EMERGENCY MEDICAL AND AMBULANCE SERVICES IN TANZANIA

AT-A-GLANCE

DIAL 112 or 114 TO CALL AN AMBULANCE IN TANZANIA*:

  • While these are the official emergency numbers in Tanzania, currently there is no ambulance service offered by the government in any region of Tanzania so be prepared to arrange private transport or enroll with a private company
  • Prehospital transport is very limited and only offered by private services. It is very much dependent on region (most private companies only operate in larger centers such as Dar es Salaam & Arusha) and is typically provided as inter-facility transfers where available
  • Transportation between facilities is sometimes provided by the sending facility, but there are geographic and infrastructural challenges
  • Not all hospitals have emergency care areas; if they do, they are often under-staffed and under-equipped, though the Emergency Medicine Association of Tanzania (EMAT) is making big strides in improving emergency care and making it a national issue

HOW CAN I CALL AN AMBULANCE IN TANZANIA?

HOW DO I CALL FOR HELP?

You cannot call 112 to directly request an ambulance to the scene of an emergency in Tanzania

As reported by the Tanzanian authorities in WHO’s 2013 Global Status Report on Road Safety, 112 is the official emergency number in Tanzania, routing calls to the police department.

However our in-country contacts report that outside of the main commercial city of Dar es Salaam, the 112 number does not consistently work in all regions.  You may either get an automated voice system which prompts you to choose either Swahili or English, then you are placed on hold indefinitely until the call drops or the call may not connect at all.

Recently, there have been efforts to ensure that 114 for reporting a fire emergency is available in all regions though it may not work with all mobile providers.

Currently, there are no government provided emergency ambulance services in any region of Tanzania. Ambulances are primarily  used to transport patients between referral health facilities. There are some private companies in Dar es Salaam & Arusha who offer ambulatory services as well as air evacuations though due to lack of runway lights at most airstrips in Tanzania, medevacs can only take place during daylight hours.

CAN I CALL FOR HELP ANYWHERE?

No, coverage by emergency medical services is limited, largely to Dar Es Salaam and other major metropolitan and/or tourist areas. Upcountry regions have can have limited network coverage and the emergency lines often are not working.

A study of Kilamanjaro Christian Medical Centre, a major referral hospital in the northern city of Moshi, found that there was no evidence of prehospital care in the region. The average time to arrival to the hospital was greater than 1 hour. A minority of patients were transported to the hospital in ambulances while most are transported by Good Samaritans in private cars or motorcycles (Rotich 2015).

The traffic police and fire department do not have ambulances and may transport you in the back of their pickup to the nearest health facility.  However due to lack of resources do not rely on this option.

WHAT OTHER EMERGENCY NUMBERS CAN I CALL?

Tanzania has two official lines for essential public safety and health services.

  • Fire: 114
  • Police: 112

On the ground experience is as follows:

  • Many government travel advisory websites (eg: https://travel.gc.ca/destinations/tanzania) list 112 or 111 as the emergency line to call however these numbers do not work in many regions outside of Dar es Salaam.
  • Not all cell networks are connected with 114. Each region has various networks which may work, however currently Vodacom and Halotel are the most reliable, Tigo is limited and Airtel does not work in most regions.
  • Your call will be routed based on your cellphone GPS location to the nearest firehall or police station.
  • You may encounter a language barrier as the call maybe answered by a Swahili speaker with very limited English. Try to enlist someone to assist with translation if possible when calling to report an incident or request emergency service.

 

GROUND AMBULANCE IN TANZANIA

In addition to those public agencies, a few private ambulance providers exist and work together with private clinics, including:

WHAT ABOUT IN DISASTERS?
ARE THE RESPONDERS TRAINED?

The Emergency Medicine Association of Tanzania (EMAT) offers emergency care training for different levels of providers. Read here for a full list of Short Courses offered by EMAT in Dar Es Salaam. The availability of trained prehospital emergency care providers (i.e., “EMTs” or “Paramedics”) is scant and documentation and/or websites detailing their existence is equally scarce.

Training for emergency physicians and nurses, however, is increasing. According to a 2012 article in the African Journal for Emergency Medicine:

“Currently at most hospitals, emergency patients are cared for in Emergency Centres (ECs) staffed with rotating personnel who are neither trained nor equipped to provide complete resuscitative care, but dedicated emergency care training projects are emerging. The first Emergency Medicine residency in the country was initiated in 2010 and will produce its first graduates in 2013. In 2011, a dedicated Emergency Nursing curriculum was introduced, and the Emergency Medical Association of Tanzania (EMAT), the first Emergency Medicine professional society in the country, was formed and ratified by the Ministry of Health. EMAT has been given a mandate to develop feasible initiatives for the dissemination of emergency care training to district and sub-district facilities. However, significant gaps exist in the capacity for emergency medical care including deficits in human resources, essential equipment and infrastructure – concurrent issues that EMAT must address within its development strategy.”

HOW WILL I GET TRANSPORTED?

Medical transportation by ground ambulance or fixed wing aircraft are the options with private providers.  However if you are up country out of the major cities, you will most likely be transported by private vehicle, taxi, motorcycle or occasionally in a police or fire vehicle.

In the case of medivac, the company must speak first to the attending doctor in order to assess whether a flight is necessary.  The fixed wing aircraft will land at the nearest airport and you will need to be transported to the airstrip.  Please note that the evacuation can only take place during daylight hours due to lack of landing lights at most airports in the country.

Also the patient will need to have their passport and a valid yellow fever card with them in order to gain entry in to Kenya or South Africa.

WHERE WILL I BE TRANSPORTED TO?

Tanzania has a government health referral system (as in the diagram below) in which patients are escalated based on the extent of their illness or injury. As previously noted, not all hospitals have ER facilities however most regional hospitals are well equipped. There are also private and mission hospitals which can provide a reasonable level of care.

You will most likely be transported to the nearest medical facility and then transferred/referred to a higher level facility. If you are conscious and able to speak for yourself, you may direct the transport to a particular hospital if you have the means to pay for such service.

In the case of medevac, the most common destinations are Nairobi Kenya & Johannesburg South Africa. It will depend on what is specified in your insurance coverage.

Tanzania Health System

HOW WILL I PAY?

FOR TANZANIAN CITIZENS

According to a 2013 post on AllAfrica.com: “DEPUTY Minister for Regional Administration and Local Government, Mr Aggrey Mwanri, has said that ambulance services are supposed to be free of charge.

 Mr Mwanri said it was against the law to make patients pay for the service when in need since the government issues fuel and pays for the maintenance of the vehicles, thus no need to charge patients.”

 

FOR U.S. CITIZENS

Check with your health insurer before traveling to Tanzania to see if they cover you overseas, and to see if they cover emergency evacuation in the event of a serious health issue.

See the US Department of State’s website on supplemental insurance coverage

ADDITIONAL INFO

COMMON EMERGENCIES AND RECOMMENDED VACCINATIONS

Common Emergencies in Tanzania

  • ROAD TRAFFIC INJURIES – According to the World Health Organization, Tanzania has a traffic fatality rate of 32.9/ 100,000 population, compared to just 10.6 in the United States (2015)
  • INFECTIOUS DISEASE – According to the CDC, the following infectious diseases are present in Tanzania:
    • Dengue
    • Cholera
    • Malaria: CDC estimates a high risk for travelers
    • Zika virus:
    • Typhoid: Transmission through infected food or water
    • Yellow Fever: More likely in visitors with prolonged stays

Recommended Vaccinations for Tanzania

According to the US Centers for Disease Control and Prevention (CDC), different groups of travelers will require different vaccinations for travel in Tanzania:

  • All Travelers:
    • Measles-mumps-rubella (MMR) vaccine
    • Diphtheria-tetanus-pertussis vaccine
    • Varicella (chickenpox) vaccine
    • Polio vaccine
    • Your yearly flu shot
  • Most Travelers:
    • Hepatitis A
    • Typhoid
  • Some Travelers:
    • Cholera
    • Hepatitis B
    • Malaria
    • Rabies
    • Yellow Fever – “Country entry requirement: The government of Tanzania requires proof of yellow fever vaccination upon arrival if you are traveling from a country with risk of yellow fever (this does not include the US – see complete list: Countries with risk of yellow fever virus (YFV) transmission.)

Read more about travel in Tanzania at the CDC website:  https://wwwnc.cdc.gov/travel/destinations/traveler/none/tanzania/ (Last accessed: Aug. 7, 2017)

GOVERNMENT OVERSIGHT

All healthcare related activities in Tanzania are governed by the Ministry of Health, Community Development, Gender, Elderly and Children. However, there are no national guidelines or governance in Tanzania specifically for prehospital emergency care.

 

Telecommunications are regulated by Tanzania Communications Regulatory Authority (TRCA)

REFERENCES
  • Adhvaryu AR, Beegle K. “The Long-Run Impacts of Adult Deaths on Older Household Members in Tanzania.” Economic Development and Cultural Change; 2012;60(2):245–77.
  • Baker T, Lugazia E. “Emergency and critical care services in Tanzania: a survey of ten hospitals.”BMC Health Serv Res. 2013 Apr 20;13:140–9.
  • Casey ER, Muro F, Thielman N. “Analysis of traumatic injuries presenting to areferral hospital emergency department in Moshi,Tanzania.” Int J Emerg Med. 2012 Jul 30;5(28):1–7.
  • Chalya PL, Dass RM, Mchembe MD, Mbelenge N, Ngayomela IH, Chandika AB, et al. “Citywide trauma experience in Mwanza, Tanzania: a need for urgent intervention.” J Trauma Manag Outcomes; 2013 Nov 11;7(1):1–1.
  • Chalya PL, Mabula JB, Dass RM, Mbelenge N, Ngayomela IH, Chandika AB, et al. “Injury characteristics and outcome of road traffic crash victims at Bugando Medical Centre in Northwestern Tanzania.” J Trauma Manag Outcomes. BioMed Central Ltd; 2012 Feb 9;6(1):1.
  • Cox M, Shao J. “Emergency medicine in a developing country: Experience from Kilimanjaro Christian Medical Centre, Tanzania, East Africa.” Emerg Med Australas. 2007 Oct;19(5):470–5.
  • Evjen-Olsen B, Olsen Ø, Kvåle G. “Achieving progress in maternal and neonatal health through integrated and comprehensive healthcare services – experiences from a programme in northern Tanzania.” Int J Equity Health. 2009;8(1):27.
  • Kuzma K et al: “The Tanzanian trauma patients’ prehospital experience: a qualitative interview-based study.BMJ Open. 2015;5(4):e006921.
  • Little RM, Kelso MD, Shofer FS, Arasaratnam MH, Wentworth S, Martin IBK. “Acute care in Tanzania: Epidemiology of acute care in a small community medical centreLes soins aigus en Tanzanie: Épidémiologie des soins aigus dans un petit centre médical communautaire.” Afri J Emerg Med; 2013 Dec 1;3(4):164–71.
  • Lund Sorensen B, Bruun Nielsen B, Raschl V, Elsass P. “User and provider perspectives on emergency obstetric care in a Tanzanian rural setting: A qualitative analysis of the three delays model in a field study.” African Journal of Reproductive Health. 2011 Sep 1;15(2):117–30.
  • Nicks BA, Sawe HR, Juma AM, Reynolds TA. “The state of emergency medicine in the United Republic of Tanzania.” Afri J Emerg Med; 2012 Sep 1;2(3):97–102.
  • Pereira C, Mbaruku G, Nzabuhakwa C, Bergström S, McCord C. “Emergency obstetric surgery by non-physician clinicians in Tanzania.” Int J Gynaecol Obstet; 2011 Aug 1;114(2):180–3.
  • Reynolds TA, Mfinanga JA, Sawe HR, Runyon MS, Mwafongo V. “Emergency care capacity in Africa: A clinical and educational initiative in Tanzania.” J Public Health Policy 2012 Dec 5;33(S1):S126–37.
  • Rotich, CC. Evaluating Access to Prehospital Care for Traumatic Brain Injury Patients in a Resource Limited Setting: Focus on Prehospital Transport. INJ PREV2015;21:A9.
  • Schmid T, Kanenda O, Ahluwalia I, Kouletio M. “Transportation for Maternal Emergencies in Tanzania: Empowering Communities Through Participatory Problem Solving.” Am J Pub Health. 2001 Oct 17;91(10):1589–90.
  • Spangler SA. “Assessing skilled birth attendants and emergency obstetric care in rural Tanzania: the inadequacy of using global standards and indicators to measure local realities.” Reproductive Health Matters; 2012 Jun 1;20(39):133–41.
  • Stal KB et al: “Women’s perceptions of the quality of emergency obstetric care in a referral hospital in rural Tanzania.Trop Med Int Health. 2015;20(7):934-40.

SCOREBOARD

% of Seriously Injured Transported by Ambulance in Tanzania, 2013

Less than 10%

[Source: 2013 Global Status Report on Road Safety, WHO]

Road Traffic Injury Deaths
(per 100,000 population)

  • Tanzania
  • Russia
  • United States

[Source: 2015 Global Status Report on Road Safety, WHO]

Reported Homicides
(per 100,000 population)

  • Tanzania
  • Russia
  • United States

[Source: 2014 Global Status Report on Violence Prevention, WHO-UNDP]

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