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.

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.

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.

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.”

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.

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!”

Learn more about our RHD program here.