There is a critical shortage of healthcare workers in sub-Saharan Africa. Tanzania is reported to have only 48% of the health workers it needs to adequately staff its health facilities. This poses a significant challenge for decision-makers who must make difficult choices about how to distribute limited healthcare roles and specialties where they can maximize benefits to patients.
In 2015, Touch developed technology to help governments distribute the limited healthcare workers they have to health facilities where they will have the biggest impact on patient care. Our tool is called POA – Prioritization and Optimization Analysis – and, in 2021, Touch expanded the application of POA to all public primary care facilities in Tanzania, which are the first point of care for the country’s 60 million people.
Touch’s POA online system calculates how many and what type of staff are needed at each facility, integrates data about current staffing levels and available health budget, and makes recommendations to health sector leaders to show where staff should be placed to best support community health needs. In 2021, Touch worked with senior officials to expand the type of health facilities included in POA to cover all primary healthcare in Tanzania. Since the tool was first developed in 2015, Touch has worked hand-in-hand with government partners to ensure that the POA platform was meeting the unique needs of the public health system.
A primary goal of POA since its inception has been to ensure that POA is locally-owned and managed for long-term impact. In 2021, we formally transitioned the tool to the national government. Transition activities included training health administrators from all 184 local government authorities across 26 regions on how to use and manage the system. The Government of Tanzania has integrated POA in its national strategy for health planning through 2024.
COVID-19 shed even more light on the vital role of biomedical technicians in repairing and managing medical devices. During the pandemic, ventilators and other intensive care equipment played a crucial role in saving lives. Since 2018, Touch has worked in partnership with the Bugando Medical Center in northern Tanzania to strengthen its biomedical engineering department, which supports a patient base of over 350,000 annually. In 2021, the Bugando engineering department was able to ensure 9 out of 10 critical devices were in working order in key hospital departments during the pandemic.
Moreover, having implemented a best-in-class routine of checking oxygen production and quality metrics three times a day, the engineering department was able to ensure ongoing oxygen supply to critical patients in the hospital. The preparedness of the department also influenced the decision of the Government of Tanzania to pledge construction of a further oxygen production facility at the hospital to help serve growing demand.
Hospital engineers are often unsung heroes, working in the background to ensure hospital services can be delivered continually. At Bugando, however, the engineering team’s ability to effectively manage the complex interplay between technical skills, systems, processes and the patient service mindset needed to support operations of a 1,100-bed hospital has not gone unnoticed. Recognized as one of the best organized departments in the country during a Ministry of Health Audit visit, the Biomedical Engineering Centre of Excellence now also acts as a champion and trainer for other hospital teams in their implementation of 5S, Performance Measurement, and Visual Management. In fact, staff from the engineering department have now supported more than 12 departments at Bugando in establishing visual management boards to view and monitor equipment performance. This culture of knowledge sharing will be critical as the hospital continually improves services for its 17 million catchment population.
The third year of the HTM program was about program transition and sustainability. Following 24 months of collaborative implementation of new operational systems and processes for a world-class hospital engineering department, the Touch team focused on a smooth transition of ownership to the engineering and hospital leadership.
A full handover of program ownership was a priority from the program’s outset, to guarantee sustainability in the long term. The Touch team continues to provide Bugando Medical Center leadership some technical support and will draw on key lessons learned and insights from the 3-year program to inform HTM program expansion to additional facilities.
Sub-Saharan Africa has some of the highest rates of maternal and newborn mortality in the world. A key cause of these unnecessary deaths is a delay in accessing care, with many patients in rural areas travelling long distances to reach health facilities. In partnership with the Vodafone Foundation, Touch developed the m-mama emergency transportation system in 2013 to ensure that pregnant women have access to safe labor and delivery care. m-mama is a technology solution that connects women with community drivers to transport them to the right level of health facility to address their acute condition. The m-mama platform evaluates driver availability and facility capacity to ensure the women are transported efficiently and admitted into the care system. In 2021, Touch and local partners implemented the m-mama program in multiple districts in Tanzania, and in Lesotho, transporting over 8,000 women and infants to critically needed health services.
Over the past year, Touch has supported capacity-building within district health units and local government to ensure that management of the m-mama program was transitioned to the local public health system. Local government stakeholders have been involved in running m-mama since its launch in Shinyanga region in 2019 and have now assumed full responsibility for managing the system, ensuring a long- term solution for delays in maternal and infant care. After 3 years of program success and over 8,000 emergencies transported, we are thrilled to announce that m-mama will be scaled across Tanzania by 2024.
Conducting life-saving blood pressure screenings.
Hypertension is a leading cause of death in Tanzania, with pregnant/postpartum women, their babies and healthcare workers being particularly vulnerable. Regularly checking blood pressure can diagnose hypertension (high blood pressure) early and save lives.
Touch Foundation in collaboration with Bugando Medical Center implemented the AstraZeneca Healthy Heart Africa program alongside m-mama to tackle this issue. The program, which came to a close this May, conducted over 77,000 screenings across 21 m-mama- affiliated facilities in Tanzania, working with healthcare workers to embed screening into their routines. We also trained more than 400 healthcare workers on how to screen, diagnose and treat high blood pressure, donated vital screening equipment and established a sustainability plan with the government on how to continue efforts to address hypertension in the future.
Building on the successes and learnings in Tanzania, m-mama launched this year in Lesotho, a mountainous nation of 2.1 million people, many of whom live in rural areas and face many challenges accessing health services. Touch Foundation’s local staff in Lesotho worked with the government and key health facilities to set-up the elements of the emergency transportation system. Since April 2021, over 250 women and babies have been referred to urgent care using the m-mama system. Touch also participates in important community education activities, supporting sound health-seeking behaviors by educating women and their families about safe pregnancy, delivery, and the postpartum period.
It is estimated that 50% of health service provision in Africa occurs in the private sector. The work of pursuing universal health coverage on the continent requires strengthening both the public and private sectors to meet the urgent needs of people: more and better trained health workers, digitally enabled service-delivery models, and greater focus on data- driven decision making among health system managers. Widescale transformation is needed to build resilient health systems and the private health sector – which includes faith-based facilities – is positioned to lead the way for
this challenging transformation, as it is unburdened by government budget pressures and inflexible service delivery models that often characterize the public sector.
Touch has a long history of supporting the private sector in Tanzania, including faith-based health institutions. In 2021, we launched a program to build service-delivery capacity in a variety of Tanzanian facilities under the Christian Social Service Commission (CSSC) umbrella, to increase their patient impact and financial sustainably. Facilities within the CSSC umbrella constitute 30% of healthcare service in Tanzania. As a pilot, in collaboration with our partners at USAID, Touch launched a set of initiatives at Sengerema Hospital to improve business performance which, in turn, targets improved patient experience. Sengerema is a hybrid public-private hospital in Mwanza region which serves a catchment area of more than 750,000 people.
Building on a joint analysis of Sengerema’s operating model with McKinsey & Co., the project seeks to identify areas for improvement which have the potential to increase earned revenue and to optimize patient experience in care-seeking. Our initial interventions included:
By piloting systems improvements at Sengerema Hospital, we are testing how practical business improvement solutions drive improved patient care and operations. Data and experiences from this pilot work will inform expansion across dozens of facilities in Tanzania over the next three years.