While Selian Lutheran Hospital has been developing its reputation as the premier center for quality care in northern Tanzania, it has been challenged by several dramatic economic realities:

• Tanzania is one of the poorest countries in the global community. Recent United Nations statistics place it as the second poorest nation I n the world. People have little and even inexpensive medical care is often unaffordable. The Tanzanian government expenditures on health are less than $2 per capita annually.

• Selian Lutheran Hospital has been actively seeking means of attracting wealthier, paying patients in order to subsidize the poor. In Tanzania, church hospitals typically have more than 60% of their running costs subsidized from abroad. At Selian, the foreign subsidy is only 40%.

• While good management and an attractive medical care setting allow the hospital to move toward greater self sufficiency, the terrible burden of poverty precludes the hospital from further capital development in terms of needed equipment and physical space.