- To modernize Tanzania’s healthcare system starting with Muhimbili National Hospital
- To build or modernize all 23 regional level hospital laboratories in the country
- To create the nations’ first public Emergency Medicine department and residency program
Tanzania faces multiple challenges in improving health care as it strives to meet the Millennium Development Goals (MDGs) and also faces a significant HIV/AIDS epidemic. Adapting resource-limited health systems to meet the lifelong treatment needs of people with HIV and other life-long diseases is a critical part of addressing the pandemic and meeting the MDGs.
In early 2003, Tanzania was among the first African countries to offer antiretroviral drugs (ARVs) to its citizens. One of the key barriers to scaling up this effort was providing testing and counseling services to help with prevention and identify those in need of therapy. Another challenge was building capacity to care for the people who would come in to seek these services. Children also are a vastly underserved population in this country hard hit by HIV/AIDS.
Similarly, Emergency Medicine was not a recognized specialty in Tanzania. Prior to 2009, emergency care consisted of casualty wards, which sorted and transferred patients to appropriate wards, delaying critical-patient care. The greatest emergency medicine needs in Tanzania are traumas, primarily motor vehicle crashes and acute exacerbations of chronic illnesses.
Over the years, the Ministry of Health and development partners commissioned several assessments that reviewed the state of laboratory services in Tanzania. These assessments concluded that laboratory services were the weakest link to provision of quality healthcare, especially HIV/AIDS care. Most public health laboratories were inefficiently designed and generally in poor condition-understaffed and physical infrastructure and equipment in a state of disrepair–leaving a critical gap in patient services.
Working with the Ministry of Health, the Abbott Fund began one of the most comprehensive initiatives in Africa to strengthen a country's healthcare system and meet these challenges. An intensive training program on HIV care and treatment, voluntary HIV counseling and testing (VCT) was begun. Facilities and systems were upgraded at more than 90 sites throughout the country to improve VCT services and prepare for the availability of treatment programs. This work included renovating outpatient clinics to ensure patient privacy during VCT renovating laboratories, donating laboratory equipment, and creating local hospital HIV management teams.
At the same time, the Abbott Fund and the Ministry of Health identified Muhimbili National Hospital as the epicenter of its health system strengthening efforts. Located in Dar es Salaam, Muhimbili is the national teaching and reference hospital. It was determined that any improvements made at Muhimbili would trickle down throughout the entire health system. A new outpatient treatment center was built, which now serves more than 450 patients per day, and contains a training facility for students and hospital staff. The center was the first to integrate HIV treatment into its other outpatient services, helping to mitigate the stigma associated with HIV status. Hospital management received training to strengthen department organization and financial management, and a modern hospital wide IT system was installed that helps track inventory, prescriptions, and patient health history.
The hospital's Central Pathology Laboratory building was modernized and computerized to provide accurate diagnostic testing that is crucial not only for lifelong monitoring of HIV patients, but for those with other chronic illnesses like diabetes. It now performs more than 4,000 tests per day.
In 2009, a new Emergency Medicine Department was opened and training programs in emergency medicine were initiated at Muhimbili. The project successfully established Emergency Medicine as a specialty and developed a model EMD. Challenges include maintaining equipment, training consistency and record-keeping.
Abbott Fund invested $10 million to modernize all 23 regional-level laboratories in Tanzania over three years with the key objectives of building or renovating the laboratories to a standard design that focused on increasing efficiency and safety; providing equipment, enforcing preventative maintenance and quality assurance strategies and on site mentorship to laboratory staff.
Specialized Abbott employee volunteers have also provided mentoring, technical support and expertise in the areas of construction, engineering, infection control, IT, waste management, security and laboratory management.
The Abbott Fund constructed a pediatric HIV/AIDS Clinical Center of Excellence in Mbeya, in the southern Highlands of Tanzania.
The Abbott Fund has invested more than USD 94 million aimed at enhancing access to health care on a national scale. Each project that has been undertaken by the Abbott Fund partnership in Tanzania is developed with an eye to future sustainability. This has meant investing not only in physical structures, but also in people, education and training.
To address the challenge that donated equipment often goes unused due to lack of maintenance or repairs, the equipment is maintained by field service engineers supported by the Abbott Fund. Abbott also donates reagents and spare parts for Abbott equipment donated to the Central Pathology Laboratory.
To meet the need for HIV test kits after the announcement of President Kikwete’s National HIV Testing campaign, the Abbott Fund donated 1 million HIV tests to jump-start the campaign before test kits from PEPFAR became available.
The standard laboratory design that optimized efficiency and safety was a key success factor for the 23 regional-level hospital laboratories.
The Abbott Fund has supported 105 lab technology students pursuing university degrees. Staff placements of laboratory personnel are made in severely understaffed labs throughout Tanzania with pay and relocation incentives.
The emergency medical residency, nurse and ancillary staff training will provide a strong professional base for emergency care in Tanzania and other positive changes are forcing attention and systemic change. Changes are being supported by Abbott Fund to address financial sustainability, consistent high quality training, and electronic records.
The success of this venture is a strong example of what can be achieved when public and private sectors each bring their strengths and work together openly to find solutions to national health issues.
Abbott Fund projects began with a focus on HIV care and donations to support care but it was apparent early in the partnership that in order to provide sustainable and complete support a wider approach was needed. In orphan and vulnerable children projects Abbott Fund has sought district government and NGO partners who include economic development activities and legal support as part of the holistic approach to communities affected by HIV/AIDS.
In building health care capacity Abbott Fund projects have been guided by the Ministry of Health need for infrastructure development and capacity building through professional development and training. In order to maintain these investments without burdening the government budgets, Abbott Fund is looking to innovative solutions to develop financial sustainability of public institutions. Abbott Fund is currently embarking on a unique approach to financial sustainability in two departments in Tanzania’s largest public hospital that will allow continues high quality care for patients, regardless of ability to pay.
Initial results indicate that it is feasible to modernize laboratories nationwide in a resource-limited country by pooling local and international resources. Clearly defined roles for each partner are essential for successful implementation of complex projects. A preventative maintenance and mentoring strategy at the laboratories resulted in positive and sustainable change in staff capacity, attitude and mindset. The value of public-private partnerships in providing adaptability and in implementing rapid changes was clearly demonstrated.
Summary of impact through December 2011 and looking forward
Facilities, systems and training have been upgraded at 90 sites throughout the country to improve VCT services. Due to these improvements, more than 450,000 people have received VCT services. A 2007 government assessment found that one in three Tanzanians with HIV taking antiretroviral therapy received services at a facility that had benefited from Abbott Fund support.
More than 19,000 health care worker trainings have been conducted to date in Tanzania. At Muhimbili, 200 physicians now serve as trainers for other health staff. More than 250 staff have been trained in laboratory equipment operation, while more than 600 senior doctors and hospital directors have received management training.
One of the most extensive hospital IT systems in East Africa has been installed at Muhimbili to track billing, reimbursement, health history, referrals, test results and drug prescriptions. Volunteer Abbott employees provide technical support in construction, engineering, infection control, IT, waste management, security and lab management.
In 2011 Abbott Fund began a program to recruit and deploy laboratory technologists to regional hospital laboratories that were rehabilitated/constructed through Abbott Fund support; to date more than 18 technologists have been placed. Abbott Fund plans to continue to address specific regional lab staff shortages in 2012.
Through Abbott Fund support, emergency room services meeting international standards are now available for the first time at Muhimbili, more than 35,000 patients received critical care in 2010, the first year of its operation and the country’s first medical residency program to train emergency medicine specialists was started. Establishing an Emergency Department with Trauma care addresses changing population needs and serves as a model for the country.