Teaching quality improvement in Tanzania: a model of inter-professional partnership for global health development

There is a great need for improved health care in developing countries.
Education is a common and fundamental aspect of health development.
Modeling education can help health care institutions develop an education culture and infrastructure.
Effective programs should be able to scale and spread, and be sustainable.⁴
Effective programs build on long-term partnerships.
There is great interest among US health care workers in serving overseas, especially short term assignments.
Actual service promotes greater engagement, lifelong commitment, and interest in global health service.⁵
Health care workers have limited ability to volunteer based on constraints in time, expense, and professional and family commitments.
Building relationships and providing moral support are important components of many programs.

Table 2

Purpose Statements

Provide learning opportunities for physicians, nurses, pharmacists, and administrators who staff CSSC Hospitals in Southern Tanzania.
Promote a culture of lifelong learning and education.
Foster inter-professional teamwork between nursing, pharmacy, medicine, and administration.
Foster relationships with international development partners.
Develop actionable quality improvement plans.
Foster sustainable improvement in medical care and the health of communities in Southern Tanzania.
Engage interest among U.S. health care professionals and students in contributing to global health development.
Foster education of U.S. students (medical, pharmacy, nursing, and healthcare administration students and resident doctors-in-training).
Provide U.S. volunteers with opportunity to learn about medicine in the developing world.

Table 3

Guiding Principles

Lifelong Learning: We believe all professionals should contribute to a culture of learning and continuously learn to improve their practice. We include students and residents in preparation for and presentation of the conference.
Inter-professional Teamwork: We include nurses, pharmacists, administrators, and physicians in both the attendance and presentations.⁶ We emphasize teamwork throughout the conference. We each bring unique knowledge and skills to share; specifically, Tanzanian presenters emphasize tropical medicine and HIV, and American presenters emphasize the growing global problem of chronic and non-communicable diseases.
Mutual Respect: We emphasize the ability of all our participants to teach and learn from each other regardless of differences in practice setting, culture, and socio-economic situation. We include local leaders in planning the conference and select topics based on feedback from participants.⁷ Presentations are delivered by both U.S. and Tanzanian professionals. We adhere to the highest international standards in the preparation of the educational content and accreditation of the program.⁸ The program is based on the foundation of a longstanding and ongoing relationship. ⁹
Continuous Improvement: Learning should drive improvement in practice.¹⁰ We include education on principles and tools for developing quality improvement plans. Each team prepares a specific quality improvement plan to implement upon returning to home hospitals.¹¹
Sustainable Impact: We believe that education and improvement are some of the most valuable ways to promote a lasting and sustainable positive impact on the health of our partner's communities.¹²

Table 4

Learning Objectives

Participants will learn current concepts and techniques in medical care in the acute hospital setting.
Participants will be able to compare and contrast current practices in U.S. hospitals and Tanzania hospitals. Reasons for differences will be highlighted.
Participants will develop quality improvement action plans for their own hospitals based on learning from the presentations and skills lab.

Table 5

Budget Spreadsheet

Item	Number	Days	Cost/person	Total	US$
Travel costs reimbursed for attendees	118		TZS 60,000	TZS 7,080,000	$3,218
Lodging costs reimbursed for attendees	118	3	TZS 150,000	TZS 17,700,000	$8,045
Meals	153	2	TZS 31,000	TZS 4,743,000	$2,156
Lecture Hall Rental				TZS 200,000	$91
Local Course Directors honorarium				TZS 960,000	$436
Honorarium for invited TZ faculty	6		TZS 100,000	TZS 600,000	$273
Local Secretary				TZS 40,000	$18
Local car and fuel costs				TZS 200,000	$91
Copying Costs	725		TZS 150	TZS 108,750	$49
Folders	145		TZS 500	TZS 72,500	$33
Writing Books	118		TZS 1,500	TZS 177,000	$80
USB Drives					$500
Pens					$250
Conference Costs Subtotal					$15,241
Wire Transfer Surcharge Add 2%					$305
Total					$15,546

Table 6

Positive Survey Comments

Very interesting, loved it
All I learned was very important
This presentation should be carried every year
Good flow of presentation, it was well organized meeting
I want to learn more about quality improvement
You are doing a great job. Please extend the time for the presentations. God Bless You!
I like how was arranged this international meeting, meeting with other hospitals and exchange of ideas
Keep it up so that the medical conference should be continuing for more updates
Continue organization of this important conference
We appreciate you and we know your contribution to us. We'll come again next year

Table 7

Opportunities for Improvement

More learning on leadership, management in hospital
Topics on quality improvement should have more time
Reduce speed of teaching
Per Diem to be paid early to meet all expenses
Please extend the time for presentations, 2 days are not enough
Management of diabetes mellitus and cardiovascular diseases should be taught in detail
American English difficult
After each session, especially for disease, you have to elaborate more on drug of choice.
Time for conference is too short (days)

Evaluation Form	RATING (Rate 1-5) 1=not valuable 5=very valuable
PLEASE RATE THE OVERALL VALUE OF THE CONFERENCE	1	2	3	4	5
PLEASE RATE THE VALUE OF EACH TOPIC
Quality Improvement: Pfeiffer/Jensen	1	2		3	4	5
Keynote Address: Sterile Technique: Kitundu	1	2		3	4	5
Co-Leadership: Plooster	1	2		3	4	5
Wound Care: Hussein	1	2		3	4	5
Cleaning, Disinfection, and Sterilization: Holmuth	1	2		3	4	5
Peripheral IV line insertion and maintainance: Jennerjohn/Gornall	1	2		3	4	5
Insulin and Goals of Diabetes Therapy: Kayworth	1	2		3	4	5
Cancer Care: Hurley	1	2		3	4	5
Rheumatologic Diseases: Ramdass	1	2		3	4	5
HIV Associated Malignancies: Rangaraju	1	2		3	4	5
BPH: Olson	1	2		3	4	5
Public Health and Nutrition: Saga	1	2		3	4	5
Hand Hygiene: Holmuth	1	2		3	4	5
Chikungunya: Creech	1	2		3	4	5
Pharmacy Stock Outs: Hwang	1	2		3	4	5
HIV Update: Mziray	1	2		3	4	5
Contraception: Anderson	1	2		3	4	5
Develop Quality Improvement Plans	1	2		3	4	5
Breakout: Community Based Primary Health Care: Jensen	1	2		3	4	5
Breakout: Administrative Keynote: Kikoti	1	2		3	4	5
Breakout: CBPHC Workshop/Learning Circles	1	2		3	4	5
Are you a… Physician Nurse Pharmacist Administrator Other
Has your competence increased in Objective 1, understanding concepts and techniques in medical care in the acute hospital setting? Yes No
Je uwezo wako umeongezeka katika lengo la Kwanza
Has your competence increased in Objective 2, understanding practices in US and Tanzania hospitals? Yes No
Je uwezo wako umeongezeka katika lengo la Pili
Has your competence increased in Objective 3, developing quality improvement action plans? Yes No
Je uwezo wako umeongezeka katika lengo la Tatu
This activity has impacted my clinical practice, competence or patient care outcomes. Shughuli hii imeathiri mazoezi kliniki, uwezo au kutawanya matokeo yangu.
Strongly Agree Agree Neutral Disagree Strongly Disagree
Was the presentation fair and free from bias ? Ilikuwa onyesho haki na huru bila upendeleo Yes No
Was the presenter fair and free from bias? Alikuwa mtangazaji wa haki na huru bila upendeleo Yes No
Please tell us the most important things you learned Tafadhali Tuambie mambo muhimu uliojifunza

Please tell us of any bias (upendeleo) you found Tafadhali Tuambie mapendeleo wowote ulio kutana

What else would you like us to know? Ungependa nini kingine sisi kujua?

What would you like to have us teach about next year? Je utapenda tufundishe mambo gani kuhusu mwaka ujao?

References

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DOI: https://doi.org/10.15566/cjgh.v4i1.129 | Journal eISSN: 2167-2415

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Language: English

Page range: 34 - 45

Published on: Mar 9, 2017

Published by: Global Health Institute at William Carey International University

In partnership with: Paradigm Publishing Services

Keywords:

Health,

© 2017 John Kvasnicka, Ken Olson, Mufwimi Saga, Ignas Danda, Randy Hurley, Gary Moody, Cindy Wilke, published by Global Health Institute at William Carey International University
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 4 (2017): Issue 1