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MUTUAL PARTNERSHIPS AT THE CENTRE OF ADDRESSING INCREASED MORAL DILEMMAS IN HEALTHCARE SETTINGS IN TANZANIA

By Our Correspondent

Moral dilemmas are an inseparable part of daily clinical practice in the healthcare setting. A moral dilemma may involve doubt or conflicting interests among clinicians, patients and their relatives. Healthcare professionals in Tanzania face an increasingly complex landscape of moral dilemmas, which require urgent attention to prevent harm to patients and their families. Moral dilemmas in healthcare settings range from resource constraints and limited access to essential medicines to challenges in withdrawing medical treatment due to religious or socio-economic factors. Ethical dilemmas in healthcare settings in Tanzania have become more complex and difficult to resolve. For patients, unresolved moral challenges may lead to distrust of the healthcare system and healthcare professionals. Yet, healthcare professionals face moral distress due to unresolved ethical challenges.

Clinical ethics support services have been developed to support healthcare professionals, patients, relatives, family members, and community members in handling ethical dilemmas in healthcare settings. For instance, in high-income countries, various types of clinical ethics support services have been established to assist healthcare professionals in dealing with ethical issues. Clinical ethics committees (CECs), clinical ethics consultation, moral case deliberation (MCD), and ethics reflection groups are essential examples.

In Tanzania, some efforts are underway to address increasingly moral dilemmas in healthcare settings. For instance, one of the priorities of the Ministry of Health for the 2023-2024 Fiscal year is to strengthen access and quality of health services. On the other side, the University of Dar es Salaam (UDSM) has been playing a pivotal role in supporting the efforts of establishing modalities to address moral challenges in our health systems through collaboration with other partners across the globe.

Recently, through its Department of Philosophy and Religious Studies, UDSM is collaborating with the University of Oslo (UiO) through the Centre for Medical Ethics and the University of Rwanda through the Department of Pharmacy to implement a project titled Enhancing Ethics and Integrity in Medical Research and Clinical Practice (ETHIMED).

The project, funded by the Norwegian Partnership Programme for Global Academic Cooperation (NORPART), runs from 2022 – 2026.

The project aims to design a clinical ethics course for capacity building for healthcare professionals, research capacity in clinical ethics, and establish clinical ethics support services, particularly a Clinical Ethics Committee at Mbeya Zonal Referral Hospital.

As part of implementing the ETHIMED project, a delegation of academics and researchers attended a special two week intensive training on research and clinical ethics at the UiO in May 2023. This training involved a group of researchers and academics from various institutions of higher learning in Africa, including the University of Dar es Salaam, the University of Rwanda, and Saint Paul’s Hospital Millenium Medical College (Ethiopia). Furthermore, the training served as a pilot for clinical ethics training conducted in November 2023 at Mbeya Zonal Referral Hospital.

As a follow-up to the training held at the UiO in Oslo, Norway, in May 2023, the project team from the UDSM conducted a workshop held in Bagamoyo from 20th – 24th June 2023. It engaged stakeholders in clinical practice to review and validate the clinical ethics course materials to align with the Tanzanian healthcare context. The workshop facilitators were Dr. Michael F. Lyakurwa (Head of the Department of Philosophy and Religious Studies), Mr. Lucas Kitula, and Mr Shija Kuhumba from the same department.

The participants of the workshop were from various institutions, including the Ministry of Health (Department of Human Resource Development and Department of Curative Services), Mbeya Zonal Referral Hospital (MZRH), National Institute of Medical Research (NIMR), Mbeya College of Health and Allied Sciences (MCHAS), and the UDSM (Department of Philosophy and Religious Studies – College of Humanities).

The reviewed and validated topics include 1) a general introduction to ethics and clinical ethics, 2) priority setting in healthcare: from society to clinical decision-making, and 3) ethical reflections on end-of-life and advanced care planning.

4) ethical reflections on patient’s autonomy and shared-decision making; 5) the place of religion and culture in clinical ethics; 6) legal reflections in medical practices; 7) clinical ethics support systems; 8) ethical reflections on coercion in the healthcare setting; and 9) communication in a healthcare setting.

Hence, during the official opening of the workshop, Dr. Rose Upor (the Principal of the College of Humanities – UDSM) remarked that the ETHIMED project is one of the ways the UDSM is making an impact on society.

“If fully implemented as per the set objectives/ outcomes, especially that of the formation of the first Clinical Ethics Committee (as opposed to disciplinary committees) at MZRH, the project is set to contribute a great deal to the efforts of the Government of Tanzania to improve quality of care in health facilities in the country.

“I also request closer cooperation between UDSM, the Ministry of Health, and the MZRH so as to realize the project’s intended outcomes,” she said.

Adding to that, Dr. Upor said the UDSM (through the College of Humanities) will closely monitor the project to ensure it is implemented per the contract.

On her part, Ms. Asnath Mpole from the Ministry of Health (Department of Human Resource Development) noted that ETHIMED activities in Tanzania align with some of the priorities of the Ministry of Health for the 2023/2024 Fiscal year, especially priority number 2, which is to strengthen access and quality of health services.

From his side, Mr. David Marenga (Health Secretary of MZRH) said that MZRH is ready to partner with UDSM and UiO in realizing ETHIMED project activities, especially training healthcare providers on clinical ethics and establishing a clinical ethics committee (CEC) at the MZRH.

“CEC will be helpful in addressing ethical dilemmas encountered on a daily basis by healthcare providers in clinical practice,” He added.

For more Details: Lucas Shija Kitula (Assistant Lecturer and ETHIMED project coordinator.  [email protected] +255684557399

Shija Kevin Kuhumba – Assistant Lecturer at UDSM and PhD student in Clinical Ethics at University of Oslo. [email protected] +255625590951

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