Strengthening local health systems to address Lymphatic Filariasis (LF) morbidity in a resource limited setting: A morbidity management project in the Lindi region of Tanzania

In Tanzania, lymphatic filariasis (LF) affects over 6 million people leading to a high burden of LF associated hydrocele: a fluid-filled enlargement of the tunica vaginalis sac around the testes. The economic, physical, and psychosocial impact of hydrocele is devastating not only for the individual, but also for the family and community. In the Lindi region alone, one of 30 regions in Tanzania, there was a backlog of 2000 men awaiting hydrocele surgery in 2011.  However, most patients did not access surgeries due to 1) inability to pay as almost 90% of patients depend on out of pocket payment; 2) an inadequate number of skilled clinicians performing surgeries; 3) limited medical supplies; and 4) patients’ fear of undergoing a non-emergency surgery under general anesthesia. To address these obstacles, the project focused on strengthening the local health system by pooling resources from stakeholders (donor, MOH, national referral hospital, regional/district hospitals, and communities) to allow for surgeries free of charge and to provide required supplies. Experienced surgeons mentored 29 local doctors and nurses on hydrocelectomy using sac partial excision technique under local anesthesia.  Also, they were provided a small incentive to conduct surgeries over weekends to avoid interfering with regular weekly duties.  By strengthening the local health workforce, pooling resources, and increasing availability of supplies, 680 patients accessed quality hydrocelectomy over 8 months; over 4 times the annual average of hydrocelectomy surgeries performed regionally before the intervention.  This intervention can be sustained through increased local capacity and ownership within district level staff.