Sustainability and affortability: A conflict that cannot be resolved? - Exemplified by the situation of the Lutheran Church in Tanzania

Public Health systems in developing countries are in a field of tension between two poles: sustainability and accessibility. A several months check on hospitals run by the Lutheran Church in Tanzania led us to conclude, however, that the great majority of these institutions have neither a survival chance nor have they made any substantial contribution to the status of public health care for the poor. Basing on the results of this check we discuss a few measures to transform church-run public health systems in developing countries in accordance with the goals of sustainability and accessibility. It is, however, evident that it will not be enough just to increase the technical efficiency of existing hospitals. What is needed - acid this seems indeed to be the only feasible way - is to effect a complete reorganisation in the sense of Primary Health Care. It is only then that church-run Public Health Care may survive in these countries and that provision of adequate health care can be ensured for many patients.