News and stories

Getting Health Workers To Where HIV/AIDS Clients Need Them Most With POA

Nov, 2019

Written by Liz Pavlovich, MScPH, Business Development Manager at Touch Foundation. She recently traveled to Mozambique, where Touch Foundation is working with HRH2030 on a health workforce analysis.

 

HIV/AIDS services start with the health professional. Yet healthcare workers are often in short supply in sub-Saharan Africa – the region of the world most affected by the epidemic. Another major constraint is the limited amount of funding available. Finally, while some advances have been made in collecting and using data on the health workforce providing HIVAIDS services, it is often still challenging to get current, reliable data when needed. Yet, this data can power how the global health community most effectively reaches those impacted by HIV/AIDS to ensure that people are tested, and initiated and retained on treatment.

 

For 15 years, Touch Foundation has developed innovative and data-driven solutions to the training and deployment of the health workforce in Tanzania and elsewhere. Two major health workforce considerations are the skills mix and the geographic distribution. Five years ago, a representative of the Government of Tanzania revealed to us that they had several tens of thousands of requests from districts for new healthcare workers at facilities across the country, but only a fraction of that to deploy, given the low budget available for staffing and modest number of graduates. A solution was needed to make the time-consuming and challenging process of prioritizing these requests easier. With support from USAID and PEPFAR, Touch Foundation created the POA (Prioritization and Optimization Analysis) methodology in 2015 to guide this decision-making process using data on the actual need and real-world budget and healthcare worker shortages.

 

Recently, we utilized POA, with PEPFAR funding under the USAID HRH2030 Program, to help inform health worker staffing allocations for HIV service delivery in Mozambique. Working with partners, including USAID and CDC, we set out to help stakeholders use data to determine the need and priority of each and every health worker providing HIV/AIDS services at each PEPFAR-supported facility in all provinces of the country. The ultimate goal was to improve the provision of client-centered HIV/AIDS services to achieve epidemic control in Mozambique, a country with one of the world’s highest prevalence rates at 12.6%[1] and lowest health workforce densities.[2]

 

The POA methodology is simple, yet the results are powerful.  Novel to stakeholders involved in health workforce planning, POA begins by assessing the total number of healthcare workers needed to deliver HIV/AIDS services. To do this in Mozambique, we mapped—from a client-centered perspective—the different types of healthcare workers involved in the clients’ care and the amount of time required from each healthcare worker. For example, a clinically stable client on antiretroviral therapy (ART) will be seen by a pharmacist at a health facility for 5 minutes every 3 months in order to collect their ART refills. They are also seen by a clinical officer for 10 minutes twice a year for adherence counseling, monitoring of their health, and lab services. If the number of stable clients on treatment served by that health facility goes up, so too does the need for pharmacists and clinical officers. A clear picture of who is involved in the care continuum for HIV/AIDS clients enabled us to quantify the total number of the various cadres of healthcare workers needed. Since we also had data on the current health workforce, we could ascertain the health worker shortage by cadre and facility.

 

Figure 1. Overview of the POA methodology applied in Mozambique for determining the need for healthcare workers providing HIV/AIDS services, and prioritizing and assigning them based on the budget constraints.

 

The real innovation of POA is that it prioritizes and recommends assignments for all the needed healthcare workers, taking into the account the limited budgets available to cover their salaries. The needed healthcare workers are ranked so that the top priority assignment is the one that is the most ‘overworked’. For example, imagine a situation where one laboratory technician in a busy facility in Mozambique is struggling to keep up with the viral load testing demands of thousands of clients on treatment, a job for several lab techs. Adding another lab tech at this facility would be much higher priority than a lab tech at a different facility with fewer patients. POA goes through this calculus for tens of thousands of needed healthcare workers to produce a comprehensive ranked list.

 

While in Mozambique in November, I worked with Touch Foundation staff to orient PEPFAR and CDC stakeholders on how to use the recommendations from POA to decide where to deploy healthcare workers across 595 health facilities. The recommended assignments would cover nearly half of the overall shortage of 18,000 healthcare workers, especially among lay cadres like community and facility counselors. Using POA, implementing partners can more efficiently plan, budget, and staff programs delivering critical HIV/AIDS services.

 

Through this approach, we improve HIV/AIDS service provision where it’s most needed, by staffing facilities with the optimal quantity and skill mix in order to test, initiate treatment, and retain clients. Data-driven decision-making can bring us closer to controlling the epidemic.

 

This post originally appeared on the HRH2030 website here.

 

[1] UNAIDS; 2018 for adults (15-49 years). www.unaids.org/en/regionscountries/countries/mozambique

[2] CIA World Factbook; 2017 physician density. https://www.cia.gov/library/publications/the-world-factbook/fields/359.html

The Powerful Impact of the M-Mama Emergency Transport System in Rural Tanzania

Sep, 2019

Sub-Saharan Africa accounts for 2 out of 3 global maternal deaths related to complications from pregnancy and childbirth. Our M-Mama program is changing that with its Emergency Transport System (EmTS)–an innovative solution that uses digital technology to triage a patient remotely 24/7 and dispatch an ambulance or community driver to bring the patient to a health facility, a process that takes an average of two minutes.

 

In July, members of Touch Foundation’s Board of Directors visited Usanda dispensary, a small rural health facility located within Tanzania’s Shinyanga region. They spoke directly to women who had experienced life-threatening complications during labor and needed the EmTS to reach quality care. We met their healthy children and also the taxi drivers who responded to the dispatcher’s call and transported them to safety.

 

Anna shared her experience during her prolonged labor. The healthcare workers at Usanda dispensary determined that Anna was facing an obstructed labor and would need an emergency C-section to save her life and her baby’s life. Through the EmTS, healthcare workers connected Anna with a community driver who transported her—by that point unconscious—to Shinyanga Hospital, where she immediately underwent surgery and delivered a healthy baby girl.

 

Agnes was similarly transported to Shinyanga Hospital for an emergency C-section due to a prolonged labor. When Agnes awoke from surgery, she was shocked to learn that she had been pregnant with twin boys! Such surprises are not uncommon when access to healthcare, like prenatal services and ultrasound scans, is limited.

 

The taxi drivers shared a different perspective and reinforced how the EmTS is a market-based solution. According to one driver, before the EmTS, taxi drivers were sometimes called for medical transport and at times, would not be able to negotiate a reasonable rate with the patient. But that has changed with the implementation of the EmTS. Now, pre-negotiated rates are paid directly to the drivers upon completion of their trips and at no cost to the patient. Trips are often long distances, and the average taxi rate is $45.

 

Today, M-Mama is up and running in all six districts of Tanzania’s Shinyanga region, providing life-saving emergency care to 90,000 pregnant and post-partum women and their newborns. Since inception, M-Mama has transported more than 8,500 women and newborns and in two years, this cost-effective program will be fully adopted by the Tanzanian Government. Furthermore, based on the demonstrated success of M-Mama, the government is interested in expanding the innovative program throughout the country. And, excitingly, we are also expanding M-Mama to Lesotho as part of a sub-Saharan Africa expansion plan with Vodafone Foundation.

 

A special thanks to Pathfinder International, an integral M-Mama partner, for organizing the meeting at Usanda dispensary.

Why hospital medical equipment maintenance is so critical to saving lives, as told by one of Tanzania’s few female biomedical engineering technicians

Mar, 2019

“When you say that you’re an engineer some people say ‘really?’ or they look at how you look physically and say ‘can you really be an engineer?’”

 

Those are words from Nziza Pachal Rufutu, a 28-year-old woman working as a biomedical engineering equipment technician at Bugando Medical Centre (Bugando) in Mwanza, Tanzania. She is responsible for installing medical equipment and performing preventive maintenance and repairs at one of the largest and most specialized hospitals in the country. Nziza’s role is critical in ensuring equipment is functioning properly so that the hospital can provide quality healthcare services.

 

From a young age, Nziza excelled in science classes. After finishing her A-levels (similar to the Advanced Placement programs in the US), Nziza considered a career in engineering. Her brother, who was at University studying to become an engineer himself, introduced her to the field of biomedical engineering. She realized that this field would allow her to link her interests in biology and medicine with engineering principles to help others.

 

Upon graduating, Nziza applied for a job at Bugando and has worked there since 2016. Nziza oversees the engineering side of the sterilization department at Bugando and, together with other engineers, works closely with the operating theatres to ensure that all equipment is in good working condition for surgeries. She explained that “Engineers provide oxygen and other medical equipment services in operating theaters. If the equipment performance is poor, then the doctors and other medical personnel can’t provide good healthcare services to the patients.”

 

One of her primary challenges working in the male-dominated field of engineering is others’ perceptions of herself and her capabilities. “They may undergrade you and think you can’t do more like men do. So maybe there are some tasks that you are not sent to do because they think you cannot do it.” Reflecting on this issue, Nziza added “they just don’t understand that it’s only a matter of hard work and having knowledge and skills, a committed mind, and a desire to learn more.”

 

Nziza embodies these attributes, and has been committed to improving Bugando since she first joined the hospital. For example, she worked with the engineering department and the Touch team to provide guidance on the equipment needed to enhance cardiology services at the hospital. After this initial project with Touch, Nziza became a member of Touch’s Healthcare Technology Management Improvement team in May.

 

Through the Healthcare Technology Management program, Nziza has taken on the role of Key Performance Indicator (KPI) Champion at Bugando. If measured on a regular basis, KPIs can help engineers understand when large machines are not functioning as intended. In her role as a KPI Champion, Nziza connects with her colleagues stationed at Bugando’s large machines (i.e. Oxygen Plants, Generator, Incinerator), and monitors the KPIs for each machine. This allows her to respond immediately to any issues, before equipment downtime can affect the quality of care at the hospital.

 

According to Nziza, “the Healthcare Technology Management program has improved the skills of the engineers as well as working facilities, and other people in the hospital have begun to see the importance of the engineering department and that we are critical to the hospital functioning well. They see that when equipment is improved, people are provided with better services.”

 

Moving forward, Nziza wants to focus on skills training for the engineering department as well as equipment training for all healthcare workers at the hospital. She is proud to be a leader in our Healthcare Technology Management program and work together with other biomedical engineers to provide better healthcare services day-to-day to Bugando’s patients. After all, the hospital can’t function without equipment that is well maintained.

Combating Noncommunicable Diseases Starts with Providing Quality Preventative Care for Young People

Sep, 2018

Dr. Bazil Kavishe can easily recall figures and statistics from projects and publications he completed over a decade ago related to how noncommunicable diseases impact Tanzanians. It’s impressive given the breadth of his career as a senior research scientist at the National Institute for Medical Research (NIMR), the largest public health research organization in Tanzania.

 

Dedicating himself and his career to improving people’s quality of life has always been Dr. Bazil’s plan, though not as a research scientist initially. While completing a clinical internship at Muhimbili National Hospital in Dar es Salaam after medical school, he was inspired to pursue a profession dedicated to noncommunicable disease (NCD) research and prevention efforts. “I thought, instead of working at the hospital and treating people who are experiencing complications [from various NCDs], it would be a good opportunity for me to join a public health team and work on interventions and operational research that may improve the prevention aspects of these conditions.” The evidence he collects ultimately informs health programs and policies with the goal of eliminating the need for hospital care through effective prevention strategies, including public education, screening, and early diagnosis.

 

In Tanzania, NCDs account for about one-third of all deaths, of which cardiovascular diseases are the leading cause. NCDs are a very real threat to Tanzanians of all ages, even more than HIV/AIDS or malaria at this point. Because of this, Dr. Bazil argues, “There is a need to focus resources on the younger population because chronic diseases are setting in at a very young age. If you don’t intervene during early childhood or adolescence, you are likely to have an increasingly high prevalence of NCDs during adulthood.”

 

Early on, Dr. Bazil and his team conducted a study to establish the burden of selected NCDs and HIV in Mwanza, Tanzania. Their research uncovered a higher prevalence of hypertension and diabetes among adults than previously thought (Read the full article). Surprisingly, they also discovered that a significant number of people aged 18-44 already had hypertension, a disease most often found in older populations. Concerned about these findings, Dr. Bazil led an independent research project to further explore the prevalence of hypertension in adolescents and children. In collaboration with colleagues in Uganda he conducted a survey in secondary schools and higher learning institutions in Mwanza and in Entebbe, Uganda.

 

Touch Foundation worked closely with NIMR and Dr. Bazil on the needs assessment for our Rheumatic Heart Disease (RHD) program. His team worked in Tanzania’s Sengerema district in 2016 to determine the prevalence of sore throats and the availability of drugs and equipment needed to treat and diagnose strep throat. Screening those who recently suffered from a sore throat can help identify strep throat cases, which, if left untreated, can damage heart valves and result in Rheumatic Heart Disease later in life. This nearly entirely preventable NCD is the most commonly acquired heart disease among young people under 25 and is particularly dangerous to pregnant women. Using this research, Touch is strengthening the health system by upgrading equipment (i.e. ultrasound machines), providing supplies, and training healthcare workers.

 

Hypertension is another dangerous and widely prevalent cardiovascular condition in Tanzania. Our Healthy Heart Africa program, is addressing hypertension in pregnancy, which is responsible for 16% of maternal deaths and many newborn deaths. Dr. Bazil sees Healthy Heart Africa as an important opportunity to educate more women on NCDs, the importance of preventative care, and lifestyle risk factors like diet. He also   believes it is critical to train healthcare workers on how to provide high quality care. Through this program and our RHD program, we will screen 50,000 pregnant women for high blood pressure and heart conditions like RHD and connect them to treatment.

 

This September, the 73rd session of the UN General Assembly brings together governments, civil society, and the private sector for the third High-Level Meeting to discuss the progress and action needed on NCDs. We believe that high quality research led by top Tanzanian organizations like NIMR as well as robust multidisciplinary partnerships are critical to addressing the burden of NCDs. Together, we can support health systems to better prevent, diagnose, treat, and manage NCDs so that all people­­—and especially youth­­—live long, productive lives.

Perspectives of a young adult living with Type 1 Diabetes on incorporating patient voices into the NCD agenda

Jul, 2018

On July 5, 2018, Touch Foundation participated in the UN Interactive Hearing on Non-Communicable Diseases (NCDs), held as part of the preparatory process for the UN high level meeting on NCDs this coming September during the UN General Assembly. Dhishana Kidambi, Bard Globalization and International Affairs summer intern at Touch’s New York office, shares some reflections on the hearing and her personal experiences living with Type 1 Diabetes.

 

“Eat three chapatis (wheat cakes) for dinner, and give yourself six units of insulin. As long as you are at 180 before bed, you should be good to go!” I hardly felt any of my endocrinologist’s optimism; cutting portions seemed like an impossible proposition to make to a 12-year-old living in India.

 

A few years later, I was at a friend’s house when I was introduced to Dr. Anjana, a pediatric endocrinologist trained and working in New York, who was appalled by the advice my endocrinologist had given me: “You calculate your insulin sensitivity, count the carbs in your food, and then give yourself a dose based on how much you eat. That way, you can eat whatever you want as long as you dose yourself correctly!”

 

When I later asked my local doctor about carb-counting, he laughed and said, “good luck trying that with a bowl of dal makhani! Carb-counting is impossible to do with Indian foods.” Despite being trained to advocate a carb-counting methodology, he believed, and my experience showed, that it simply could not be practiced in India.

 

As someone living with a NCD in the Global South, I can say that it is this clash of absolutes between the technical knowledge created and disseminated by multilateral organizations in the Global North and the realities of living in the Global South that make the management of NCDs so challenging. NCDs are often highly individualistic, and the most effective management techniques arise from the integration of lived insight with technical experience.

 

As part of the preparatory process towards the third High-Level meeting of the General Assembly on NCDs, the interactive hearing consisted of several panel discussions that offered an opportunity to deliberate on the best way to manage NCD care between various stakeholders in resource constrained communities. The agenda of the hearing was to discuss the role of five different areas that will need to be addressed: scaling up action against NCDs, financing, promotion of multi-sectoral partnerships, political leadership, and accountability.

 

The panels addressed many important issues that could improve action against NCDs, ranging from the need for catalytic funds, massive technology building, a skilled workforce, and multi-sectoral partnerships between the public and private sectors. While panelists recognized that the ultimate goal is to empower people with NCDs to take charge of their health, most consideration is given to political actions that require the cooperation of powerful global actors, highlighting the conflicts between the private and public interests that need to be resolved.  As someone living with a NCD, it felt as though the narratives of people with NCDs, and the value of their insight, needed a more prominent position.

 

Since its inception, Touch Foundation has focused on strengthening local health systems. This approach recognizes that there are too few healthcare workers and too many breakdowns in national health systems.

 

The health systems approach taken at the interactive hearing recognized various actors (infrastructure, drugs, regulation, healthcare workers, etc.) as separate entities, rather than a single system in which bonds could be strengthened. Panelists in the sub panel titled “Engaging people with NCDs” maintained that this approach does not effectively recognize sustainability and continues to place people living with NCDs on the sidelines and creates difficulties for people from different cultural backgrounds to navigate the health system.

 

Creating a system that implements a locally informed approach on a global scale remains an important aspect of addressing NCDs. In this context, Touch Foundation makes important contributions to creating a more holistic health system that is patient-centric. The comprehensive systems approach adopted through programs like Treat & Train offer an effective model to treat NCDs. By optimizing healthcare facilities with the goal of developing local leadership, Touch is able to effectively prioritize all aspects of the healthcare system. This offers a useful framework to resolve the challenges that people with NCDs face, and include the crucial voices of patients that have been missing in the global response.

Celebrating the future of healthcare in Tanzania at our 2018 Asante Supper

Jun, 2018

On May 10, 2018, Touch Foundation’s staff, board members, and guests enjoyed a wonderful evening at the Morgan Library & Museum in New York City learning about the future of healthcare in Tanzania while celebrating Vik Malhotra and McKinsey & Company’s enduring commitment to Touch’s work.

 

We were honored to host the former President of Tanzania, Jakaya Kikwete (pictured here alongside Touch President Lowell Bryan & Honoree Vik Malhotra), at this year’s Asante Supper. While serving as President of Tanzania from 2005 to 2015, Mr. Kikwete made healthcare a national priority, greatly expanding the government’s investment in the training of healthcare workers and the expansion of healthcare facilities nationwide.

 

Mr. Kikwete has been a longtime friend of Touch: his leadership enabled us to enter into a Public Private Partnership with the Tanzanian government and the US government, which remains in place to this day. We were delighted to share our accomplishments and vision for the future of healthcare in Tanzania with Mr. Kikwete, who continues to be a dedicated maternal and child health advocate through his partnership with The Access Challenge’s One By One: Target 2030 campaign, which is aimed at promoting universal health access in Africa.

 

Sean Ryan, a partner in McKinsey’s Health Care Strategies practice and Touch Foundation’s newest board member, took the stage during the dinner program to share a surprising discovery that resulted from the McKinsey engagement he led in Tanzania’s Lake Zone last November:

 

“It turns out that making doctors better business-people can help transform medical care. The practices they build will expand access to healthcare in Tanzania, free up capacity at public hospitals, and create new opportunities for doctors across the country.”

 

The program also included a Q&A session featuring Dr. Isidor Ngayomela, entrepreneur and orthopedic surgeon in Tanzania, who shared how opening his own health facility–Kamanga Medics Hospital–has allowed him to treat more patients while employing more doctors:

 

“I used to see 100 patients in a day at Bugando, which is a reason why we also started Kamanga. Because the patients were overflowing…some patients will be benefiting from Kamanga because they will be attended to quickly and go back into their working places. And so, in a way, you de-bulk these other government hospitals and so share the patients as well.”

 

To learn more about Touch’s accomplishments and vision for the future of healthcare in Tanzania, we invite you to watch our Asante Supper video.

School Heart Screenings are Saving Young Lives in Rural Tanzania

Apr, 2018

Zacharia Masatu, a 12-year-old from Tanzania’s Sengerema district, is the second youngest of nine children born to two farmers. Zacharia is in 6th grade at the Bukirigulu Primary School and had never seen a doctor before a Touch-supported heart screening at his school.

 

At the age of four, Zacharia’s parents started to notice that their son was not a healthy young boy. Zacharia had difficulty breathing and always seemed to have a cough. His parents did not think it was a serious disease, though, and took him for local herbal treatment. Although this did not seem to be working, Zacharia’s parents were not able to take him to see a doctor because hospital services were not financially or physically within their reach.

 

As part of our efforts to decrease cardiovascular disease, our partners at Bugando Medical Centre, with support from Touch and Medtronic Foundation, have screened over 3,000 school children in the Sengerema and Buchosa districts. The pediatric cardiologist at Bugando, Dr. Glory, performed an echocardiogram on Zacharia and immediately realized the 12-year-old was in grave danger. His eldest sister came to his school at once and the two traveled five hours to Bugando in Mwanza, a ferry and several hours away from Zacharia’s home in Sengerema, to seek life-saving treatment. Zacharia was diagnosed with a serious heart condition called Ebstein Anomaly and had surgery the following day. After just over 2 weeks, he was discharged, feeling better than ever before.

 

Unfortunately, the surgical team was unable to perform the corrective surgery Zacharia needed for complete valve repair because of Tanzania’s limited capacity for cardiovascular surgery. Instead, they drained his heart of fluid and administered medication that will allow him to better manage his condition going forward. As a result, Zacharia will never lead a completely normal life. He will not be able to play sports or become a farmer like his parents, and he will have to take medication and receive monthly checkups to manage his heart disease.

 

School heart screening projects targeting specific diseases (in this case, rheumatic heart disease) are often one-off endeavors, but Touch’s systems thinking and decades of experience in the region ensure that bedside ultrasound diagnostic capacity becomes embedded in district level health systems. Without bedside ultrasound diagnostic capacity reaching a school in rural Tanzania, Zacharia’s life threatening heart condition would not have been diagnosed, and Zacharia would not have had the chance to reach adulthood. Zacharia’s story is just one example of the ripple effect of impact that endures long beyond the life of Touch’s support for health system improvements.

Caroline Mtani is fierce about helping mothers and babies

Feb, 2018

“I have devoted most of my work to serving the disadvantaged, pregnant women and children under the age of five.” Working in an under-resourced facility, Caroline Mtani is often exhausted by her day’s work. But she still finds herself spending any free moment she has in the maternity ward; “When I see the baby is drinking and is active, I feel happy. No one has the spare time to spend with the babies, but I enjoy it.”

 

Caroline Mtani is boundlessly energized by her work at Sengerema Designated District Hospital (SDDH), a rural hospital in Tanzania. Caroline has worked at SDDH for her entire medical career, spanning nearly three decades. For the first twenty years, Caroline worked as a nurse midwife. After the birth of her second child, and with support from her husband, Caroline decided to get her Assistant Medical Officer (AMO) diploma from the Catholic University of Health and Allied Sciences (CUHAS) in Mwanza, Tanzania. The AMO diploma allowed her to provide the full spectrum of maternal care, including C-sections. Deciding to pursue the advanced diploma was not an easy choice as it required her to leave her two young children and husband and move to Mwanza for two years of challenging studies. Caroline succeeded in obtaining her diploma and returned to work with SDDH to provide care to mothers, newborns, and other patients in this underserved area.

 

Touch first partnered with SDDH in 2013. Tanzania continues to face a severe shortage of healthcare workers like doctors, nurse midwives and AMOs. Touch’s Treat & Train program tackles this gap in Tanzania’s health system. The Treat & Train Network connects hospitals and training facilities so that medical and nursing students can gain valuable hands-on experience during clinical rotations while also helping to provide better care to patients in under-resourced health facilities. With her wealth of knowledge about the Lake Zone’s medical facilities as well as a drive to bring impassioned healthcare workers to SDDH and the surrounding area, Caroline, the Co-coordinator of the program, is essential to the success of Treat & Train.

 

Four years after Treat & Train began at SDDH, Caroline continues to pursue her goal of bringing positive change to her community through better healthcare. She is the National Facilitator for the Helping Babies Breathe training program at SDDH as well as the clinician in charge of maternal issues and the Supervisor of the Mobilizing Maternal Health Program.

 

Caroline reflected that “Touch is like family”. These deep, trust-based relationships with our local partners are the heart of what we do at Touch and key to sustainable change. Caroline has facilitated a meaningful partnership between Touch and SDDH out of a personal drive to empower her own patients and her fellow healthcare workers. She continues to strive towards the goal of creating an ever stronger SDDH and Tanzanian health system, a goal we can proudly say we share and are working together to achieve.

Restituta achieved her dream of helping other women

Dec, 2017

Working as a dispatcher in Touch’s Mobilizing Maternal Health program, Restituta helps women in labor reach emergency care. 

 

Restituta Mabilla Limbe is a determined 34-year-old woman who always dreamed of helping women and young girls in her community. Growing up in Sengerema, a rural town in north-west Tanzania, Restituta noticed a pattern of inequality between the women and men in her community. In spite of having four siblings, she was the only child expected to work, because she was the only woman. Her younger brothers were free to do as they pleased, while she and her mother carried all of the family’s responsibilities. To Restituta, women unjustly had more difficult lives since traditional norms required them to work hard day and night.

 

Inspired by the inequality she witnessed as a child, she dreamed of a way to help other women in her community. Her dream had to be put on hold due to her family’s lack of finances at the time she was enrolling in University, a rare accomplishment for Tanzanian women. Restituta was obligated to study Information Technology because it was the only course she could receive funding to complete.

 

After several years of studying and then working as a graphic designer in another part of the country, Restituta moved back to Sengerema to be closer to her family. One day, she saw an advertisement for an open dispatcher position as part of Touch Foundation’s Mobilizing Maternal Health program. Holding the flier in her hand, Restituta felt certain this position would allow her to realize her dream of helping women.

 

Today, Restituta is the top dispatcher at Sengerema District Hospital. Her typical day at the referral center, which is open 24/7, involves taking calls and arranging emergency transport via a mobile application for pregnant women and newborns so women can safely deliver at health facilities in the care of skilled providers. She has even earned the position of Team Leader because of her hard work and commitment leading her peer dispatchers. However, this is not Restituta’s only role. She is also the mother of two young boys, a four year old and one year old. With the support of her mother, Restituta is able to leave her children at home and go into work every day to save mothers and newborns.

 

Restituta’s job is often challenging due to cultural barriers. Traditionally women in Tanzania are accustomed to delivering in their own homes. With nearly half of all Tanzanian women giving birth at home without the care of a skilled healthcare worker, there is a high risk of birth complications. One of Restituta’s greatest challenges is convincing family members that their loved one is in grave danger and needs to be transported to the hospital immediately. Through Touch’s Mobilizing Maternal Health program, Restituta has been a key player in reducing maternal mortality by 27% in her community.

 

Restituta has achieved her dream of helping women in her community, but her work is far from finished. Her interest in the health field has grown immensely and she hopes to return to school and earn her nursing degree in order to continue helping vulnerable women and young girls.

The benefits of mentoring in health education

Nov, 2017

Tanzania is one of 57 countries identified by the WHO as facing a human resources for health (HRH) crisis with an estimated shortage of 181,100 healthcare workers in the country. Currently in Tanzania, there are fewer than 4 nurses and midwives per 10,000 people, compared with the WHO optimal ratio of 16 per 10,000 people.

 

Mentorship is a novel technique to address systemic problems in health education such as poor morale and strenuous working conditions. Primary healthcare personnel play an important role in increasing the accessibility of healthcare, specifically in low- and middle-resourced communities. One of the best ways to enhance primary healthcare in vulnerable areas, such as rural Tanzania, is by creating mentorship programs for nurses and midwives. Finding ways to improve healthcare worker training has always been among the major priorities of Touch Foundation’s approach.

 

In alliance with WHO guidelines, Touch Foundation views training, clinical mentoring and supportive supervision of nurses and midwives as an effective strategy for improving the retention of healthcare workers and improving the overall strength of the Tanzanian healthcare system. Dr. Renae Stafford, Touch’s Program Director of Academic and Clinical Services, co-authored two articles, (http://ow.ly/Mrsj30gCtbf) (http://ow.ly/hrOM30gCteK), highlighting the great potential in clinical mentorship of midwives and nurses. Our Treat & Train program incorporates mentoring and preceptorship as a means to enhance clinical safety and promote professional communication, problem solving and crisis management. This will allow communities to achieve sustainable results when improving health and providing quality health services.

 

The training and mentoring of midwives and nurses is particularly beneficial in assuring antenatal, delivery, emergency obstetric and post-natal services to improve maternal and newborn health in low-resource settings, like the Lake Zone of Tanzania. With nearly half of all Tanzanian women giving birth at home without the care of a skilled healthcare worker, maternal and newborn death is all too frequent. In fact, a woman in Tanzania is 80 times more likely to die from pregnancy-related causes than a woman in the United States. Through our Treat & Train program, we have trained maternal healthcare workers in Emergency Obstetric and Newborn Care. Well-trained healthcare workers form an important link to our Mobilizing Maternal Health program, where emergency transport has led to a 27% decrease in maternal deaths.

How one Burundian doctor became the only OBGYN in Sengerema, Tanzania

Oct, 2017

Dr. Harusha Simplice is the only obstetrician-gynecologist at Sengerema Council Designated Hospital, serving over 700,000 people. After becoming a general practitioner Dr. Harusha secured his specialist training through Touch’s Treat Train program, which improves medical education and patient care in the Lake Zone.

 

A Burundian refugee forced to flee to Tanzania as a teenager, Dr. Harusha Simplice always knew he wanted to be a physician. According to his mother, at the ripe age of two he used to comfort his friends and family by reassuring them that one day he would be a doctor. His father also wanted to be a doctor, but he was never able to practice as he died in an accident two months after graduating from medical school. When Dr. Harusha was in his final year of schooling his mother was diagnosed with cervical cancer and died just a year later. It was his mother’s death that cemented his desire to help women and strive to one day become an obstetrician-gynecologist.

 

After graduating, Dr. Harusha began practicing medicine at Sengerema Council Designated Hospital. Five years later, Dr. Harusha, now a father of two boys with another one on the way, decided he needed to find a way to receive specialized training to become an obstetrician-gynecologist and pursue his aspiration of helping women. At this point Dr. Harusha encountered Touch Foundation, just as we were in the process of expanding our Treat & Train program to Sengerema Council Designated Hospital. Through Dr. Harusha’s perseverance and partnership with Touch, he was able to receive the education required to specialize in Obstetrics and Gynecology.

 

Today, Dr. Harusha is the only trained OBGYN at Sengerema Council Designated Hospital. This 300-bed hospital serves over 700,000 people and delivers about 25-30 babies per day. For Dr. Harusha, it is not uncommon to attend to multiple women giving birth in the same room with the help of just two nurses. In fact, in Tanzania the shortage of healthcare workers is a main contributor to the high maternal death rate.

 

In early October, Dr. Harusha completed a training held by our partner MeduProf-S on SonoSite ultrasound machines in order to perform heart disease and obstetric ultrasound screenings during maternity checkups. For all of the clinicians present at the training, this was their first experience with an ultrasound machine. In the United States, women usually receive an initial screening at the beginning of their pregnancies to confirm a viable pregnancy. Most women in the United States will receive numerous ultrasounds throughout a pregnancy, and at least 1 anatomy screening at 20 weeks to ensure healthy development. Most Tanzanian women have never received an ultrasound screening during their pregnancy, but this is changing as women are increasingly requesting them and the technology is becoming more widely available. Dr. Harusha’s training, and others like it, will not only give women access to ultrasounds to ensure the health of their developing babies, but will also screen them for any heart anomalies, which can go undiagnosed until delivery, putting the mother at risk during labor. Following the training, the SonoSite ultrasound machine installed at Sengerema hospital, and three additional machines were installed in other high-risk area health centers.

 

Dr. Harusha truly believes in the sustainability of the unique education model of Touch’s Treat & Train program. He continues to learn new skills which are valuable for him and also valuable to the medical students he is training and to the women he is attending to. For Dr. Harusha, continuing his education and partnership with Touch empowers him to achieve his goal of saving the lives of women and children.

A GLOBAL MOVEMENT TO SAVE LIVES OF MOTHERS AND NEWBORNS // TOUCH FOUNDATION PLEDGES COMMITMENT TO EVERY WOMAN EVERY CHILD MOVEMENT

Oct, 2017

To ensure that every mother can enjoy a healthy pregnancy and every child survives beyond their fifth birthday worldwide, the UN and World Health Organization launched the Global Strategy for Women’s, Children’s and Adolescent’s Health (2016-2030). This Strategy is promoted by Every Woman Every Child, a global movement mobilizing new collaborations and partnerships between governments, multilaterals, the private sector and civil society to achieve the Sustainable Development Goals (SDGs). 

   

Today a woman in Tanzania is still 80 times more likely to die from pregnancy related causes than a woman in the United States. Multipartner collaboration and collective action are needed to address the root causes of such a huge disparity. On September 192017, Touch Foundation announced our first Every Woman Every Child commitment at the annual Every Woman Every Child Private Sector-Innovation high-level event, held during the 72nd session of the UN General Assembly. We have committed to raising $1 million dollars, combined with other committed funds, to expand the Mobilizing Maternal Health program across eight districts of Tanzania over the next four years to save the lives of mothers and newborns.

 

Touch Foundation, together with our partners including the Tanzanian government, Vodafone FoundationPathfinder International and D-tree International, will provide over 11,000 pregnant women and their newborns facing a medical emergency with safe, fast, and free transportation. Using mobile phone technology, our transport system is designed to take emergency calls (911-like) from remote areas on its toll-free line, triage a patient remotely 24/7, dispatch an ambulance or community taxi to bring the patient to a health facility, and monitor the patient’s progress from the moment help is called until their discharge. In addition, we will continue to improve the quality of health services in rural areas by training healthcare workers and building infrastructure like c-section theaters and neonatal intensive care units. Our evaluation of the first phase of this program in one of the pilot districts proved that this approach could reduce maternal mortality by at least 27%. Many more mothers and newborns will be saved as we scale up our evidence-based program.

 

Touch is enthusiastic about our commitment to Every Woman Every Child. We believe this international network will provide valuable global context to our programs and overall work, as we continue to align our mission with promoting the Global Strategy Principles and SDGs. Redoubling our efforts globally, together with our partners, we are moving towards creating the world in which, as the former UN Secretary General Ban Ki Moon put it, “no woman, child or adolescent would face a greater risk of preventable death because of where they live or who they are.”

WHY CAN STREP THROAT HAVE SUCH HUGE HEALTH CONSEQUENCES IN TANZANIA?

Aug, 2017

Rheumatic Heart Disease is a preventable cardiovascular condition that is rare in the U.S. but still causes hundreds of thousands of deaths each year in low-resource settings with weak health systems. It begins with a case of untreated strep throat.


A case of strep throat is no stranger to school-aged children in the United States. If treated with antibiotics, this common bacterial infection is relatively harmless and uncomplicated. But for people in countries like Tanzania, it’s not that simple. Cases of strep throat may be left untreated because basic health services cannot easily be reached and, over time, this spirals into an inflammatory reaction of the heart valves called acute rheumatic fever, which then induces rheumatic heart disease (RHD). RHD disproportionately affects young adults in the prime of their lives and can be especially fatal for pregnant women.


Renae Stafford, Touch’s Program Director of Academic and Clinical Services, co-authored an article published in March in Global Health that compiles information to help us better understand how to treat and prevent RHD in Tanzania and Uganda. The study found that nearly 2% of schoolchildren in Tanzania and Uganda are affected by RHD. Moreover, deaths from RHD persist even in the presence of care with up to 27% of patients dying in surgical wards. Poor infrastructure and medical supplies, insufficiently trained healthcare workers, and other weaknesses in the health system contributed to these poor outcomes. Additionally, a lack of patient knowledge, stigma, and a history of poor interaction with healthcare workers mean that patients often don’t seek care until it’s too late. Ultimately, the Global Heart article stresses that there remains a great need for high-quality, up-to-date data on RHD, especially within low-income countries like Tanzania.


At Touch Foundation, we are committed to working with our partners to protect people in Tanzania and internationally from dying from this preventable yet fatal cardiovascular condition. With the support of Medtronic Foundation, Touch is tackling RHD by ensuring the health system is equipped to prevent, diagnose, and treat patients, especially vulnerable children and pregnant women, by conducting health worker training, upgrading equipment at health facilities, and hosting strep screening days at schools. Read more about how we are addressing non-communicable diseases like RHD here.


Read the full article: Annesinah H. Moloi, Sumaya Mall, Mark E. Engel, Renae Stafford, Zhang Wan Zhu, Liesl J. Zühlke, David A. Watkins, The Health Systems Barriers and Facilitators for RHD Prevalence, Global Heart, Volume 12, Issue 1, 2017, Pages 5-15.e3, ISSN 2211-8160, http://dx.doi.org/10.1016/j.gheart.2016.12.002.

LOOKING BACK ON OUR MOVING ON MATERNAL AND NEWBORN EMERGENCY CARE SYMPOSIUM

Jun, 2017

On May 18th, 2017 Touch Foundation and Vodafone Foundation hosted a symposium in New York City. We invited expert panelists to share innovative evidence-based approaches to improve maternal and newborn health in sub-Saharan Africa and other low-resource settings and achieve the Sustainable Development Goals.

 

The first panel focused on the impact of an emergency referral and transport system (EmTS) on maternal lives saved in Tanzania, which was launched in 2015 by Touch Foundation, Vodafone Foundation, ELMA Foundation, USAID/PEPFAR, and Pathfinder International as part of the Mobilizing Maternal Health (MMH) program. In the first year, the EmTS resulted in a 27% decline in maternal mortality rates and saved many more newborns in two districts. The panel stressed the importance of high-quality data collection to enable quick fixes and targeted resource allocation. The panel stressed, in relation to the EmTS, the importance of critically analyzing the data in order to achieve buy-in from all partners including the Government of Tanzania and to scale in the future. In addition to data, the program’s tangible impact on Tanzanians has bolstered government and community trust.

 

The second panel, Innovative Approaches to Barriers to Care, featured panelists examining a range of innovative approaches to remove barriers to quality health care for women and newborns. Mutually beneficial partnerships, a systems approach to integrating devices and interventions, and locally-led innovations were three key approaches discussed. The panelists, leaders of international NGOs and medical device companies, emphasized that productive partnerships depend on a generous understanding of each other’s relative strengths and interests. They also recognized that strong health systems and consistent product innovation can promote self-sufficiency. Lastly, they highlighted that there is an opportunity to support local innovation through North-South partnership, resource allocation, and an environment that enables risk-taking.

 

For further reading on this topic, please see our Mobilizing Maternal Health Impact Report. To read the full Symposium Report Out, click here. Thank you to all those who were able to attend and a special thank you to our moderator, Lord Michael Hastings of Scarisbrick CBE, Global Head of Citizenship for KPMG, and to our panelists: James BonTempo, Chief Strategy Officer, D-tree International; Dr. Siobhan Crowley, Director of Health, ELMA Philanthropies; Dr. Ntuli Kapologwe, Director of Health, Social Welfare & Nutrition Services, Tanzania’s President’s Office of Regional Administration and Local Government; Massimiliano Pezzoli, Country Director, Touch Foundation; Lee Wells, Director, Vodafone Foundation Ventures & Head of Programmes, Vodafone Foundation; Robert Miros, Chief Executive Officer, 3rd Stone Design; Lois Quam, President and Chief Executive Officer, Pathfinder International; Stephen Rudy, Chief Executive Officer, Gradian Health Systems; Andrew Storey, Director, Maternal and Newborn Health, Clinton Health Access Initiative

THE STORY OF ALLAN JOEL AND HIS DRIVE TO SAVE LIVES IN THE OPERATING ROOM

Jun, 2017

Five billion people live without access to safe, affordable surgical and anesthesia care. These operating room services are crucial to treating people with cardiovascular conditions, bone fractures, pregnancy complications, and many other health issues. If these services are inaccessible it can lead to an avoidable disability or premature death.  This situation is far too common in Tanzania where surgical and anesthesia care is lacking and the country is facing a large shortage of healthcare workers with the needed skills. 

 

Allan Joel is an ambitious 29-year-old nurse anesthetist trained to meet all of a patient’s anesthesia needs before, during and after surgery or the delivery of a baby. Allan developed a passion for medicine in 1989, the year his father was diagnosed with diabetes. He witnessed his father suffer from inadequate medical care and decided at a young age to pursue nursing so that he could help his father and others in need. After graduating from nursing school, he applied for a nurse midwifery position at Sengerema Hospital, a 325-bed rural hospital serving 800,000 Tanzanians. Limited funding and resources at the hospital prevented Allan from getting a position and forced him to reconsider his career.

 

Touch accepted Allan Joel’s application to work as a medical scribe aiding the Treat & Train program. While Allan worked as a medical scribe, he was able to spend all of his free time volunteering in the ICU and operating theaters at Sengerema Hospital. In the ICU and operating theaters, Allan was exposed to anesthesiology and realized the impact he could have on patients’ lives in this field. Inspired to learn the skills necessary to provide life support in a safe surgical environmentAllan applied for a one-year nurse anesthetist certification at Bugando Medical Centre. With the help of a Touch-funded grant, he graduated in September 2016 and promptly returned to Sengerema Hospital to begin working in the operating room.

 

Mortality and morbidity related to anesthesia and surgery are all too common in Tanzania. We recognize the importance of a safe and sterile surgical environment to protect everyone, including patients, healthcare workers and students, from infection, injury, and other harm. Touch, together with hardworking individuals like Allan Joel, is working to improve access to safe surgical care and save lives at Sengerema Hospital and our other partner health facilities.

 

With Touch’s help, Allan was able to start a career in the field of anesthesiology. Although Allan’s work comes with many challenges, including working with only a limited number of trained specialists and equipment, his dynamic drive to find solutions has made him an integral part of the hospital. He has already devoted seven years of his life to improving the care of patients and aims to return to school next year to qualify as an Assistant Anesthesiologist. Touch is proud to support the ambition of young healthcare workers and improve the lives of Tanzanians by providing greater access to quality skilled providers and safe surgical care.