In need of health care and medicines, many rural Tanzanians have to trek long distances to their nearest public health facility. Once there, they often find the medicines they need are out of stock, generally having to turn to private drug outlets, or duka la dawa baridi, to buy their prescribed medicines—and often paying more money for drugs of uncertain quality. This is the plight of many in Tanzania, where life expectancy had fallen to 44 years in 2001, from 50 years in 1990 (World Bank 2003), and infant mortality is 107 deaths per 1,000 and rising.

The Virtual Leadership Development Program (VLDP) works to help strengthen health managers and their teams to address real organizational challenges. One such organization is Kenerela, a network of religious leaders with HIV working throughout Kenya to increase HIV/AIDS awareness and address stigma, denial, and discrimination issues."My mother, stop lying to me.

The Angola Project works to improve diagnosis and treatment of childhood disease. {Photo by Carmen Urdaneta 2004.}Photo by Carmen Urdaneta 2004.

Improving Quality of Health Services in the Worst of Circumstances "Take me to surgery!" Sofia screams the words, battling after the hours of pain she has endured. She lies on a small bed in the Cacuaco Health Center maternity ward, where two nurses are doing their best to help her. Sofia arrived several hours earlier, brought in after laboring in her home for hours. Even though she was given three doses of the labor-inducing drug Pitocin, she has not given birth.