Interview - Improving health in Zanzibar

Somerset GP Dr Jonathan Rees talks about his work with Health Improvement Project Zanzibar.

Dr Rees has participated in several findraising cycle rides for HIPZ
Dr Rees has participated in several findraising cycle rides for HIPZ

Can you explain a bit about your background?

I did basic surgical training in the late 90s then spent three years as a urology research registrar.

This involved visiting men with prostate cancer and interviewing them and their partners about their quality of life - it helped me realise that I belonged in primary care more than surgery, which led to me changing career in 2003.

I am now a six-session partner at Brockway Surgery in Nailsea, Somerset. The rest of my week is spent working in our local community urology service as a GPSI.

What is Health Improvement Project Zanzibar?

Health Improvement Project Zanzibar (HIPZ) is a small charity which was started by Dr Ru MacDonagh, a consultant urologist in Taunton.

We are unusual in that we operate in public/private partnership with the government of Zanzibar - it pays for the running costs and staff salaries, but we have control.

We took over Makunduchi Hospital in the south of Zanzibar six years ago and have transformed it from a non-functioning hospital into a busy, trusted institution delivering quality care. We built a primary care unit there - previously the population of 75,000 had no primary care - which now sees more than 2,000 patients a month.

In 2011 the government asked us to take over a second, bigger, hospital at Kivunge in the north of Zanzibar, which serves more than 180,000 people and is in very bad condition.

Again, there is no primary healthcare, so our first priority is to build a unit to give people access to basic healthcare, including vaccinations and antenatal care. It is a huge challenge and we need to raise money for this infrastructure.

How did you become involved in the charity's work?

I worked in Zanzibar's main government hospital in 2000 when I was a urology trainee. When HIPZ was set up, Dr MacDonagh asked me to become a trustee, based on my experience of Zanzibar and other African countries.

As a trustee, I oversee and advise on all aspects of the charity's work. I go to Zanzibar about once a year - although I would love to go more. As a keen cyclist, I've also done fundraising bike rides for HIPZ.

What did the recent bike ride around Zanzibar involve?

The bike ride is a very effective way for a small charity to raise funds - we did our first ride in 2010 and managed to make more than £80,000, which was used to build and equip a primary healthcare unit and a maternity service at Makunduchi Hospital.

This year, 35 riders took part, including Peter Andre and his brother Michael. He was on the bike ride as he was operated on by Dr MacDonagh, became interested in the charity and offered his support.

Because he took part we were accompanied by an ITV camera crew and a producer. The ride will be featured in two programmes on ITV2 as part of the next series of Peter Andre - My Life.

We were there for eight days in June, riding for six - the furthest ride for me was about 105km in 35 degsC heat. It was very enjoyable, but hard work. We hope to top £50,000 in donations.

This is my third ride for HIPZ. I cycled in Zanzibar in 2010 and London to Paris in 2011 - I have raised more than £13,000 across the three rides.

What do you enjoy about your involvement in the charity?

I am passionate about healthcare in Africa, having worked there before and seen the huge need. However, I am also aware of how well-meaning western aid has failed to deliver sustained improvements in the past.

I am involved in the work of HIPZ because I believe our model is fundamentally different, based on collaboration with local government and healthcare staff.

The public/private partnership means we deliver far more for far less money - much of what we offer is micromanagement and setting up efficient systems, it's not always about spending money.

What challenges do doctors face in Zanzibar?

They are enormous and various - language, culture, poverty, lack of access to basic medicines, poor infrastructure, to name but a few.

However, the population is positive about HIPZ and our doctors have a fantastic time and usually go back.

Is the charity keen for other GPs to work in Zanzibar?

We have a UK doctor at each of our two hospitals, involved in clinical work, training of staff, logistics and redesign of services.

We are always looking for doctors who are interested in spending some time in Zanzibar, but realistically, we need a minimum of six months' commitment because it takes a fair while to get up to speed and learn Swahili. Anyone who is interested can contact us through our website.

  • For more information about the work of HIPZ and further details of how to donate or volunteer, visit

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