Follow Us
Tanzania
-
Tanzania Human Resources for Health Collaborative
|
Collaborative Profile
-
Community directed interventions for Malaria, Tuberculosis, and Vitamin A in Onchoceriasis endemic districts in Tanzania
|
Community Resource
-
A Baseline Assessment of Self-management and Community Support for HIV/AIDS Patients at Four Facilities in Morogoro, Tanzania
|
Publications
Since its development in 1996, the Chronic Care Model has been successfully used in over 1500 health facilities to guide the redesign of health care systems to meet the complex needs of chronic illness patients. Recently, several Ministries of Health, including the Tanzania Ministry of Health and Social Welfare, incorporated Chronic Care principles into their plans and certain guidelines aimed at health systems strengthening. Self-management support is a key aspect of the Chronic Care Model. To achieve sustained improvements in patient outcomes and quality of life, patients need support which increases their knowledge about their health and helps to build their skills and self-confidence to self-manage their illnesses.
In an effort to identify gaps in patient self-management of HIV and to inform the planning of interventions aimed at strengthening self-management support, the USAID Health Care Improvement Project (HCI) worked with the Tanzania Ministry of Health and Social Welfare to conduct a baseline assessment in the region of Morogoro. The assessment examined the extent and effectiveness of patient-centered self-management support provided to people living with HIV and identified community resources available to support self-management for patients with HIV.
-
Developing quality participatory pharmacy practice for children living with HIV/AIDS in Mbeya, United Republic of Tanzania
|
Improvement Report
-
Tanzania | Morogoro ART/PMTCT Improvement Collaborative
|
Collaborative Profile
-
Tanzania | Mtwara ART/PMTCT Collaborative
|
Collaborative Profile
-
Tanzania | Lindi ART/PMTCT Collaborative
|
Collaborative Profile
-
Cross-sectional examination of service delivery and costs of community- and home-based care in Tanzania
|
Publications
This baseline evaluation in the Tanga District of Tanzania will evaluate the current scope of Home-Based Care (HBC) services and associated roles and responsibilities across stakeholders to inform the development of a framework and standard operating procedures for the HBC program.
This baseline evaluation will address six questions:1. How has the widespread provision of ARVs changed the scope and mandate of HBC in Tanzania?2. What is the current scope of HBC services that are being provided?3. How have changes brought by the provision of ARVs affected the relationships and roles of NGOs in providing services to PLWA?4. What are the expectations of patients, health workers and the MOH of the HBC standards of practice? (What are the essential services that should be provided?)5. What are the deficiencies in the current HBC practices?Answering these questions will inform the development of a framework and standard operating procedures (SOP) for HBC in Tanzania. SOPs are written procedures, based on national HBC guidelines, which will provide a detailed description of processes or steps to be followed in performing specific tasks (both clinical and non-clinical) related to delivery of particular healthcare interventions. The goal for developing SOPs for HBC is to provide guidance to providers and managers in the field on procedures for effective and efficient implementation of quality HBC services in line with the National HIV and AIDS Quality Improvement Guidelines and current best practices in the National HBC Guidelines.This will be a prospective cross-sectional study that examines HBC from the perspective of the three principle components of the health system: the providers, patients, and implementing partners. Both quantitative and qualitative data collection methods will be used. In-depth interviews will be the primary source of information. Quantitative data will be collected on the demographic and health characteristics of patients and HBC workers and details of the home visit (frequency, time taken, services provided, support needed, etc). Qualitative data sought include expectation and perceptions of HBC services from all perspectives, the important components of HBC, and the main perceived problems facing the delivery of HBC service as identified by HBC workers, implementing partners and patients. Furthermore, through discussions with all stakeholders suggestions on how to practically improve quality and optimize the functioning of the HBC system will be collected. -
Tanzania | Iringa Region Infant Feeding Improvement Collaborative
|
Collaborative Profile
-
Tanzania | Tanga Region ART/PMTCT Improvement Collaborative
|
Collaborative Profile
-
Strengthening systems and improving health outcomes in Tanzania
|
Publications
In 2007, USAID asked HCI to work in collaboration with the Dutch agency PharmAccess International (PAI) to assist the Ministry of Health and Social Welfare (MoHSW) of Tanzania, regional and district level stakeholders, and implementing partners to set up a harmonized QI program for ART and PMTCT services in line with the MoHSW’s National Quality Improvement Framework. This short report describes HCI's approach to develop and promote a harmonized QI plan for ART and PMTCT services countrywide using a uniform set of QI tools, indicators and a reporting process integrated into the existing MoHSW monitoring and evaluation channels.
-
Community Health Worker Programs: A Review of Recent Literature
|
Community Resource
-
Malaria Rapid Testing by Community Health Workers is Effective and Safe for Targeting Malaria Treatment: Randomised Cross-Over Trial in Tanzania
|
Community Resource
-
Strengthening Community Health Systems to Improve Health Care at the Community Level
|
Publications
This short report summarizes the ways in which the USAID Health Care Improvement Project (HCI) is working with local groups and partners to apply quality improvement (QI) methods within the Community Health System in order to strengthen the impact of CHWs and other service providers at the community level, while at the same time increasing sustainability of programmatic impacts. Currently carrying out activities in more than 30 countries globally, HCI seeks to develop the capacity of health systems to apply modern QI approaches to make essential services better meet the needs of underserved populations; improve efficiency and outcomes; reduce costs from poor quality; and improve health worker capacity, engagement, and performance.
-
Implementing the HMC Resolution on Task Shifting- Focus on Injectables. Evidence Review and Development of Country Workplans
|
Community Resource
-
Sequential Validity of Quality Improvement Team Self-assessments in Tanzania
|
Publications
Emerging evidence indicates that collaborative improvement is a cost-effective way to improve health care quality in diverse cultures. Such improvement generally relies on data from quality improvement (QI) teams’ own assessment of their facility’s performance and results. The validity of self-assessment data is important to both the teams themselves and to the collaborative as a whole: These data provide QI teams with the information they need to identify quality problems and to learn whether their actions actually improved quality.This report presents the results of an investigation of sequential validity of self-assessment by service providers in an improvement collaborative in the Mtwara Region of Tanzania. Study objectives were to determine the validity of self-assessments by the QI teams and whether validity improved during the first year of the collaborative.The study was carried out in nine health care facilities participating in an improvement collaborative in Mtwara Region of Tanzania, during its first 10 months of activity. The collaborative is addressing HIV/AIDS care, particularly as it relates to antiretroviral therapy (ART) and the prevention of mother-to-child transmission of HIV (PMTCT).The research team defined eight activities in the self-assessment process that can influence the validity of the information that results: 1) writing the records, 2) storing and retrieving records, 3) selecting records from which to abstract data, 4) abstracting data from the selected records, 5) summarizing the abstractions, 6) the agreement of computer and written records, 7) the quality and use of computer records, and 8) communicating the summary data (results related to improving the quality of care) to other members of the QI team and the clinical staff. The team then developed and tested forms and procedures for measuring the validity of the information each activity produced.The study found significant upward trends in measurement scores occurred for the tasks of writing the record, selecting the sample, the use of computer results, and communicating results. No significant change in validity occurred in storing and retrieving records, abstracting or summarizing selected records, or agreement of written records with computer records. However, some of these activities started high and remained high throughout the study: For retrieving records, validity was close to 100% in the first and last two measurements for most cases; for abstracting records, a small increase occurred in validity during the study for all three indicators but was significant for only one of them; and for summarizing abstracts, errors were zero or close to it throughout the study. Changes in validity were roughly the same for all three indicators.Over the course of the study, validity either improved or started and remained high for most self-assessment activities; none decreased. The communication activity, which differs from the others in that it does not contribute directly to the validity of the performance scores reported by the QI teams, had a very low end-of-study score across all sites, suggesting limited use of data for QI activities. With few exceptions, this study shows that self-assessment as part of Mtwara improvement collaborative provided valid data and improved as the collaborative matured. This finding—coupled with the result that some steps in the self-assessment process, such as storing and retrieving records and communicating results, are not always done well—suggests the need to address these activities early in a collaborative. The finding that the validity of abstracted data between QI teams and the gold standard set by the expert reviewers was not statistically different is especially encouraging.
-
Spread of PMTCT and ART Better Care Practices through Collaborative Learning in Tanzania
|
Publications
The Tanzania National AIDS Control Program (NACP) and PEPFAR initiated the Partnership for Quality Improvement (PQI) in 2007 to develop and promote a harmonized quality improvement (QI) plan for antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) services countrywide. The partnership included PEPFAR’s HIV/AIDS care and treatment implementing partners, with technical leadership from the USAID Health Care Improvement Project (HCI), implemented by University Research Co., LLC (URC), and PharmAccess International (PAI).
The PQI introduced the “Improvement Collaborative” strategy to generate better care practices to improve care provided to those needing HIV and AIDS services and has developed improvement collaboratives in four regions. Collaborative improvement is built on multiple teams working on a common aim and sharing learning about what works to achieve results more rapidly. This study evaluates peer-to-peer learning among health workers and the spread of better care practices within regions and across regions in the PQI ART/PMTCT collaboratives in Tanzania.This cross-sectional evaluation used quantitative and qualitative methods to measure use of mechanisms for exposure and sharing of change ideas, changes implemented, and factors that facilitated or hindered sharing and uptake of change ideas. Data were collected in three regions (Tanga, Morogoro, and Mtwara) in a total of 25 sites. URC/Tanzania staff collected data through interviews and focus group discussions with team members, Council Health Management Teams, Regional Health Management Teams, implementing partners, and the NACP during the period of February to May 2010.The evaluation found that across the three regions, the great majority of ideas were “borrowed” from other teams, indicating that ideas of other teams are the main sources of adopted changes. The most commonly used (and also the most favored methods) of presenting information about changes were oral presentations with visuals, written descriptions, provision of tool/materials, evidence on effectiveness and warnings to avoid failures. Simplicity of the change idea was most frequently listed as the most important factor to try an idea, while a perceived lack of necessity was the top reason not to try. External support was the most important factor favoring implementation, while lack of technical support was the top hindering factor.The results of the study indicate that shared learning and spread of better care practices or effective changes is taking place both within and across the three regional collaboratives studied. Teams desired relatively detailed information about “how to do” the changes they were exposed to. Results also show that not all changes were equally spreadable; spread depended on how straight-forward was their implementation and whether it required authority or resources beyond the purview of the facility. Additional mechanisms for sharing learning across regions are needed, as well as mechanisms within regions that build on existing structures and meeting opportunities. -
The Partnership for Quality Improvement to Improve PMTCT and ART Services in Tanzania: Assessment of Results, Capacity, and Potential for Institutionalization
|
Publications
The USAID Health Care Improvement Project was asked by USAID in 2007 to assist the Tanzanian Ministry of Health and Social Work (MoHSW), regional and district level stakeholders, and implementing partners to set up a national Quality Improvement (QI) program for ART/PMTCT services in line with the Tanzania National Quality Improvement Framework. The QI program soon became known as the Partnership for Quality Improvement (PQI). The main aims of the PQI were to: 1) Build capacity for a harmonized QI approach among the many implementing partner organizations working this area, thereby accelerating the speed of and increasing the resource pool for QI in Tanzania; 2) Strengthen capacity for QI at national, regional, district and health facility levels (particularly in light of recent health care reforms to decentralize health services); and 3) Demonstrate the effectiveness of QI collaborative methods in improving patient outcomes in a limited number of regions (a prototype prior to spreading to additional regions).
HCI worked with the National AIDS Control Program (NACP) and the Dutch NGO PharmAccess to develop and implement the PQI. PQI was first launched in Tanga in May 2008 in partnership with AIDS Relief; the second region, Morogoro was included in February 2009, with Family Health International (FHI); and the third region, Mtwara, was added in June 2009 with The Clinton Health Access Initiative (CHAI) and Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). CHAI and EGPAF also committed their own funding and began to replicate PQI in late 2009 to the Lindi region.
The evaluation study examined how well the PQI has worked in the three first regions (Tanga, Morogoro, and Mtwara) and identified how the approach could be further strengthened or modified for spread to other regions in Tanzania in the future.
-
Improving Care for People with Chronic Conditions in East Africa
|
Publications
Until recently, malaria and other acute infectious diseases were the leading causes of mortality and morbidity in East Africa, and the health systems in the region were generally designed to manage acute conditions. Now with the advent of the HIV pandemic and increasing prevalence of non-communicable diseases, health systems are struggling to manage people with chronic conditions. Helping health systems change from the acute care model to one which has structures and processes in place to help people living with chronic conditions manage their condition at home will require transformation at many levels. HCI is working with the Ministries of Health in Uganda and Tanzania to make these changes. This flyer describes current efforts supported by HCI to promote the use of the Chronic Care Model, an evidence-based set of principles for improving chronic condition care that has been endorsed by the World Health Organization.
-
Baseline Assessment of HIV Service Provider Productivity and Efficiency in Tanzania
|
Publications
Tanzania, like many other countries in Africa, is facing a severe shortage of qualified health professionals. Only 35% of positions in government health facilities have been filled, leaving Tanzania in the wake of burgeoning human resources for health crisis. According to the Annual Health Statistical Abstract from 2008, the national average of the population per medical officer was 64,000, 31,000 per assistant medical officer, and 7,000 per clinical officer. The shortage of health professionals has been exacerbated by the HIV/AIDS pandemic and other communicable diseases such as malaria and TB.
In an effort to improve the quality of care of HIV services delivered in Tanzania, the USAID Health Care Improvement Project (HCI) and the Ministry of Health and Social Welfare (MOHSW) began implementing a partner improvement collaborative in the Mtwara region in nine care and treatment centers in June of 2009. The aim of the collaborative is to apply QI methods to ART and PMTCT services in order to ensure a high quality of care is being delivered to clients. The collaborative is now looking to integrate HR interventions into its work in order to improve efficiency of service delivery, and strengthen health worker performance and engagement. Health worker productivity and engagement are integral to improving efficiency as they determine what tasks health workers perform and how engaged and motivated they are to perform at a high level.In collaboration with the Government of Tanzania, HCI designed a baseline assessment of HIV/AIDS service providers to gather information on productivity and engagement. The information gathered from this baseline assessment will be used to develop a set of HR improvement packages based on best practices that will be integrated into the ongoing ART collaborative. The baseline was conducted in six sites in the region of Mtwara from June 30th- July 6th, 2010.The assessment identified several areas where human resource management systems can be improved to strengthen provider efficiency and productivity and improve the quality of HIV/AIDS service delivery. All health workers should be provided with written job descriptions that clearly align their tasks and goals. Without written job descriptions, it is impossible to implement strong performance management. Recognition and reward systems can be improved to ensure that health workers get the acknowledgement and praise they deserve when they perform well. The process for performance evaluations needs to be communicated clearly with lower level facilities. Facility managers and providers should also learn how to set performance objectives. Promotion and career advancement opportunities are somewhat rare, which may affect worker motivation. The majority of employees are moderately engaged, regardless of the type of facility or the position they hold, but specific areas of engagement, such as recognition and materials, could be improved. Productivity appears to vary throughout the day with providers being very productive in the morning when patients arrive and productivity levels decreasing dramatically in the afternoon when client loads are low. Client flow does not appear to be a problem, but is something that should continue to be monitored since client loads can vary dramatically by day.
