Archdiocese of Mwanza: Improving the health condition.

The specific problem I am solving is poor health services among Archdiocesan health facilities in Mwanza region. 

The capacity of the health system in the facilities owned by Archdiocese of Mwanza is in critical condition as they lack sufficient staff of all cadres, possess old buildings, poor supply chain and insufficient primary health care services. Lack of sufficient staff is caused by high turn over of health workers, some of them assuming work at Government health facilities and others retire from work while others die. The other major cause may be related to lack of sufficient funds for recruitment of new health workers, funds for purchasing medicine and medical supplies and renovation of buildings as well as for mobile clinics in the remote areas. Other causes may be related to lack of knowledge on use of new technology. The Archdiocesan health facilities serve about 2 million people in Mwanza region, so people will suffer from receiving optimum care, making them to wander from place to place in search for optimum care and hence, delay in receiving care if no solution is made to alleviate the situation. The community around these facilities suffers both from communicable and non-communicable diseases. Shortage of resources is the main challenge for attaining of Sustainable Development Goals (SDGs) in Tanzania and in Africa in general. The World Health Organization (WHO) asserts that in order to achieve SDGs, a minimum density of 2.5 health workers per 1,000 people is required. In Tanzania there is a severe shortage of health workers especially in the high skilled cadre and the density is estimated to be 1.5.

The solutions expected to alleviate this problem is to secure funds for recruitment and deployment of sufficient staffs, renovate the buildings, improve the supply chain and improve primary health care services through application of improved technology. 

The Health Department of the Archdiocese of Mwanza was established in 1990 as an executive organ of the Archdiocese of Mwanza under the highest authority of the Mwanza Archdiocesan Medical Board.

The Health department is coordinating and monitoring health facilities, training institutions, health projects and health units. The institutions include: Sumve Designated Hospital (SDH), Bukumbi Hospital, Sumve Institute of Health and Allied Sciences and Technology (SIHAST), Bukumbi Institute of Health and Allied Science (BIHAS), Nyakahoja Polyclinic, Buhingo Dispensary, Shaloom Care House and Parish Health Committees distributed in 84 parishes in Mwanza region. To achieve the goals of these institutions, resources are essential. Therefore, the institutions have been depending on income from own sources, sponsor ships, gifts/donations in running day to day activities. The SIHAST and BIHAST recruit health workers some of them to work in the Archdiocesan health facilities and others to work elsewhere in health facilities in Tanzania. The Archdiocesan health facilities generate income from user fees which are used to buy medicine, medical supplies and other medical equipment. Recently these facilities have introduced a new technology of monitoring their income so that every fund paid to hospital services are monitored by a specific technology. The old buildings are now repaired using user fees and primary health care services are conducted in these health facilities through assistance from government donations. Other primary health care services are conducted in the parishes through Parish Health Committees in volunteerism basis. Information on health from these committees  is obtained through mobile phones though outdated, efforts to improve this technology is under way.

The Archdiocese of Mwanza Health Department is serving this solution through its institutions. It has 7 institutions and 84 parishes serving more than 2 millions people in Mwanza region comprising of 6 million. The most vulnerable people such as women and children, elderly people and the poor are beneficiaries of the services provided. Pregnant mothers and children under five years of age receive care free of charge with some support from the government. People living with HIV/AIDS also receive care from these health facilities free of charge with some support from government grand. 

Parishes from different localities in Mwanza region provide counseling and health education in the community to their believers and around the community and, especially to people with chronic diseases such as HIV/AIDS, diabetes, hypertension and cancer who also receive psychological counseling from priests. 

However, the most vulnerable groups such as pregnant women, under fives and old people are undeserved due to the growing number of these groups. These groups receive care free of charge however, at times, funds to obtain medicine and other medical supplies may be limited necessitating to receive sub-optimal care in the health facilities.

The solution is aimed to improve this situation through securing of funds to buy medicines and medical supplies and hiring qualified staff in the health facilities to provide optimal care. These staffs will also reach the vulnerable people who live very far from the health facilities. With the stock of money the organization will be able to recruit and replace health workers who drop from work. The supply chain will be improved through purchasing the required medicine and other medical supplies for managing extra patients. Primary health care services will be improved through regular visits to the remote areas and provide care. People who are hard to reach like poor people, women, children and the poor living at especially difficult conditions will be reached as there will be availability of transport to facilitate mobile clinics with improved technology. Health education to these communities will be provided to modify their unhealthy behavior and adopt the health style using different health action models with improved technology. 

Together with my team, we are well-positioned to deliver this solution efficiently. We have an extended health facilities with a diversity of parishes that comprise health committees that originate from the community. These Parish Health Committees serve many people in the community. They provide health education and counseling sessions in the Archdiocese of Mwanza. These Health committees comprise a mixture of skilled people including retired health workers living in the community, health workers working in health facilities, community health workers and volunteers, religious workers and indigenous people. The solution is actually a community based aiming to improve the health conditions of people living in the community. Most of the health problems are obtained during health education sessions in the community where community health interventions are planned together with the community and short term plans regarding their health problems and priorities are planned.

At the top level, the team is well organized to provide support at the lower level. The team include also officer in-charges of implementing health facilities and primary health care workers who are also the implementer of these services at the lower level.

Approximately 2 million people in Mwanza region are currently served by the solution. Most of the clients are women and children. 

I am applying to Solve for aid to solve and improve this challenge which is the main cause contributing to poor health services in our Country leading to both high maternal and infant morbidity and mortality rates in the country. The Archdiocese of Mwanza has well established system to deal with health issues in the region. What it lacks is technological and financial support to control over and meet with emergencies like epidemics and other incresing demand of health services in the community it serves. The organization has tried enough to build resilience to the Archdiocesan health facilities with minimal support from development partners. The Archdiocese of Mwanza especially the Health department expects that Solve will be able to connect to other partners who will be able to provide support of any kind ranging from material support, financial support and technical to be able to achieve the solution effectively. Our organization will  appreciate any kind of support which will assist in accomplishment of the solution in question.

The solution approaches the problem in a holistic way as it tries to involve both the community and the implementer of the solution. They come together to discuss the challenges regarding their health and design way to improve the situation. The solution involves also leaders in the organization who oversee the progress of the solution. The institutions like hospitals are adopting new technology for example they are using Electronic Hospital Solution (EHS) to manage patients and control revenues obtained from user fees. 

At the community level efforts to use mobile phones in producing reports are underway. People will be trained on the use of smart phones to produce reports and community members with phones will be enabled to report to a health worker or enabled to diagnose by himself/herself before decided to seek a health worker or health care in a health facility.

It is expected that people will be aware of their health problems through improved technology and the market will be changed through this technology.

My impact goals include: Reduction of morbidity and mortality in the community. In this goal, one  objective is to have satisfactory infrastructures in which planned activities is to renovate existing buildings and add new ones -at least 40% renovation and one new building. Maintain the infrastructure regularly including infrastructure for technologies. Equip the institutions with the necessary and required facilities. Adherence to the government standards and consultation regularly. Prepare top ten diseases inpatient and outpatient protocol within the first six months and keep updating using improved technology.

The other objective is to have qualified staffs. The activities to be implemented include: recruit skilled staffs annually wherever there is vacancy; regular professional development and expose staffs on current development. 

The other objective is to have standard medical care and prevention with improved technology. The activities include: standard laboratory investigations; regular community awareness; continuous specialized clinics conducted; regular and immediate follow-up of progress on health status of patients; good custom care to clients/patients; immediate referral of patients; intensive care unit service provided; standard emergency services provided; standard obstetric and gynecological services provided; surgical services with specialized surgical procedures performed (within 3 years); Radiological services (x-ray, USS, ECG) provided (within the first year of the strategic plan); ensure availability of medical supplies, medicine, medical equipment and reagents.

The other objective is to reduce morbidity and mortality in people living with HIV and AIDS. The activities include: community awareness on HIV and AIDS; Supporting people living with HIV and AIDS; counseling and testing of HIV; regular counseling to people living with HIV and AIDS; cooperate with government and other partners in providing CTC services. 

The other objective is to have a standard management information system. The activities include: install reliable software hospital information system in the first two years; keep updating software; recruit IT personnel within the first two years; regular staff orientation on hospital management information system.

The other objective is to expand in offering health services. The activities include: expand in infrastructure such as ICU, emergency building, ophthalmology, dental unit, theater, standard labor ward and mortuary; acquire the necessary and required facilities such as current books and equipped skills laboratory regularly and when there is a demand; always recruit qualified professional staff and other supporting staffs; publicity on monthly basis; strengthen relationship with community and like minded institutions.

The other objective is to have mutual relationship with parish committees. The activities include: to organize regular meetings between two parties to brainstorm common issues; to seek some individuals with health profession for giving medical support in the parishes; to establish health committees. 

The other objective is resource mobilization. The activities include: To generate funds from local community (donor mapping, fund raising events, community awareness, proposal writing, internal income generating activities e.g. shops, canteen, pharmacy, poultry agriculture etc); generate funds from international donors (donor mapping, publicity, proposal writing, networking etc).

The progress toward the impact goals are measured using two approaches. One is internal monitoring and evaluation. This approach include: units and general meetings to assess level of performance and setting new strategies; Monthly and Quarterly performance reports;Performance appraisal and review of duties after every six months; use of developed performance forms with specified and measurable indicators; conduction of monthly Quality Improvement Team (QIT) meetings; use of suggestion boxes and monthly review of written documents; monthly review of work plans;regular supervision and follow-ups; budget check and review every month, monthly bank reconciliation; review the prepared financial reports.

The other approach is external monitoring and evaluation. This approach will include inviting external Auditors; Hiring External monitoring evaluators (consultants: half a year and yealy evaluation.

The Archdiocese of Mwanza, Health Department is trying to improve the health condition of people based on the following Logical Framework Approach:

Narrative Summary

Objectively Verifiable Indicators

Means of Verification

External Factors (important assumptions)

Goal:

To contribute to the improvement of the health condition of people in the Archdiocese of Mwanza through provision of sustainable health services.

-Increased demand of health care;

-Zero number of deaths from pregnant women and children under 5 years;

-Well established health facilities;

-No stock out of medicine and medical supplies.

-Health facility data;

-Records from health facilities

-Reports;

-Physical observations,

-Survey.

-People’s willingness to utilize health services;

-Political stability.

Purpose:

To provide excellent health care through improved technology.

Specific objectives:

1.       To have satisfactory infrastructure.

2.       To have qualified staff.

3.       To have standard medical care and prevention services.

4.       To provide care to people living with HIV and AIDS.

5.       To have standard management information system.

6.       To mobilize resources.

-Number of buildings renovated;

-Number of new buildings

-Number of staffs recruited;

-Number of qualified staffs employed;

-Number of reported epidemic diseases;

-Number of CTC established;

-Number of computers used. 

-Electronic Hospital solution and other systems in place;

-Type of electronic system used;

-Number of fund-raising events performed;

-Number of proposal writings accepted.

- Physical observations

- Reports;

- Interview with clients;

-Records;

-Surveys; 

-Availability of funds. 

-Funds are available in time;

-Communities appreciate services provided.

-Support on new technology available.

-People’s willingness to donate;

-Proposal writings accepted by donors.

Outputs:

1.       Health buildings renovated.

2.       Qualified staffs deployed.

3.       Standard medical equipment obtained.

4.       Care and Treatment Center for HIV and AIDS established

5.       Hardware and software materials obtained.

6.       Funds secured. 

-Number of buildings renovated’

-Number of qualified deployed;

-Number medical equipment obtained by type;

-Number of CTCs established; 

-Number of computers obtained;

-Type of software used.

-Reports;

-Inventory;

-Physical observations.

-Receipts;

-Funds available all the time of renovation;

-Materials available all the of construction in reasonable price.

Activities:

1.       -Renovate old buildings.

2.       Construct new buildings.

3.       -Recruit staff

-Employ qualified staffs.

3. -Procure medical equipment

4. -Secure buildings for CTC.

  -Construct new building.

5. Procure computers and Laptops.

6. -Conduct fund raising sessions,

  -Proposal writing.

  -Obtain funds from user fees, shops and donors.

Inputs:

-Funds;

-materials

-Engineers;

-Students;

-Staffs;

-Buildings;

-Reports;

-Financial reports;

-Conducive environment to enable all activities to take place.

The core technology that powers my solution is use Electronic Hospital Solution (EHS) and Health care systems which are being implemented in our health facilities. These technologies have enabled our facilities to reduce the amount of paper work used, increasing the amount of revenues received from user fees and reduce the number of visits to the facilities, hence better utilization of resources. Also mobile phones are extensively used to submit health facility reports through WhatsApp, and advertisement through U-tube, Facebook, emails and internet.

The Health department is coordinating and monitoring health facilities, training institutions, health projects and health units. The Archdiocesan health facilities generate income from user fees which are used to buy medicine, medical supplies and other medical equipment. Recently these facilities have introduced a new technology of monitoring their income so that every fund paid to hospital services are monitored by an automated computer software (Hospital management systems). The aim being:

• To reduce or eradicate costs resulted from use of papers; 
• To promote transparency and accountability;
• To minimize leakage of medicine, medical supplies and finances.

In order to implement the above technologies, the department requires:

• Infrastructure which will allow the software system to manage all departments in particular hospitals, Polyclinic, dispensaries and parish health facilities.
• Software system which is suitable to manage in particular hospitals, Polyclinic, dispensaries and parish health facilities.
• Hardware capable of running the above software systems.
• Train staffs from hospitals, Polyclinic, dispensaries and parish health facilities to adapt newly implemented technologies.

The solution team is formed by a diversity of people from different localities. The Archdiocese of Mwanza is a Catholic organization allocated in Mwanza region in Tanzania and is formed by 7 denaries distributed in 4 districts of Mwanza region namely Nyamagana, Ilemela, Misungwi and Magu. In 1990 the Organization established a Health Department of the Archdiocese of Mwanza under the highest authority of the Mwanza Archdiocesan Medical Board to oversee and complement health services provided by the Government in the areas of Bukumbi in Misingwi district (served by Bukumbi hospital), Sumve in Kwimba district (served by Sumve Designated District hospital), Buhingo in Misungwi district - Misasi area (served by Buhingo dispensary), Nyakahoja in Nyamagana Municipality (served by Nyakahoja dispensary), Kirumba in Ilemela Municipality (served by Shaloom Care House) and a diversity of parishes distributed throughout the districts of Nyamagana, Ilemela, Misungwi and Magu.

Services are provided to all people regardless of tribe, race or religious backgrounds. The representatives of the team are drawn from all the parts where the solution is implemented. Members of the team have equal opportunity to the services provided. They play part in planning and implementation of their own health problems. At planning stage each member is allowed to prioritize what he/she is appropriate. In implementing the solution, every member is consult through mobile phones by either text messages, WhatsApp or Facebook. All the contributions from members are respected and horned.  

The Health department of the Archdiocese of Mwanza provides services to its beneficiaries through 2 hospitals, 2 dispensaries, 1 civil society organization, 2 institutes and 84 parishes and sub-parishes. Our beneficiaries receive our services in these institutions through creation of awareness for services rendered to them. Upon receiving information about our services people come for services.

Awareness creation is made from different sources including advertisement in public meetings and congregations, advertisement in radios and televisions, and in mobile phones through WhatsApp, U-Tube, Facebook and Instagram. 

People with health problems appear in our health facilities for treatment and counseling. People need this service for solving their ill-health problems which hinder them from executing development endeavors. 

Sick people seek care and advice in our health facilities regardless of tribe, race, religious or political backgrounds. A sick person is registered and his/her history taken and examined by a qualified health worker and, depending on his/her complaints, the patient is investigated using medical equipment such as ultrasound machines, x-rays and other laboratory services. Patients are finely given medicines according to their diagnosis and then scheduled for follow-ups until he/she is completely cured.

On the other hand, people living with HIV and AIDS have special clinics called care and treatment centers (CTCs) in the health facilities. These clients are first diagnosed with the health facilities but sometimes in the community by community health workers who then refer them in the health facilities. Prior to the diagnoses, clients receive counseling by a trained counselor who refer her/him to the CTC of choice.

At the CTC clients are rechecked for HIV using specific reagents for more confirmation and treatment. Depending on the condition of the client, patients are put on the life long treatment of ant-retro viral therapy (ARV) which are given on monthly, quarterly or 6 months period. HIV/AIDS patients undergo a series of investigations to monitor progress. Apart from normal laboratory investigations clients have the opportunity to check for their CD4 and viral levels to monitoring the success of treatment.

My plan for becoming financially sustainable is to supervise the services provided by our institutions. Clients utilizing our services will be monitored through Electronic Hospital Solution (EHS) technology which has showed improvements in revenue collection and utilization and reduce the costs resulted from paper work. Other plans are: strengthen relationship with government, community, like minded institutions, and international institutions; Staffs development/constant staff development; Create and improve income generating activities and resource searching; keep team work; Purchasing of items/ facilities of reasonable quality at right cost through cooperative analysis; Careful planning/ monitoring, evaluation and adjustment; Put in place succession plans and reduce the gap between owner and institution managers. Together with improved technologies used in our institutions the organization is likely to become financially sustained. 

Examples of my plan to achieve financial sustainability include use of revenues collected from user fees in our health facilities, tuition fees generated from our institutions, contributions from parishes.

Others grants from governments which are provided to our hospitals to assist in purchasing medicines and other medical supplies. The introduction of Electronic Hospital Solution technology is likely to improve efficiency and improve revenues from our customers.