Healthcare workers are essential to healthcare delivery. There is a direct link between a country’s number of healthcare workers and a country’s health outcomes.
Without healthcare workers to accurately diagnose patients and administer treatment, the impact of other interventions, such as increasing drug supplies or building health facilities, is limited. While international volunteers provide crucial support, training a country’s local healthcare workforce ensures a sustainable pipeline of healthcare workers into the future.
Although the number of healthcare workers is rising, Tanzania still lags far behind the World Health Organization’s (WHO) recommended minimum ratio of 23 per 10,000 people2 with 5 nurses, midwives, and doctors per 10,000 people3,4. Exacerbating the problem, Tanzania’s limited healthcare workforce is concentrated in urban centers, while 70% of the population live in rural areas5.
Our work aims to:
2Global Atlas of the Health Workforce, WHO 2010.
3“Healthcare worker” in this instance refers to physicians, nurses, and midwives.
4 Human Resource for Health and Social Welfare Strategic Plan 2014-2019. United Republic of Tanzania. 2014.
5Population and Housing Census, United Republic of Tanzania 2012.
Through our investments in teaching equipment and extensive construction projects such as student dormitories and a dissection lab, CUHAS-Bugando has become one of Tanzania’s largest medical schools. The student body has expanded from approximately 300 to nearly 3,000 students and the number of degrees offered has doubled.
By building CUHAS-Bugando’s financial and management capacity, Touch now only contributes about 5% of its operating budget, in contrast to an initial 80%. Planning for CUHAS-Bugando’s self-sufficiency ensures the sustainability of its degree programs while also enabling us to invest in CUHAS-Bugando’s other areas of need, such as developing it into a center of excellence for both onsite medical training and distance learning.
Since 2004, Touch has partnered with the Catholic University of Health and Allied Sciences (CUHAS) and Bugando Medical Centre (BMC), the affiliated teaching hospital—together referred to as “CUHAS-Bugando”—to meet Tanzania’s need for healthcare workers.
Touch’s signature Treat & Train Network began with an initiative to improve medical education while also providing better patient care to under-resourced health facilities. During the final years of a student’s medical studies, clinical rotations in a hospital and clinic setting familiarize students with different aspects of the clinical environment. As these rotations became overcrowded, we partnered with CUHAS and BMC and other hospitals to create a network of facilities enabling students to do clinical rotations at other hospitals, away from the main teaching institution at BMC. In addition to external clinical rotations, students also experience healthcare challenges firsthand through village-based, public health research.
The external clinical rotations have improved the student-to-faculty ratio which may be as high as 30 to 1 at Bugando Medical Centre to as low as 5 to 1 at our partner hospitals, allowing students to gain more hands-on clinical experience. In addition, faculty clinicians posted at these facilities not only train students but also provide patients with much needed care and enhance the skills of the host hospital’s healthcare workers.
In addition to building student and faculty housing at each hospital rotation site, we invest in clinical infrastructure, medical supplies, and teaching equipment to prepare the hospitals for teaching and to further enhance the patient care environment. Read more about the Treat & Train Network capacity building.
Bolstered by the overwhelmingly positive feedback from students and faculty, we continue to expand our external clinical rotations. We have added new hospitals to our training sites and expanded the rotations to include nursing students.
“By sending us on this external rotation in Sengerema, Touch has helped me get more exposure, especially in [operating] theatres. I’ve also developed closer relationships with faculty, and feel more free to ask questions,”
-Redegunda, an CUHAS-Bugando student, on his external clinical rotation experience at a partner hospital.
Following students’ graduation, we collaborate with our partners to ensure that graduates work in areas that are in high demand for healthcare workers. We also maintain contact with graduates to follow where they work over time and to understand how their careers evolve. This effort is critical in ensuring that Tanzania’s new healthcare workers provide quality care where they are needed most.
Our intensive regional graduate tracking informed our approach to a national policy to ensure healthcare workers are placed in areas of greatest need. The availability of skilled healthcare workers is still a major challenge in Tanzania, especially in rural areas. The Tanzanian government places all healthcare workers in health facilities. Without a standardized process for modelling staff needs at various health facilities, placements often do not match health facility needs. Placements also do not take into account the likelihood of a graduate to work in a place far away from his or her hometown or desired city of residence. This results in nearly 50% of graduates nationwide failing to report to their assigned facility or leaving within the first few months5, contrasted with 96% of Touch-supported graduates who remain actively working in Tanzanian healthcare institutions.
Touch is supporting the national government in optimizing the distribution of the country’s scarce healthcare workforce. We have adapted the World Health Organization’s Workload Indicators of Staffing Need (WISN) tool for use in Tanzania. The WISN tool provides a systematic method for calculating healthcare worker requirements based on each facility’s workload.
Through our deep understanding of Tanzania’s healthcare worker needs and policies, we have also developed a Priority and Optimization Analysis (POA) tool based on the WISN tool. POA allows the Tanzanian government to prioritize a health facility’s staffing needs based on its budget and the limited healthcare worker supply. We have tested the WISN and POA tools in six regions and are currently assisting the Tanzanian government as they evaluate integration within their existing practices.
5Tanzanian Ministry of Health and Social Welfare. Posted Staff Tracking Report, 2007-2010.