HEALTHCARE SYSTEMS IN OUR HOST COUNTRIES

The following text provides background information on the healthcare systems of various countries where we offer medical rotations, and healthcare internships and volunteer opportunities. It also explains how the medical facilities we cooperate with fit within these systems, helping interested individuals choose the most suitable option for their elective, internship, or volunteer work.

If you have any further questions, please feel free to contact us, and we’ll gladly assist you.

Tanzania and Zanzibar

We can arrange electives, healthcare internships and final year rotations (medicine, nursing, therapy), as well as volunteer assignments for healthcare professionals in various public and private medical facilities in Tanzania. There is also an option to complete pre-med or pre-nursing internships.

In Tanzania, the healthcare system operates under a referral system: patients typically seek care first at "medical dispensaries," which are found in almost all neighborhoods of larger and smaller cities such as Moshi and Dar es Salaam, as well as in many villages. These clinics provide basic treatments such as minor injuries, infections, malaria, hypertension, diabetes, and in some cases, childbirth.

There are both private and public dispensaries. Public dispensaries are usually very basic in terms of facilities and equipment. In rural areas and city outskirts, these dispensaries often lack a stock of standard medications and can only provide very basic first aid. Private dispensaries are generally similar to public ones, though some are better equipped and offer more comprehensive treatments.

Any licensed nurse in Tanzania can open a private clinic. Dispensaries are typically run by a nurse or a "Medical Officer." In Tanzania, a Medical Officer is a healthcare professional whose qualifications are between those of a nurse and a doctor. Some dispensaries employ additional nurses, Medical Officers, and lab technicians.

Nurses and Medical Officers can prescribe and administer standard medications. However, dispensaries usually do not employ doctors who have completed a full four-to-five-year medical degree. If your university requires supervision by a doctor for your clinical rotation or internship, it cannot be conducted at a dispensary.

Volunteers with professional qualifications in healthcare (nurses, doctors, therapists) can actively contribute in dispensaries, performing tasks like suturing wounds, conducting treatments, or assisting with births. Qualified professionals may even work independently without supervision. Pre-med internships are also possible in dispensaries.

In Zanzibar, the Ministry of Health generally does not allow foreign volunteers to work in dispensaries.

The patient load in dispensaries can fluctuate significantly, typically increasing during the rainy season (March to June and November) when infections and malaria are more common.

If a dispensary cannot treat a patient due to limitations in the nurse's or Medical Officer's qualifications or resources, the patient is referred to a regional hospital. Patients may also directly visit regional hospitals, especially those living nearby in urban areas, as they often expect better care there.

Regional hospitals in Tanzania have very high patient volumes. Medical students, trainees in healthcare professions, and qualified professionals will encounter a wide range of medical conditions, often in advanced stages.

Patients visiting regional hospitals usually come from low- or middle-income backgrounds and seek treatment only when they feel critically ill. Delays between visiting a dispensary and seeking care at a regional hospital often worsen their condition. Poor patients frequently rely on relatives, neighbors, or church communities to fund their treatment.

A doctor's consultation at a regional hospital costs around 7,000-10,000 Tanzanian Shillings (€3-5), with medications costing an additional 2,000-10,000 Shillings (€1-5). Larger procedures and inpatient care cost between 100,000 and 200,000 Shillings (€50-100). The average monthly household income for a family in Tanzania is about €150-200, but 65% of households live on €50 or less per month. Preventive health checkups are uncommon, even among wealthier individuals, and minor symptoms are often ignored. Only employees of larger companies typically have health insurance.

Regional hospitals have standard departments and can be a challenging environment for internships. The high workload often leaves practicing doctors with little time to provide detailed explanations to interns. Tasks for interns and volunteers often include assisting nurses with tasks such as suturing wounds and changing bandages or accompanying doctors during consultations and rounds. Participation is always supervised by a healthcare professional. Regional hospitals employ qualified professionals who can certify your elective or internship for credit by your university or college.

Specialized "referral hospitals," such as Muhimbili National Hospital in Dar es Salaam and Bugando Medical Centre in Mwanza, rank one level higher than regional hospitals in the 3-tier referral system. They are often associated with medical universities. Patients cannot directly visit referral hospitals but require a referral from a regional hospital. An exception is Mnazi Mmoja Hospital in Zanzibar, which accepts patients directly as there are no regional hospitals on the island.

The quality of equipment and facilities varies between departments in regional and referral hospitals. Some are modern and well-equipped, often due to funding or donations from international development programs.

Due to the limitations of state healthcare facilities, many private institutions have been established in Tanzania. As treatment costs are higher than in public hospitals, the quality of facilities, equipment, and care standards is generally superior.

Private hospitals serve patients with sufficient financial means. Some are operated by non-profit organizations or churches, which use income from wealthier patients to provide free care for those without means. Facilities and equipment in these hospitals are often better than in public institutions unless certain public hospital departments have been upgraded with foreign funds. Private hospitals tend to have lower patient volumes, allowing medical staff more time to explain procedures to interns and volunteers.

Doctors often work simultaneously in public and private hospitals due to low salaries, necessitating multiple jobs.

Electives and healthcare internships in regional and referral hospitals in Tanzania are generally recognized by all international healthcare faculties. Final year rotations can be conducted and done for credit at Muhimbili Hospital in Dar es Salaam and Bugando Medical Centre in Mwanza, both teaching hospitals affiliated with medical universities.

Morocco

In Morocco, we arrange clinical rotations and internships in private hospitals, which are of a higher standard compared to public facilities. In terms of infrastructure, equipment, and the professional qualifications of staff, these hospitals are comparable to European hospitals.

The treatment costs in private hospitals in Morocco are high for many Moroccans. However, private hospitals often allocate funds to offer low-cost or even free treatment for underprivileged patients.

The recognition of an elective placement or internship in a private hospital in Morocco for university credit is generally possible.

India

In India, we organize pre-medical, pre-nursing, nursing internships, electives, and various other healthcare internships exclusively in private hospitals.

Government hospitals are free of charge for patients, but in terms of equipment and facilities, they are of a low standard and are usually very overcrowded, so that the staff hardly has time to take adequate care of the patients. Patients typically have to arrive early in the morning and then wait for hours without the certainty of receiving treatment on the same day.

Private hospitals charge fees. There are private hospitals of different price levels and varying quality, but all of them offer better services than government hospitals. Private hospitals also accept patients who have government health insurance.

The tasks that are typically carried out by nurses in Western countries are generally divided in Indian hospitals between nurses and lower-level female hospital staff, who are called "ward ladies" or "ayahs."

Nurses are more involved in medical tasks than in direct patient care, and they usually have to follow strict protocols while having less autonomy and fewer decision-making powers than nurses in the West. They are more like assistants to doctors and act according to the doctors’ instructions.

Ward ladies (or ayahs) perform non-medical tasks such as washing, bathing, dressing, feeding, and assisting patients with using the toilet. They change bed sheets and clean the patient's surroundings, as well as transport them to other departments. They assist the nurses by handing them materials, disposing of medical waste, and holding or calming patients.

In Indian hospitals, food is usually not provided, but this is taken on by family members, who bring food for the patients from outside the hospital. They also assist the ward ladies with feeding, bathing, etc.

Nicaragua

In Nicaragua, we can arrange elective placements and internships at the private hospital AMOCSA in León.

Similar to India and Morocco, this private hospital offers a higher standard of care compared to public hospitals.

Bolivia

Public hospitals in Bolivia operate at a very basic standard. Treatments are free, except for medications, but the hospitals are overcrowded. To receive care on the same day, one must often queue as early as 4 a.m. Staff are underpaid and therefore often unmotivated.

Private hospitals provide better services but are unaffordable for most people.

The COMBASE hospital in Cochabamba, Bolivia, with which we collaborate, has been run by a religious non-profit organization since 1964. It caters to people from low-income backgrounds who cannot afford private hospitals. It charges minimal fees for treatments and aims to provide more humane and better services than public hospitals.

COMBASE does not have substantial funding and is therefore simply equipped, comparable to public hospitals in Bolivia.