News and stories

Meet the People Behind Hospital Equipment

Feb, 2021

We established our Healthcare Technology Management (HTM) program over 2 years ago with one of the largest hospitals in Tanzania and our oldest partner, Bugando Medical Centre (BMC). Since then, the program has been improving infrastructure and introducing new practices with BMC’s Engineering Department, so engineers are better able to serve the hospital. As the program continues to expand, we asked the staff about their work and how their experiences on the job has changed since HTM began.

 

A hospital’s ability to properly treat patients rests on the usability of its equipment, technology, and generator power. This is where the ever-critical engineers come in. Hospital engineers both fix and upkeep all hospital technology and equipment, spanning from defibrillators to oxygen plants. In doing so, they ensure that patients can get the procedures they need in a timely and safe manner.

 

We’re excited to introduce you to some members of the team!

     

 

The first face you see when walking in the door of BMC’s Engineering Department is Mary Fidelis’. She’s been working as a secretary there for 32 years. “[I] make sure that all the jobs in the Department are completed on time,” she explains. “So when the jobs are sealed, I [work to] make sure that the clients are also happy.”

 

The job tracking system introduced by the HTM program helps her manage work orders efficiently, giving full visibility and control of maintenance activities and ensuring faster turnaround on assignments, so clinicians do not have to wait very long for equipment to be ready to go. She also points to the new workshop (get a tour here!), saying that the more convenient working space has made “the environment [more] conducive and attractive.”

   

 

Next, pictured above is Emmanuel Silas, who’s been on the team for almost 4 years as a biomedical engineer. “Our aim is to save the [lives] of our patients, you know. So that’s why I chose to be a biomedical engineer.” His real passion is for upkeeping and fixing cancer treatment equipment. Testing the safety and performance of each machine, which he’s doing in the photo at the top of this news story, is key for making sure that equipment is ready to go.

   

 

Now, meet Nziza Rufuto¸ who’s been working as a biomedical technician at BMC for 4 years. “I like when I manage to work on something that becomes a help to someone who is in need,” she says, “when I manage to do that – that’s when I’m happy about my job.” With the HTM program’s introduction of Key Performance Indicators (KPIs), Nziza says that “you know exactly what you are doing, and you measure what you’re doing and you know where to improve…” Apart from tracking and identifying bottlenecks, KPIs motivate staff by making work more visible and opening space for further growth.

Nziza will be saying goodbye temporarily to the Department this year when she leaves to pursue a Bachelor’s degree in Electrical and Biomedical Engineering. Her plan is to return to BMC’s Engineering Department with enriched skills after completing her studies (learn more about Nziza’s here!).

   

 

Next up, Dianes Moses, also a biomedical technician. Dianes has played a critical role in implementing the Work in Progress room. This room is one of the new workshop’s core elements where the engineers’ work is organized and monitored with visual management boards like the ones in the picture. Like Nziza, she’s also pursuing her degree in Biomedical Engineering. We wish them all the best in their studies!

   

 

In the above photo, Senior Biomedical Technician, Everest Magoti, explains how the KPI board works. Magoti has been with the Department for over 20 years, specializing in maintaining ICU and operating theater equipment. When asked why he decided to pursue this career those many years ago, he said there were two reasons: “Of course, [the] first [was] to help the people and [the] second [was] to make long-living medical equipment.”

   

 

Finally, Jumanne Seleman, the head of Mechanical Section, has been with the Department as a mechanical technician for 15 years. A champion of KPIs and job tracking, Seleman and his team record and monitor the performance of BMC’s Oxygen plants, ensuring that minimum oxygen purity and pressure levels are maintained to efficiently serve the hospital.

 

Learn more about the HTM program here!

Welcoming our Newly Appointed Executive Director

Feb, 2021

Touch Foundation is pleased to announce that Massimiliano Pezzoli has been appointed Touch Foundation’s Executive Director.

 

Massi has been with Touch for over 8 years and has effectively led our program efforts for most of that time. Under his program leadership, Touch has built an extraordinary program team and has successfully developed and implemented programs that have improved access to healthcare in sub-Saharan Africa. He has played a major role in in both Touch’s geographic and programmatic expansion.

 

Celia Felsher, Touch’s President and Chief Executive Officer, said “We are very excited about Massi stepping into the position of Executive Director. Massi will now be responsible for all of the programmatic and operational functions at Touch, working with me and the Touch Board in leading our efforts to continue increasing our impact across sub-Saharan Africa.”

 

Before joining Touch, Massi was a Senior Manager at McKinsey & Co., where he spent four years serving major clients in the private health sector and in government and regulatory authorities across Europe, America, and the Middle East. Massi holds a PhD in Biomedical Engineering from the Georgia Institute of Technology, an Executive MSc in Health Economics, Policy and Management from the London School of Economics, and an MSc in Aerospace Engineering from the Polytechnic of Milan.

 

Lowell Bryan, Touch’s Chairman of the Board, stated that “Massi has continually shown his commitment to Touch and our mission and we are looking forward to working with him in his new role.”

Thoughts on POA from a Government of Tanzania Representative

Jan, 2021

If the COVID-19 pandemic has taught us anything, it is that healthcare workers, when equitably distributed, make all the difference in saving lives. Unfortunately, they are in short supply around the world, and, more specifically, in sub-Saharan Africa. Touch Foundation has been working for over 15 years to train more and effectively allocate existing healthcare workers in Tanzania and other nearby countries. Unfortunately, a limited health workforce, paired with limited funds to pay healthcare workers, poses severe challenges to equitable care.

 

With our data-driven Prioritization and Optimization Analysis (POA) tool, also known as WISN+POA, we are supporting the Government of Tanzania (GoT) to solve this problem. Every year, the Government assigns healthcare workers to health facilities around the country, an oftentimes arduous and complex task. With a deficit of healthcare workers to begin with, Government staff need to be especially careful about where to place the healthcare workers who are available. We began collaborating with them in 2015 to make this process more effective. POA is an online tool that uses data to make suggestions on healthcare worker placement based on the healthcare workers available, the amount of need at certain health facilities, and the funds available to pay them.

 

Excitingly, we just released the beta version of POA that includes additional cadres and district hospitals, making the process even more user-friendly for members of the GoT, which is key to both equitable healthcare access and sustainability of the tool. The WISN+POA beta version was tested in a workshop attended by GoT representatives from different ministries to incorporate any final feedback. Following the workshop, we spoke with GoT staff members to get their thoughts on the update ahead of the official release later this year. Juma Mabrouk, the Human Resource for Health Coordinator at the President’s Office of Regional Administration and Local Governance (PO-RALG) was kind enough to provide a few words on his thoughts about POA, its importance for the GoT, and our collaborations. Here is what he said!

 

“WISN+POA is fantastic! It is hugely beneficial for the Government of Tanzania (GoT) as it enables the GoT to easily make data-driven decisions about distribution of new and existing healthcare workers where they are needed most across Tanzania.

 

At PO-RALG, the process for allocation of HRH is very strenuous on our staff and the WISN+POA system automates a lot of the manual processes which can make life much easier for staff and allow them to focus on other important activities within the HRH Planning Process.

 

The new functionalities incorporated within the WISN+POA system is great, especially the homepage, as it provides a snapshot of the national shortage of health care workers and it can also provide details at the LGA and Facility level.

 

On behalf of PO RALG (Health), we really appreciate the tireless work and contribution that Touch Foundation are undertaking to ensure the WISN+POA system is successful and sustainable for the foreseeable future.”

 

We’re excited to continue working with Mr. Mabrouk and all our government partners to ensure that people throughout the country have access to the healthcare workers they need.

 

Learn more about POA here.

Providing Lifesaving Transportation, One Taxi at a Time

Dec, 2020

When Regina George began to experience labor pains, the nearest health facility to her was not equipped to care for her complicated twin birth. She needed to get to a higher level facility. Without a way to get there, she began walking home. Christian, a community driver employed by the m-mama program, drove past her at just the right time.

   

On June 24th of last year, Regina George began experiencing intense labor pains, over a month before her due date. She headed straight for the dispensary near her home in rural Tanzania. During her pregnancy, doctors had guessed she was pregnant with twins, and so when she arrived at the dispensary, the healthcare workers knew they didn’t have the capacity to give her the care she and her babies needed. Thus, they referred her to a higher-level facility in Shinyanga, a larger town about 17 miles away. Without any money to pay for transport, Regina left the dispensary and began walking home.

 

Christian Mbuligwe saw her just as she reached the town center, breathing heavily through her labor pains. Christian is a taxi driver and, for 2 years, had been employed by Vodafone Foundation’s m-mama program in Tanzania, implemented by Touch Foundation. That means he has the training and skill to provide emergency transport to women and infants experiencing emergencies before, during, and soon after childbirth. He explains that he felt compelled to help. Christian rushed to action, stopped his taxi to pick Regina up and drove her straight to Shinyanga Regional Referral Hospital, the hospital where she had been referred originally.

 

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Christian (left) and another m-mama taxi driver playing with one of Regina’s boys.

 

Regina was in labor at the hospital for a long time, she remembers, and doctors ultimately opted for an emergency C-section. Three days later, Regina returned home with two healthy twin boys. We recently met up with Regina and Christian, to listen to their story and to hear their perspectives on emergency transport and the m-mama program. They both spoke about the importance of emergency transportation in the rural area. Many women, they explained, don’t have the financial means to pay for transportation to the higher-level facilities, so without the m-mama program, and drivers like Christian, they wouldn’t get the care they need. Christian explains that his m-mama employment has helped advance his own economic position as well.

 

Regina’s connection to the program was a bit unconventional – usually women in need of assistance (or their healthcare worker) call a toll-free number, speak to a dispatcher who triages them and ultimately arranges transport for them by an m-mama community driver like Christian. We’re proud to say that this process has provided transportation for thousands of mothers and babies in critical condition. We’re also proud of stories like Christian and Regina’s, that demonstrate m-mama’s wide-reaching impact on lives around Tanzania’s Shinyanga Region.

Portrait of Damian Masanja

Damian Masanja: Empowering Engineers to Improve Healthcare Access

Sep, 2020

Damian Masanja began working with Touch Foundation’s Healthcare Technology Management (HTM) program in 2018, partnering with engineers at our long-time partner hospital, Bugando Medical Centre (BMC) to promote biomedical excellence. BMC just hired Damian as a full-time Technical Performance Manager to continue working with BMC technicians to ensure that Lake Zone equipment is always fully functional. We sat down with Damian to talk about the HTM program, his role, and his exciting vision about the future of biomedical engineering.

 

Damian Masanja Baluhya has spent almost two years working closely with Touch and the engineers at BMC to implement core processes and build capacity in their engineering department. In August, Damian stepped into a new role with the HTM program, employed directly by BMC, and will continue his groundbreaking work with engineers by conducting a performance assessment over the next 18 months. This is a big deal; as Damian says, “engineering is pivotal to all hospital successes.” Improving engineering outcomes has a direct impact on patient care. For example, when engineers in the Department recently reduced the average downtime [due to malfunction] of hospital equipment by 11 days, it meant that more equipment is now readily available to perform the procedures patients need.

 

Much of this improvement is due to Damian and the engineers’ work to set clear goals, problem solve, and ensure efficient routines in the office. Key Performance Indicators (KPIs), which the department now employs to track things like completed jobs and operating room activity, play a huge role in the team establishing goals and following through on them.

 

A KPI board in the engineering department.

 

When something doesn’t go as expected, Damian is quick to problem solve with the engineers: “now we want to interrogate every answer to a question: why? why? Until you have 5 ‘why’s.’” Asking “why” in this way creates space for improvement and positive change.

 

This desire for interrogation and learning makes sense given that Damian is driven by his love of teaching. “Teaching,” he says, “has always been a passion, whether it’s in a classroom or it is building capability.” Building capacity, both with skills, like computer literacy, or with practice, like implementing routines, is critical to ensuring sustainability, which is one of Damian’s main goals for the program. In his new role at BMC, Damian will continue mentoring members of the department and coordinate future technical trainings.

 

Damian with some members of the engineering team.

 

For a program like this to be sustainable, there must be ownership from the people impacted by the program (e.g. the engineering team at BMC). Thus, when Damian introduces new practices and systems, he does it in close partnership with his team, working to ensure buy-in so that everyone understands, owns, and agrees with the changes. “I am happy that I have been enjoying the very good relationships with most of the engineering staff,” Damian says. He’ll spend time in his position at BMC evaluating adherence to processes and best practices, continuing to raise the department’s performance and service quality. With all the successes that the department has seen over the past two years, Damian is setting high goals for the HTM program. “Hopefully,” he says, “this department and Bugando Hospital can become a real center of excellence in Tanzania and East Africa.”

Touch’s Commitment to the Sustainable Development Goals with POA

Sep, 2020

Touch Foundation is committed to achieving the United Nation’s Sustainable Development Goals (SDGs), focusing on strengthening health systems to ensure a better and more sustainable future for all. We believe that healthcare workers are the ultimate drivers of SDG 3 (ensuring health and well-being for all). When designing and implementing programs like Prioritization and Optimization Analysis (POA), we collaborate with global actors to ensure long-term, locally led change that supports the equitable distribution of healthcare workers and accelerates the realization of the SDGs.

 

The COVID-19 pandemic has solidified what many of us already knew: healthcare workers, in adequate numbers and with the proper mix of skills to meet the needs of the communities they serve, is a nonnegotiable part of ensuring health and well-being for all people, everywhere (SDG 3). We created POA (Prioritization & Optimization Analysis) to improve the allocation of limited healthcare workers given the demand for health services, as well as real world budget and supply constraints. Using this tool, governments in sub-Saharan Africa and other health workforce planners can deploy healthcare workers to facilities and communities with the greatest need.

 

Since our inception, Touch Foundation has supported the training of over 6,000 healthcare workers and we’ve used POA, with the support of local governments and PEPFAR, in 4 sub-Saharan African countries to allocate members of the health workforce where they’re needed most. These essential workers are at the heart of achieving SDG 3.

 

Though significant progress has been made to achieve the Sustainable Development Goals, we still have a long way to go, and countries in sub-Saharan Africa face some of the largest deficiencies in health access. This region carries nearly one quarter of the world’s disease burden while possessing only 3% of its healthcare workforce and only 1% of its financial resources for healthcare. Now, more than ever, given the dramatic setbacks caused by COVID-19, we must buckle down on our collective action over the next 10 years to achieve the health-related SDGs. Working towards good health and well-being will be the keystone in achieving all 17 Goals, from gender equality to decent work and economic growth.

 

Training, effectively allocating, and supporting healthcare workers is key to achieving nearly every SDG target related to health and well-being. These include ambitious reductions to the global maternal mortality ratio and neonatal mortality rates, ending the AIDS epidemic, and strengthening emergency preparedness and response. With healthcare workers equitably distributed, and thus facilities better staffed, more services become readily available, making it far easier for patients to access care.

 

To have a sustainable and catalytic impact, we recognize the importance of collaboration across business, government, philanthropy, and civil society partners. That’s why we’re excited to continue our engagement with the United Nations Global Compact and Every Women Every Child, and continue actively partnering with leaders around sub-Saharan Africa to ensure that healthcare workers can fill in the biggest gaps.

 

Learn more about our POA program here.

 

Learn more about our work to promote maternal health here.

Group of healthcare workers on the hypertension screening team

How One Healthcare Worker Team Uses Digital Health to Perform More Hypertension Screenings During COVID-19

Aug, 2020

The global COVID-19 pandemic has posed a threat to essential health services around the world. Despite this, healthcare workers at a hospital in Tanzania (pictured above) have continued providing services to pregnant and postpartum women in the community using digital technology to record and track screening data. Not only that, they have increased the number of monthly hypertension screenings.

 

Frontline healthcare workers are at the forefront of ensuring quality maternal healthcare in Tanzania. The healthcare workers at Sengerema Council Designated Hospital, serving a population of over 650,000, play a crucial role in keeping women and babies safe by screening for hypertension at prenatal and antenatal care visits. Hypertensive disorders are among the leading causes of death for pregnant women in Tanzania, and so diagnosis and treatment are key to reducing maternal deaths. A team of nine healthcare workers at the hospital have screened over 10,500 women since 2019, when they joined AstraZeneca Pharmaceuticals’ Healthy Heart Africa (HHA) program implemented by Touch.

 

Mr. Makala, an RN in the HHA program, reported that with increased precautions, COVID-19 did not influence their screening capabilities. In fact, the hospital team increased its screening numbers per month by at least 150 since the pandemic began, now screening over 1,000 women every month. When asked why this might be, Mr. Makala explained that the care the healthcare workers provide from beginning to end continues to foster trust throughout the community, making more women feel comfortable to visit and get screened.

 

Digital health has promoted ease and efficiency in these screening services. The healthcare workers record results and other key data on tablets, which are synced to an online dashboard. Mr. Makala explains that the tablets are easier to use than paper forms, prompting answers to skipped questions and saving time with typing ease.

 

What’s more, the use of digital technology has fostered strong communication between the healthcare workers on the frontline and Touch Foundation’s program team, which has been indispensable given limited travel opportunities during COVID-19. The tablets help the program team at Touch support the healthcare workers from afar, track screening progress, and continue collecting data to study the prevalence of hypertension in the Lake Zone of Tanzania.

 

Working together with AstraZeneca and healthcare worker teams like Mr. Makala’s throughout the region, we will educate, screen, and refer for treatment 50,000 pregnant women and 1,800 healthcare workers over three years.

 

To hear from another nurse delivering maternal hypertension screening and care on the frontlines, click here.

Frontline Healthcare Workers Save Pregnant Women’s Lives with RHD Prevention and Care

Jun, 2020

For the last five years, Touch Foundation, with the generous support of Medtronic Foundation, has worked to address Rheumatic Heart Disease (RHD) in the Lake Zone of Tanzania. As we come to the end of the program, we celebrate the powerful role that frontline healthcare workers can have in RHD prevention and care. Touch volunteer, based in Mwanza, Tanzania, Madison MacLean writes about one of those healthcare workers, Mercy, who is committed to ensuring excellent prenatal care.

 

RHD develops from untreated strep throat and ultimately results in permanent heart damage, which can be very dangerous, especially for pregnant women. Because of this danger, screening, early diagnosis, and treatment are critical to saving lives and our program addressed the ways in which these can be integrated into standard care procedures in Tanzania. Now, upon completion of the program, we are taking the time to reflect on the program and celebrate the people who helped define it. One of those people is Mercy, a sonographer at Kambarage Health Center, who participated in Touch Foundation’s training series for healthcare workers on RHD prevention.

 

Mercy is the only sonographer at Kambarage Health Center (KHC) and feels strongly about providing prenatal care. Her passion for her work stems in part from her own experiences. As part of another Touch Foundation program supported by AstraZeneca Pharmaceuticals, Healthy Heart Africa, Mercy was screened and found to be hypertensive early on in her pregnancy. She was able to receive the proper treatment, and she and her unborn child remained safe. She thus knows both firsthand and through her professional work the importance of providing services that will lead to early detection and care for others too.

“It is important to screen women and children for Rheumatic Heart Disease because then we are able to know in the early stages and get treatment earlier.”

There are very few cardiologists who can do these screenings, especially in rural areas. Many of these services are only available at the larger referral hospitals. We supported the training of Mercy and other healthcare workers to screen pregnant women and children during routine prenatal visits at the clinic. She now has the knowledge and equipment to screen and identify issues in pregnant women, increasing early detection and referring those patients before their conditions become severe.

“If more healthcare workers could be trained and upskilled like I have, it will have a big impact. It can improve the services and we can increase care for people living in remote areas and refer them in the first stages of an issue.”

The RHD training has shown first-hand that providing frontline healthcare workers like Mercy with the training and equipment to implement an early screening system can save lives.

“We met a pregnant mama yesterday, she used to come to the clinic because she had high blood pressure. We found out yesterday she has a problem with her heart. We were able to give her a referral to the regional hospital to get treatment. This is a good thing for us!”

2020 Virtual Asante Supper Marks Leadership Change

May, 2020

Members of the Touch Foundation community gathered virtually on May 18, 2020 to honor our Founder and President for the past 15+ years, Lowell Bryan, for his profound leadership and dedication to saving lives and relieving human suffering. Due to the COVID-19 pandemic, we re-imagined the event and held it online. If you missed it live, not to worry! You can view the event on demand here.

 

Rik Kirkland, Director of Publishing at McKinsey & Co., moderated our Asante celebration and interviewed Lowell on the urgency COVID-19 adds to the need to address Africa’s infectious disease burden and the potential to deploy digital health at scale to catalyze change in African health systems. The discussion was inspired by a white paper on this topic, which Lowell wrote and which we released during the event.

 

In the paper, entitled Early Thoughts on Potential of COVID-19 to Promote Digital Health in Africa, Lowell discusses the ways in which digital health has the potential to expand access to healthcare and decrease the infectious disease burden throughout the African continent. You can read the white paper on our website here.

 

This particular Asante was bittersweet as we honored Lowell for his tireless commitment to Touch Foundation as he stepped down from his position as Touch Foundation’s President. With that, we also welcomed Celia Felsher, longtime board member, who has taken his place. We are thrilled both that Celia has taken on the President role and that Lowell is not going far: he will remain active as Chairman of the Board and on several board committees.

 

After looking back at our impact over the years and exploring the gravity felt around the world with the COVID-19 pandemic, we ended the night by looking with determination to the future. As Celia said in her closing remarks,

“As has been made abundantly clear from the current COVID-19 pandemic, we are all, regardless of where we live, interconnected, and the strength of healthcare systems everywhere is necessary to ensure the health of all of us. Touch’s work is, therefore, more important than ever.”

 

You can view the online event here and read more about our programs and Lowell’s history with Touch here.

Notes from a Nurse: The Importance of Screening Mamas for Hypertension

Feb, 2020

“We introduced them to the program, explained the importance of screening for hypertension, and took their vitals. After this they say, ‘Thank you, thank you very much Nurse.’”

 

These words come from Byera Kwesiga, a nurse and site coordinator at Kahama Hospital in the Lake Zone of Tanzania, as she describes her work to protect mamas from the adverse effects of hypertension. As manager of the hospital’s Healthy Heart Africa Program, Byera organizes staff in the Reproductive and Child Health department and ensures that pregnant and postpartum women are properly screened for hypertension.

 

Hypertension, or high blood pressure, is among the leading causes of death in Tanzania and is especially dangerous for mothers and their babies. High blood pressure in pregnancy can develop into preeclampsia and eclampsia, which are both life-threatening, especially when left untreated. That’s why Touch Foundation is partnering with AstraZeneca’s Healthy Heart Africa program to screen pregnant and postpartum women in Tanzania.

 

Byera was among the nearly 150 Tanzanian Lake Zone health workers we trained in 2019 on the adverse effects of hypertension and how to conduct detailed screenings and diagnose pregnant and postpartum women. By December 2019, they had performed over 10,000 screenings! The information they collect during these screenings is not just helping them provide better care to patients: the data also helps us better understand the prevalence of hypertension in pregnant and postpartum women in the Lake Zone.

 

Byera is saving lives by ensuring mothers are screened during their antenatal and postnatal clinic visits. Before the program began, Byera says that she and other health workers often only discovered hypertensive cases during or right before labor and delivery, which didn’t give the opportunity to protect mothers from the life-threatening effects of high blood pressure. Now, screening during clinic visits allows Byera and her colleagues to diagnose hypertensive cases early, allowing more preventative measures to be taken. Byera remembers a pregnant patient whose blood pressure was approaching dangerously high levels during an antenatal screening. Because the nurses at Kahama Hospital caught it early, they were able to provide her with the proper medications and monitor her to ensure that she remained healthy and her baby was born safely.

 

At Touch, we’re excited to continue working with nurses like Byera, particularly in 2020, the Year of the Nurse and Midwife, who are leading the way in improving maternal health around sub-Saharan Africa.

Reflecting on 2019: Story from a Volunteer with Touch in Tanzania

Jan, 2020

Written by Juliana Andrade, a lawyer living in Brazil who volunteered with Touch in Tanzania for nine weeks, supporting our M-Mama program and providing legal expertise.

     

After building a career in profit oriented businesses, I decided to volunteer in projects that aim to solve critical development challenges in our world. This decision, fortunately, brought me to Touch Foundation, where I was able to use my professional expertise to contribute to projects that are saving lives and improving healthcare in Tanzania. Touch’s unique data-driven vision, in which sustainability and purpose walk together and guide day-to-day decisions, was the perfect fit for me. I have found Tanzania to be so beautiful and welcoming. There are development challenges and failures in health systems resulting in inadequate access to healthcare. So, being part of an organization with vast experience with the local environment and stakeholders enabled me to feel supported and stay focused on working at my optimal level. Touch’s commitment to innovative solutions and sustainable results enhanced my belief that people who have experience in the business world can play an important role in solving the challenges faced by our global community. I am so thankful for this experience, which has changed who I am and what I want to achieve in the next chapter of my professional life.

     

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.