MICHAEL BOTTA: Good afternoon
and welcome to the Harvard
School of Public Health's
Decision Making, Voices from
the Field series.
My name is Michael Botta, a
PhD candidate in Harvard's
Program in Health Policy.
And today, I have the pleasure
of introducing Professor David
Homeli Mwakysua, currently a
Bruntland Senior Leadership
Fellow here at the Harvard
School of Public Health.
Professor Mwakyusa comes to us
with a diverse background of
significant accomplishments,
all of
them befitting a leader.
A medical doctor, he has
completed fellowships in
gastroenterology in both
Scotland and the United
States, and served as the
Director of Administration and
Hospital Services at Muhimbili,
the national
hospital of Tanzania.
An academic, he serves as
Professor of Medicine at
Tanzania's Dar es Salaam
University Medical School.
A politician, he was recently
elected to Parliament and is
now serving his third term,
currently the Chairman of the
Parliamentary Standing Committee
on agriculture,
livestock, and water.
Previously, he served as
Minister for Health and Social
Welfare for five years, during
which time he oversaw
improvements in treatment of
malaria, HIV aids, and
tuberculosis, while also
prioritizing child health and
pioneering the Primary Health
Services Program.
It is our great honor
to be joined by Dr.
Mwakyusa this afternoon.
Now, I will turn the session
over to Dr. Wafaie Fawzi.
Dr. Fawzi.
WAFAIE FAWZI: Good afternoon and
welcome to this session of
Voices from the Field.
It's a great pleasure to welcome
Professor Mwakyusa to
the Harvard School
of Public Health.
Voices from the Field, as many
of you know, are sessions that
invite leaders who have been out
there in the field making
difficult decisions and asking
them about their experience
and learning from those
experiences.
We expect that many of our
students will follow in those
footsteps and aspire to
leadership positions
themselves in academia, in
public service, national
governments, international
organizations or a variety of
other institutions.
This will be an interactive
session.
So please feel free to ask
and provide comments
when the time comes.
On a personal note, I should
start by saying that I was
very fortunate for the past 20
years to have been working and
collaborating with many
Tanzanian colleagues, both for
the Ministry of Health in Dar es
Salaam as well as a number
of academic institutions, and
I have learned from many of
these colleagues over
these years.
It's a country that has also
taught us many lessons, and we
are delighted that the
architect of major
improvements in public health
in Tanzania over the recent
past, Professor Mwakyusa,
is with us today.
I'll start with a sort of
general question to you if I
may, Professor Mwakyusa.
As we have heard from
Mike, you have been
a leader many times.
You graduated as a physician,
became a District Medical
Officer overseeing health
services for several hundred
thousand people in Chilanga.
You went on to become a
Professor Department Chair,
head of the largest hospital
in Muhimbili.
Minister Member of Parliament.
And now, chairing the board
of a new university.
You must have accumulated many
lessons in leadership over
these various positions, and
we would appreciate if you
could share some of
those right now.
DR. DAVID HOMELI MWAKYUSA:
Thank you.
May I start by thanking the
organizers and for the
opportunity for me to sit in
this chair in Harvard.
As you know, Harvard is a
household name in academia,
and I can see my CV going up
just by sitting in this chair.
Thankful, I thank my colleagues
at the Brundtland
to be able to bring
me over here.
It's true.
I've had some positions
of leadership.
My country is the home
of 45 million people.
I would say I'm one of the lucky
ones to be able to hold
positions like that.
As you heard in the
introduction, I was District
Medical Officer in [? Chadjo ?]
for about 300,000
people, health matters.
And then I went for
post-graduate training and
Chair of my department
of Internal Medicine.
And later, Director over
a Medical Center, which
incorporated their
medical faculty.
I held that position until
I went into politics, and
somewhere along the line for
five years, I was Minister for
Health and Social Welfare.
As you remarked, I hold the
chair of agriculture,
livestock, and water
in the Parliament.
But also, I Chair of the
council of one of our,
actually, our new Institute
of Science and
Technology at home.
Previously I was Chair of the
council of another university
called Mzumbe.
So I have accumulated quite
a bit of experience.
And I would say that I have not
been to any school which
taught me how to lead.
Whatever I have, I have
learned by doing.
And all of you are going
to be leaders, whether
you like it or not.
I mean, you are going to be
leaders, maybe a small
institution, a large institution
but, of course,
you always aspire
to go higher.
But whatever position you are
going to be, you're going to
lead people.
So I've learned quite a bit,
and I would say you should
learn from others, from juniors,
and from your own
mistakes to correct what
didn't work and see
if you can do better.
Now some of the things I had
learned were that when you
lead, you're leading people, you
put your targets and you
want to reach there.
And in decision making,
try to involve them.
It will be easier for you
to move along together.
You shouldn't be a boss.
There are so many times a
co-worker talks to another
one, why are you doing
this thing that way?
And you said, because the boss
told me, he's not part of it,
it's just because
you told him.
Try to get them involved
in the decision making.
Of course, the last voice is
yours, and the plans maybe
yours, but then you should try
to persuade people to see the
way you want things to be,
because ultimately, you're the
one who's accountable
and answerable.
Another thing is that one
has to put priorities.
In my field as a medical person
at home, where almost
everything is constrained,
priorities are important.
But you find all the strategies
are important.
They're priorities, so you have
to work the priorities
within priorities.
Now you have to set targets
and don't lose your focus.
The targets have to
be time bound.
You can't keep on working
all the time without
reaching the target.
In my class, I told them last
week, that my principle is to
put targets, but they
should be higher
than what seems feasible.
If I give an example, at home
we're so short-staffed in the
health worker workforce.
Actually, we are at 30%
of what we need
of the skilled workforce.
We have very few dispensaries.
Almost everything
is [? field ?],
[? field, field ?].
So I came up with the Primary
Health Development Program,
where I have very
ambitious plans.
The target is it's a 10 year
program up to 2017 where I
would like to see a dispensary
in every village, a health
center, among other things.
And people came saying, you're
always saying you don't have
enough resources for the
programs which we have, and
now you're telling us that
you want to reach there.
But my principal is, that when
you put a target, put it a
little higher than what
seems to be feasible.
If the level is four, for
instance, I'll put it at five,
and I'll strive to
get to five.
Four may be low enough that if
you start implementing, you'll
reach four without
any problem.
But if I put at five, and I get
to 4.5, you'll see that
the implementation is, actually,
better than if I put
it at four.
When you reach it without much
problem, and everybody comes
and pats you on your back
to congratulate you.
So though there are other
targets, which that's been my
principle, my guiding
principle.
Another thing is that one has
to be consistent in the
decisions you make.
Particularly, the right ones,
and do not try to impress
people or go out of the line
to please someone.
As a Minister for Health, for
instance, we have 116
paramedical schools where we
train X-ray staff in the
paramedical corridor, nurses,
medical assistants, and so on
and so forth.
The vacancies to go into that
type of training is very
competitive.
We don't have many
to go around.
There are many young men and
women who finish our secondary
schools, and they would
like to get into.
So the first time I walked
into my office, you get a
phone call from a friend, a
colleague, or even a fellow
minister asking if you could
take one of his or her
relatives into the school.
I mean, we have a program how
to select, and what they're
trying to do, is to ask you to
bend the rules so that you can
please him.
And I said, we have a program.
If he is suitable, they'll
check him out.
The moment you take him, word
will go around, and everybody
who is in trouble say just
go and tell him.
Just go and tell him and
things will be fine.
But I was there for five years,
and they knew that if
you go to him, he
is not helpful.
He can't help you.
And another thing I would like
to say is about leadership.
Leadership is about change.
There have been leaders
before.
You're the leader now.
There will be leaders later.
And what you're supposed to do,
is that you have to make
some positive change in the
institution or the people that
are leading.
Always I ask myself, and this
is what I say, I [INAUDIBLE]
a board under my ministry.
I tell them, I give
you three years.
At the end of the three years,
you should be able to tell me,
what should we remember
you for?
What legacy, what footprints
did you leave?
Otherwise, this business as
usual, is long time gone.
Because they're out doing
it that way, and
you do it that way.
You have to be innovative when
trying to change things for
the better.
That is one of my principles.
All the time I ask myself, when
I leave tomorrow, will
they remember me, for what?
So you try to strive to do
things which may will make a
positive change in the
institution of
which you are leading.
Maybe some things will come
up in the discussion.
WAFAIE FAWZI: That's
really helpful.
So you have had many changes,
positive changes,
as Minister of Health.
Your legacies are obvious
to many people.
You have managed to start this
ambitious program of putting a
dispensary in every village, and
its continuing after your
tenure as minister.
You managed, somehow, to
convince the powers that be
that the budget for health
goes from 5% to 12.5%.
And there have been significant
improvements in
actual health of women
and children as a
result of these programs.
So the question to you really,
many of these changes are how
to do alone, how to do even just
within the confines of
the Ministry of Health.
So how do you manage to, as a
leader, get along members of
your team and other ministries,
and other sectors,
that impinge on health, to buy
into your agenda, so that
you're able to achieve this?
DR. DAVID HOMELI MWAKYUSA: For
members of my ministry, it was
not very difficult.
It was not very difficult,
because as a leader, you
should know that you can't be
in every place where things
are being done, because
they're being
done on your behalf.
Tanzania is a large country.
I told my students that it is
twice as large as the State of
California, and there's no way
you can be everywhere.
So you have to deputize,
get things done.
But they say a good leader is
someone who, actually, admits
that he can't be everywhere, but
he has a machinery to know
what is happening.
So we used to meet.
I used to get reports and the
reports have to be in time, so
this was not much of a program
in the ministry.
And to delegate is important.
It is something important,
because if you're ever met a
medical officer, he's also a
leader in that capacity.
A good leader is someone
who creates
leaders, not followers.
So if you trust him, you give
him the skills, then later
he's going to be a bigger
leader than he was.
That's the whole state
of delegating.
But my contact with other
ministries, either on
one-to-one, but also as a group
in the cabinet, because
to have my agenda going, you
have to make a case.
As you remarked, when I went in
as minister, the health was
not quite a priority in terms
of budgetary allocation.
We were at about 5%.
But you come up with ideas and
computize them together with
your colleagues and try to move
that agenda, and people
get convinced in saying, I
think this is a priority.
So we managed to go
up to about 10%.
It went up to 12%.
Now we are at 10.4%, but it's
healthier than it was before.
So that is the general
in the cabinet.
But on a one-to-one basis,
it's also important.
Say, I need water
in my hospital.
I just go walk to my colleague,
the water minister,
and speak with him [INAUDIBLE]
is see how far he can help.
And a lot of them--
again, it is making a case to
make them see the way you see
them and convince them.
WAFAIE FAWZI: That's great.
I'll open it up in a second.
Could you elaborate a little bit
on the machinery that you
said you put in place?
So there are more than 130
districts all over the
country, 26 regions.
There are 45 million people.
How do you know what's happening
on the ground in the
far, remote parts of
the country as far
as health is concerned?
How do you trust these reports
are actually accurate?
DR. DAVID HOMELI MWAKYUSA: Trust
is one thing, but how we
do is something else.
But when I launched the
Primary Health Care
Development Program,
I had seminars.
Actually, I summoned all the
district medical officers and
their supporters.
There are 600 of them.
We met in Arusha for a
seminar for one week.
And I requested the president
to chair it up.
When the president speaks, they
listen more than they do
me, so he was there,
they came.
So we, actually, knew what
we were trying to do,
and we sent it over.
I mean, they were the teachers
or trainers of trainees.
So when they go to their
own place, they
also conduct a seminar.
So in the end, we had a program
which, actually, was
owned by almost everyone.
So we have a monitoring and
evaluation system, which is
now computerized.
And we took on board,
what is the epical--
WAFAIE FAWZI: Adminstrative--
DR. DAVID HOMELI MWAKYUSA: Yes,
yes, where actually, in
my office in Dar es Salaam, you
can press a button and you
know about the drug supply
in Sumbawanga,
how they are doing.
So we think this type of system,
but it helps us.
But we also do have meetings
periodically to get people
voice their ideas, their
concerns, and then we improve
or make changes as necessary.
WAFAIE FAWZI: I'm also aware
that you have been quite
accessible as minister, and so
you traveled and had yourself
on available to the public so
you could definitely hear
first hand from the
beneficiaries.
Let's open it to you for any
comments and questions.
Please introduce yourself,
your name and department.
DENISE: Hello, my name is
Denise [INAUDIBLE].
I'm in the MPH program here in
health policy and management.
I'm a fourth year medical
student at the University of
Michigan, so I'm just
here for the year.
And thank you so much for coming
and giving your advice
about just different things we
could think about as we're
progressing in our careers
in terms of leadership.
I wanted to ask you,
specifically, about within in
medicine, you mentioned that
you did do some training
outside of the country, and then
was able to come back and
implement some of
these changes.
And I'm from Ghana, and I wanted
to know how was that
process of kind of going
abroad and getting your
training, and then coming back
and kind of incorporating
yourself into to the system?
I just wanted to get your
insight and advice about how
you were able to come back and
lead change within that system
after kind of being
away from it?
DR. DAVID HOMELI MWAKYUSA: You
mean after training in
different places,
and I went back?
Well, home is home, and maybe
the lucky thing was that I
trained and worked before
I came over here.
We get problems with young
people coming to train here
for the first time,
and sometimes
they come on vacation.
And they compare the problems
they see at home and what is
obtaining here, shortages of
this, shortages of that.
As a District Medical Officer,
an x-ray may break down for a
whole month, but people come
with broken bones.
I had to fix them.
Now this type of thing is what
discourages our young men and
women to go back.
But we, now in the Foreign
Ministry, we have a
[? dashboard ?]
for the department, and we are
very serious about it.
We would like to get incentives
to get our people
to come back.
And they should know what is
happening at home, how much we
are trying.
I know there's no way I can
compare the salary I would be
getting here.
Professor here may be getting
about, maybe, 23 times as much
as I'm getting at home
but I'm comfortable.
So we would like to link with
them, this [? dashboard ?]
thing.
We move from city to city,
country to country, to tell
them what is happening at home,
how much progress we are
doing, and what it means if they
came back home and some
are coming back home.
WAFAIE FAWZI: That's great.
Thank you.
Other questions?
Hi my name's Paul [INAUDIBLE].
I'm an MPH candidate here.
My question relates
to prioritization.
You mentioned that earlier you
face so many challenges in
terms of health care
in your country.
How do you prioritize?
For example, how did you decide
to make putting a
dispensary in every village
your priority?
What sort of information
do you take
to make that decision?
DR. DAVID HOMELI MWAKYUSA:
We take the
information which is there.
And they say that when I was
appointed minister, our
president went from ministry
to ministry.
He did summon us to
the state house.
He had a message to tell
us, we as ministers.
So when he came to my ministry,
the first question
he asked me was where are you
taking the ministry to?
I thought that was a very unfair
question, because I had
never led a ministry before.
But he's my boss, I had
to say something.
So five years prior to my being
minister, I was a member
of Parliament, so I had to
reflect back what are the
health issues that need
to be addressed?
I know people had to walk,
sometimes 10 kilometers, to
the nearest dispensary.
Even if they went, that
dispensary may be manned by
just a nurse, because
we can't afford--
there are no clinical officers
and the medicines are in short
supply chronically.
So these are the types
of things.
So as I said, these things
are all priorities.
There's no way you
can say, priority
number one is malaria.
It's not like building roads
where you can say, well, this
road can wait until next year,
till the budget of next year.
So that's why I say priorities
within priorities.
There are strategies and
plans, which have to go
hand-in-hand with others, but
some of them may be given less
money this year just
because all of the
situation on the ground.
So we make priorities according
to what actually is
dictating, what are the
concerns, what are the needs,
and what you want to achieve.
And you try to get as few a
priorities as possible.
Because, otherwise, if you have
10 priorities, that's not
a priority list.
At the end of the day, you want
to see an impact in the
budget allocation that
you have given.
WAFAIE FAWZI: That's helpful.
Could I ask you--
you went into politics
at some point.
If you could tell us
how that happened?
Politics is not a very nice
word in many countries.
It's associated with
bureaucracy, and inefficiency,
and perhaps, corruption.
How did it happen, and what
advice do you have for our
students who might
be considering
going down that line?
DR. DAVID HOMELI MWAKYUSA:
When I decided to go into
politics, I was a director at
that time in Muhimbili.
And a few months back, I went to
my village, and a couple of
[? voters ?] came to my home
and asked if I could become
their Member of Parliament.
I said, me?
I was surprised.
Actually, of all the people who
were surprised to see me
go into politics,
I'm number one.
I never expected to
be a politician.
And actually, I remember it was
January, and come May, I
was supposed to have made up
my mind and started the
process, because you have got
to go through your party and
the general election.
By April, I told my wife, I told
my friends, no, I'm not
going into this.
And they said, the process comes
next month, and if those
people wanted you to become
their Member of Parliament,
you should've told
them earlier.
We have kept quiet
all this time.
There is no time they can
look for someone else.
So I say, well, why
don't I try.
After all, I won't make it,
because people didn't know me.
I was incarcerated in Muhimbili
doing all sorts of
things without going back
to my home village.
But when I tried, unfortunately,
I won.
But this was after considering
other issues, because these
were my people who brought
me up, they
trained me to that level.
I was working in a consultant
hospital, so I did not have
much access to treat them.
So I told myself, these are the
people who will go to me
to where I am and I've trained
so many doctors.
Unfortunately, when you look
at the list of the trainees
coming to the medical school,
people from my area were very
few, if any.
So I say, why don't I
go back and try to
see what can be done?
Actually, in my district, there
are two constituencies.
On the east, there is
a colleague called
[? Professor Mondose ?].
He's an engineer.
So the same day, we decided to
go, and when we went through
the election, we made history
that two professors from one
district did it happen.
So that was it, and actually,
I don't regret.
As you said, politics is
not a very good word.
They say politics
is a dirty game.
When I was living in Muhimbili,
I sent notices on
the notice board to tell
them I'm leaving.
I thanked them for their
assistance and
working with me.
And people came to my office
and someone told me, you're
going into politics?
The way we know you,
are you going to
learn how to tell lies?
But I don't believe that
politics is a dirty game, but
I know there are politicians
who are dirty.
I know there are doctors
who are dirty.
I know there are lawyers
who are dirty.
So in every field there
are dirty people.
There's no where you are taught
to become dirty just
because you became
a politician.
You may have heard people say
doctors write very badly.
Their handwriting
is illegible.
The first thing they learn when
they go to medical school
is to write badly.
But that's not true.
It's not true.
I know some doctors whose
handwriting is
very good, like mine.
But [? input ?]
politicians, I told them I'm
going to be a politician of a
different kind, and I think
I'm a politician of a
different kind.
WAFAIE FAWZI: So do you enjoy
being Member of Parliament?
And mind you, I heard
the [INAUDIBLE]
district your constituency
now has internet?
So they would watch you
and hear what you say.
DR. DAVID HOMELI MWAKYUSA: Yeah,
I enjoy doing something
which gives me challenges.
And to find myself a politician,
something I never
thought of, something you never
go to school someplace
to become one, to me, it's
a challenge I want
to meet head on.
So you asked if I enjoy.
I enjoy because there
are many challenges.
In your introductory remarks, we
have standing committees in
Parliament.
I mean, we have them
here in the Senate.
We have one chamber at home, the
Senate, and the Congress,
and the House.
And when I was requested by my
colleagues to be Chair of
agriculture, and livestock,
and water--
in the distance water is
connected to health, something
which I knew.
But the others, I was blank.
But I'm enjoying heading that
committee, because there's so
many challenges and 80% of our
people depend on agriculture,
actually, for their
livelihood.
So it's challenges,
challenges.
I don't want easy stuff.
WAFAIE FAWZI: That's great.
Yes ma'am.
MARY: Hello, thank you.
My name is Mary [? Sando, ?]
and I'm here in the MPH program
in the Department of
Global Health and Population.
Thank you Professor Mwakyusa.
I just have two questions.
One is regarding the budget.
I would like to commend you
for really pushing it very
hard to enable it to move from
5% to 12.5%, but then what
could be some of the reasons
why it would go down to 10?
And what can we do to sustain
it in a more positive
direction in the future?
But also, with regards to
staffing, health care staffing
at only 30%, what would you
think would be among the major
steps to take as a country going
forward that we can also
see a positive increase
in that as well?
Thank you.
DR. DAVID HOMELI MWAKYUSA: First
of all, about budget
sustainability, well, the
government cake is small, so
we don't expect a lot.
And, unfortunately, you find
more than 40 or just less
percent is donor funded.
I said it was unfortunate,
because I don't like to see
myself begging all the time.
We're not proud of begging.
So in the short term, I wouldn't
mind people coming to
help me out.
So to sustain it, actually,
first of all is to maximize
our potential our own.
Having a big budget should
not necessarily mean--
you know, bigger budget,
more output.
So the amount of money you have,
actually, there's an
incoming and then out.
It means somewhere here.
You have to be sure
that the money is
spent the way it should.
We say we need more money for
health, but we need more
health for that money.
So at the end of the day, you
may find that you increase the
budget, but the output is not
actually going exponentially.
So that is one thing we are
really trying to do, and when
I was there, I started a project
called Money Well
Spent project.
We started with family planning
tools, medicines and
so on and so forth, to try to
track family planning, money,
and tools from the
source right up
to the final recipient.
So then that, actually, it
showed us a lot of ways where
leakages happen and what
we could do better.
So what I'm saying is that, we
would like to sustain the
budget with our own money.
For whatever activities that
we set out to do, we had a
budget line.
That is, I wouldn't like
to say this program on
immunization, it was the Danish
who were helping us.
Then you go to sleep without
putting any money.
The moment they walk out,
you're in trouble.
So for every activity
you have to have a
budget line for that.
Now regarding the human
workforce, the health
workforce, we are at 38%,
which is very low.
There's a problem of input.
There was a problem
of enrolling them.
There was a problem also
retaining them.
And some of our people have
left the country.
So this immigration and
migration is both
internal and external.
From the districts to the towns,
actually, I have about
50% of my doctors in Dar
es Salaam alone.
It's that bad.
But also some of them walking
across the borders.
The borders are porous these
days, and people just walk out
as and when they wish,
so that is another
thing we can talk later.
But what we are trying to do, we
have increased enrollment,
actually, more than 300%.
We have looked at our syllabi.
We wondered should it take four
years to train a nurse
who is going to work
in the village?
So we look at the syllabi and
tried to put different stages,
so that someone who goes to work
in the village doesn't
need so many skills, if you
have transportation and
[? a reference ?] system
which is working.
But we're also looking at
incentives to incentivize
people to come back to the
country, but also, to work in
the villages.
And we have our past president,
President Mkapa.
He has started a foundation
which is working very well.
Actually, that model is working,
and we are getting
into the way things should
be done nationally.
Very few incentives, not
necessarily monetary
incentives, just to make sure
they have a house, make sure
there is solar electricity,
because the grid electric
can't reach there.
There are these things which
make their life easier.
And if you talk nice to your
colleague who's in charge of
roads, then if there is a road
getting there, they won't see
any reason why they should
come and work in town.
And for you people who are out
of the country, I exhort you
to come back.
It's a difficult problem.
We have discussed with it
in the [INAUDIBLE].
At one point, actually, I
found myself in Davis.
They wanted to convince me
that health workforce
migration is brain circulation,
rather than brain drain.
I did agree with that.
For a physician, walking across
from Canada to come and
work here, you know that someone
would come from here
to go to Saskatchewan
and work.
The conditions are
much the same.
They just want to change.
But for my country is
a net supplier.
I have a lot of doctors in this
country, but you don't
find Americans coming
to my country.
Is that brain circulation?
To me, that is a drain.
So we are talking debenture
together to try to see how we
can address it.
Because there are pull factors
and push factors.
There are things which push
them out of the country.
We are responsible. here
to look after.
But the pull factors, I can't
pay my doctor like he's paid
out of the country, so we have
to address this problem.
It means if they get a
job here, there's a
need, there's a vacancy.
So they, themselves, should
try to train more.
But also, because I spend so
much money training them in
Dar es Salaam, they
should help me
financially and otherwise.
WAFAIE FAWZI: Well, you have
put in a system to attract
people back, and encourage,
and incentivize retention.
Other questions?
MARY: Hi, thank you so much
for speaking with us.
My name's Natalie.
I'm in the Global Health
Department and
I'm a Master of Science.
My question is back to the
budget, and if you could just
speak to us a little bit more
about the political process,
and how you were able
to get such a
huge jump in the budget.
Because, like you said, it's
a small pie, so where
did that come from?
And how do you go about such a
process like that and working
with your colleagues?
DR. DAVID HOMELI MWAKYUSA:
Thank you.
First of all, the jump was
not a one day thing.
Maybe today I'm at 5%,
tomorrow I'm at 10%.
Now it was a gradual process
until we reached there.
But what we did was--
I was telling my students
yesterday that we had some
activity, and I told them
about Jeff Sachs.
Jeffrey Sachs, who came to my
office one day, and he is
passionate about bed nets.
He thinks if we use bed nets,
we can extinguish malaria.
And he said, you, as Minister,
what would it mean if tomorrow
you issued a decree to tell
people that I want all
Tanzanians by tomorrow, they
should sleep under a bet net.
And I told him I can't.
He said, why?
I said because I have a
policy to follow and
it doesn't say that.
What does it take to
change a policy?
I say we change them
in looking at other
circumstances.
Suppose the policy
allows you to.
I said, sir, I can't.
Why?
Because I don't have
the logistics.
Getting these bed nets here to
Dar es Salaam does not mean
that it reaches the
people out there.
So he says, suppose you
have the logistics?
I said I can't.
Why?
Because I don't have money.
And he told me not to speak
about money, because money is
pled in the world.
All you've got to do
is to make a case.
So that opened me
up, actually.
So what we need to do, and what
we did, was to come up
with the programs and convince
other people.
Because this cake of the total
budget is under everybody in
the other ministry.
If you just go and say, Mr.
President, I have very little
money, can you give
me some more?
He will ask you, you
want me to make a
cut in which ministry?
We are all sitting there,
so money's not there.
If you come up with solid
problems, and everybody sees
it this is, actually, a priority
and it is workable,
you will probably
get more money.
WAFAIE FAWZI: Talking about aid,
you mentioned about 40%
of the budget comes from
bilateral, multilateral
institutions.
Many times countries find it
difficult to accept the
conditions that donors impose,
and some countries find that
really they have no
other option.
But you have been quite
successful in terms of
accepting that aid and making
the best out of it, while
still being in control
of your own ministry
and your own programs.
What leadership skills are
needed in that context?
DR. DAVID HOMELI MWAKYUSA:
They could be personal.
You may want to know
what we are doing.
First, we have what is called
a joint assistance strategy.
It's a strategy which we put
together with our other
financials, so they know
us and we know them.
And what we would like them to
know about us, is that we know
where we are.
We know where we want to go.
And this is the finances which
we have, and let us talk about
the budget gap.
We don't encourage someone
coming and say, he's so
sympathetic with us and wants
to help us out say, to look
after [INAUDIBLE] and
so on and so forth.
If it is not within the roadmap,
then we would like to
convince him otherwise.
We would like them to swim
along with us in the same
river other than having
separate programs.
So they know about us, and as
you say, some put conditions,
which may be difficult for us.
I may say that UK have not
implemented some threats,
which they said, homosexuality
at home is something we don't
want to hear.
You get me?
So the prime minister of Britain
at the Commonwealth
Meeting said homosexuality.
I mean, who you love, or who you
marry, should not be the
concern of someone.
This is a basic right.
And he went on to say four those
who won't tow the line,
we may consider taking
off our assistance.
And we voiced this, we
are poor, but for
that, we'll be proud.
You can take your assistance.
So it seems like there are areas
where we cannot bend our
principles.
We have our own values.
So I don't know if I came
closer to what you
wanted me to say.
WAFAIE FAWZI: That's helpful.
Could I ask you one
last comment?
At this school, about 60% of
our students are women, and
these are the future leaders
in public health.
In Tanzania, and in Africa, in
general, if you could comment
on leadership and
gender equity.
Tanzania seems to be doing
very well by my sort of
observation.
The head of the medical school
at Muhimbili is a woman
recently, the head of the
hospital, following you, is a
woman, the head of the National
Institute of Medical
Research, Speaker of Parliament,
several Members of
Parliament.
Do you think you have solved
that problem in Tanzania or is
there still a long way to go?
And what would you do?
DR. DAVID HOMELI MWAKYUSA:
We have a long way to go.
And I'm happy and surprised
that a lot of the students
are, actually, women.
Even people who are working
in offices are women.
And when I get on the bus from
Cambridge every morning,
actually, there may
be only two men.
Now I'm [INAUDIBLE] out, and
I wonder what is happening.
When I go to my office on the
10th floor, I ask Betty if you
have to be a woman to get a job
there, because most of the
people who work there
are women.
Yeah, one thing, actually,
can be traced back to our
traditions and so
on and so forth.
At home, a woman is someone who
should stay at home, look
after children.
And we are changing that.
We would like them to be in
leadership positions.
But I wouldn't be happy to
give someone a leadership
position just because
she's a woman.
You have to empower them.
You have to help them get the
skills, competing skills.
I wouldn't be happy if you and
Betty Johnson went in a job,
you're better qualified, but
because she's a woman, then
she's given the job.
No.
So we are looking
at education.
The enrollment rate in primary
school when they go to school
is, actually, 50-50.
It's a class of 40, 40 women,
40 boys, but the attrition
rate then, it becomes
higher and higher.
So what we are trying to do is,
actually, to see, first of
all, to incentivize them.
And then create the right
conditions for them to
progress and be able
to compete.
And those you mentioned,
actually, did just that.
There were not given
those jobs just
because they're women.
But we are getting there
in Parliament.
About 30 or some percent
are women, which is
much more than Kenya.
In Kenya, there are so few.
One Member of Parliament was
saying, you have so many women
in Parliament.
We have about three, but
they're so noisy.
How do you--
But women in Parliament I expect
not to be too noisy.
But gender is mainstream in
whatever we want to do, you
ask yourself, how does
it impact on gender?
So in all the plans, all the
programs, you will be asked in
Parliament or in the Cabinet you
are passing a paper, you
will ask about gender
mainstreaming.
Just like, HIV, you have
to be asked about HIV.
WAFAIE FAWZI: This has been a
fantastic session, a very rich
discussion.
I know you've been really
an inspiration to
many people in Tanzania.
And thank you very much for
sharing those lessons of
leadership with our students,
who will certainly take them
and absorb them.
And not only those who are here
in the studio, but there
are many others who will
be able to watch this
recording over time.
DR. DAVID HOMELI MWAKYUSA:
Thank you.
WAFAIE FAWZI: We wish you all
the best when you go back to
Tanzania as well.
