipuli she looked beyond the community’s immediate needs to its long-term survival. A mother and child clinic anchors the Rural Center of Excellence, but the facility is equally devoted to teaching as it is to treating patients.


Image of school design rendering via the architects Nicholas Gilliland and Gaston Tolila

Building a teaching clinic in a country where there’s an estimated one physician for every 20,000 residents is notable in itself. But there’s more: The complex will also include a joint primary and secondary school focusing on kids who would otherwise not receive an education, whether for financial reasons or because of other disruptions in their homes. The center not only ensures that children will be born healthy, and stay healthy (using immunization, growth monitoring, and nutrition programs), but that they will be educated and taught skills that can be applied to better life in the village and beyond. Women will not only have access to medical attention to give birth safely and receive prenatal and postnatal care, but will also have access to family planning resources and education and treatment programs for STDs and HIV. The center will provide continuing education to ensure that residents will be able to run the programs themselves. The building’s construction is done mainly by locals, many of whom were in desperate need of work when the project started, and many see the center as a way to guarantee continued employment.


Image of community members building the school via Open Architecture Network

The community of Ipuli got on board with the project early; it donated 10 acres of land for the complex. Locals chipped in whenever possible, with women weaving baskets to generate extra income for its completion. When it is finished the community will continue to shape its future—specially formed councils will provide the oversight to ensure the center’s programs are meeting community needs.

The Rural Center of Excellence is an important example because too often when faced with health care–related problems we don’t see past triage. In this case, the solution to closing a gap in the health care system may have the power to completely transform an entire community.

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