January 19, 2019

Growing a Social Enterprise: Meet Rehema

Originally posted on CCBRT’s blog.

The CCBRT Private Clinic

Learn how Rehema leads the expansion of CCBRT’s Private Clinic

This month we are focusing on sustainability, and there’s no better example of sustainability than CCBRT’s mission to become a healthcare social enterprise. Rehema, General Manager of the Private Clinic, joined CCBRT in 2010 from the private sector. She took on the task of expanding our previous Private Clinic into a sustainable funding source for CCBRT that would meet the healthcare needs of Tanzania’s growing middle class and contribute to the healthcare needs of the most vulnerable. CCBRT’s social enterprise model ensures that all Tanzanians – regardless of ability to pay – are able to access essential healthcare. Revenues from the Private Clinic are re-invested in CCBRT’s main hospital, which treats vulnerable Tanzanians from across the country for free or highly subsidized rates.

While this social enterprise model is unique in Sub-Saharan Africa, it has proven successful in similar low-resource contexts, such as India. Using two decades of experience in Tanzania, CCBRT analyzed lessons learned from Aravind Eye Care System and Narayana Hrudayalaya Heart Hospital, which operate similar models, to create an innovative financing model that will ensure sustainable growth. Since the new Private Clinic has opened its doors, Rehema and the CCBRT team have embedded lean management thinking and culture into its operations – another innovation for the African health sector – improving patient flow and efficiency, minimizing waste and ensuring smooth service delivery.

Patients in the Private Clinic waiting area

A healthcare social enterprise is new to Dar es Salaam. Initially, patients feared that the free or highly subsidized rates would be eliminated. Rehema worked with CCBRT’s Marketing and Customer Care Department to educate the community on CCBRT’s social enterprise model, spreading the word about expanded services and opening hours. There is no difference in care between CCBRT’s main hospital and the Private Clinic. Additionally, the prices for CCBRT’s private services did not increase when the new clinic was built.

Rehema is focused on quality and continued growth for the Private Clinic in 2019. CCBRT has a goal of expanding services by ten percent to include dental, dialysis and primary care. She also hopes to increase the number of patients seen per day to 80. To meet this goal, Rehema and her team are continuing to build capacity of the new facility through staff trainings and recruitment.  

October 24, 2018

Life After Parent-Carer Trainings (PCTs)

Originally posted on the CCBRT blog

 

How did a PCT help Juliet support her child’s development?

CCBRT staff working with parent/caregivers.
Photo credit: Sala Lewis

Juliet, a mother of five and an entrepreneur, attended one of CCBRT’s parent-carer trainings (PCTs) about six months ago. Her journey to CCBRT started when her daughter was only one year old:

“I realized that my daughter had a developmental problem. She was not able to sit properly and her neck was not stable,” she said. Fortunately, community members told her that CCBRT may be able to help. After visiting the hospital, Juliet’s daughter was diagnosed with cerebral palsy and started physiotherapy sessions. The sessions helped Juliet’s daughter become stronger and more mobile, but the new mother wanted to support her daughter’s development even more. That’s when she learned about PCTs.

CCBRT started PCTs to engage parents/caregivers of children with cerebral palsy as the primary providers of their child’s treatment plan. PCTs take a simple approach to understanding and supporting children with cerebral palsy. After an overview of the condition, parents are taken through ten modules focused on home-based care of their children – including communicating, positioning, feeding, playing and using assistive devices – to help them create suitable environments. By bringing parents/caregivers together to understand cerebral palsy, observe therapy and learn to evaluate their children’s condition (when to get urgent care, how to identify changes, etc.), the PCT sessions build confidence, knowledge and experience that enable families to support children’s growth and development.

At the beginning of the summer Juliet attended a week-long PCT. In those five days, she learned more about cerebral palsy and practiced feeding and holding her daughter properly. Thanks to her new skills, life after PCT has been much easier. By stretching her daughter’s palms, for example, Juliet has helped further improve her daughter’s mobility and strength. “Because of the training that I got from CCBRT, I have seen a lot of improvements in my child’s development. Before I started working with her at home, she could not unfold her palms and her neck was very weak, but now she can hold and touch things,” Juliet explained. 

She is very thankful to now have the confidence to support her child’s development outside of formal physiotherapy sessions, especially since it is hard for her to travel to CCBRT as often as she would like. The PCT empowered Juliet to continue her child’s therapy at home. She concluded, “I thank God every day for CCBRT. I hope you continue providing these trainings, because you are touching the lives of many people.” While PCTs don’t replace the critical need for more rehabilitation staff and resources in Tanzania, teaching parents to provide for their child helps maximize the impact of physiotherapy sessions and optimize development outcomes.

September 7, 2018

Meet Dr. Timothy: What’s a Vacuum Delivery?

Originally posted on the CCBRT blog

 

“My interest is in helping women give birth – I love what I’m doing,” says Dr. Timothy.

Dr. Timothy Mushi has worked on CCBRT’s Maternal and Newborn Healthcare Capacity Building team since 2013. As a clinical trainer, he supports health workers in 22 capacity building sites to deliver high quality care to mothers and newborns. His most recent training program – held in a series of sessions earlier this year – focused on vacuum-assisted deliveries.

Meet Dr. Timothy

“Mothers in labor need to deliver within a certain time frame,” Dr. Timothy explains. “Prolonged labor isn’t healthy for the mother – it leaves her exhausted and can cause fistula or death. And it certainly isn’t good for the newborn, because it can cause birth asphyxia.” If a woman is eligible, trained nurses and doctors can use a vacuum device to ensure that babies are delivered during the appropriate window of time. Put simply, “when vacuum rates go up, fistula goes down.”

The procedure only takes 10 to 15 minutes, requiring much shorter preparation and recovery time than a Cesarean section. “The vacuum can have negative side effects if done poorly,” warns Dr. Timothy, “so that’s why we focus on training.” In this latest round, Dr. Timothy worked with 97 providers in seven of the busiest Dar es Salaam health facilities. His sessions consist of a brief classroom-like training to identify existing skills, followed by on-the-job training to fill knowledge gaps and give health workers a chance to perform the procedure with his assistance. From March to April, 42 vacuum-assisted deliveries were done under his supervision. Average skill scores of participants increased from 53% to 85% at the conclusion of the training.

Stories from the field demonstrate just how important this work is. Dr. Timothy recalls entering a busy labor ward one morning, where the doctor on-call was finishing his eighth Cesarean section since the night before. Exhausted, he asked Dr. Timothy to look after the final woman waiting for surgery.

“I reviewed the client and discovered that the baby was low enough for a vacuum extraction,” says Dr. Timothy. He performed a successful vacuum-assisted delivery, avoiding the need for surgery altogether. “The doctor observed my procedure and insisted that he would not leave until he learned how to do one, too. And the mother had not wanted an operation – she was so thankful for our help.”

August 31, 2018

New Private Clinic 101

Originally posted on the CCBRT blog

We’re excited to announce that after three years of construction, the new CCBRT Private Clinic building opened in July.

Confused about what our Private Clinic is, or how it differs from our standard services? Today we’re answering your questions.

What is the Private Clinic?

In 2004, CCBRT started offering private services to help subsidize the cost of care provided to patients who cannot afford crucial health services. Since then, the clinic has grown substantially: last year it served 7,608 new patients and provided 11,630 consultations. The revenue it generated was reinvested into the provision of CCBRT’s standard services, ultimately funding treatment for 20% of the hospital’s patients.

Although physically separate from the rest of the hospital, the Private Clinic offers the same high-quality ophthalmology, optometry, orthopedics and rehabilitation services, in addition to ear, nose and throat (ENT) and gynecological services. Patients at the Private Clinic can book appointments in advance over the phone, and the clinic building offers air conditioning, free internet and waiting room televisions.

What’s special about the new Private Clinic building?
The new building expands CCBRT’s current Private Clinic space by 300%,giving us more room to accommodate more patients in our current service areas, and to expand into new services.

In addition to our existing private service areas – ophthalmology, optical, orthopedics, physiotherapy, ENT and gynecology – the expanded clinic will offer a well baby and pediatric clinic, and will ultimately provide general medicine consultations. As well as a larger optical shop, the clinic will contain its own pharmacy and a phlebotomy lab for patients to visit for bloodwork and lab tests.

With large windows and motion sensor lights, the clinic is both well lit and energy efficient. Disability-accessible toilets are located on each floor, and the building’s four levels are connected by both stairs and elevators. As in the existing Private Clinic, patients will have air conditioning and free wi-fi. Visitors to the clinic can park in the parking lot close to the building’s main entrance on Ali Bin Said Road.

Why does CCBRT need a Private Clinic?
CCBRT provides life-changing care to thousands of Tanzanians living with disabilities every year. To ensure that everyone who needs our services is able to access them, we provide high-quality treatment to our patients at highly subsidized rates or free of charge. We believe cost shouldn’t be a barrier to healthcare.

The Private Clinic doesn’t only enable us to reach more Tanzanians with high quality medical services – it also helps make our accessible model sustainable in the long term. “Our goal is to be the major donor for CCBRT,” says Rehema Ngamilo, General Manager for Private Services. “Our goal is to give back to CCBRT so that we can give back to the community.”

What are the Private Clinic’s hours?
In addition to new space and new services, the new clinic will also offer extended hours for some service areas. The eye clinic, orthopedic clinic, optical shop and pharmacy will be open from 7:30am to 8pm from Monday to Friday, and from 9am to 1pm on Saturday. ENT will maintain its current hours: 7:30am to 4pm Monday to Friday. Hours for the gynecology, well baby and pediatric, physiotherapy and general medicine clinics will be set following the clinic’s opening.

May 21, 2018

“They need to know that there is life after fistula”

Originally posted on the CCBRT blog

“I always do the night shift, so I have lots of time to talk,” says nurse Damaris in the fistula ward. In fact, talking is part of her job. Damaris is one of very few nurses in Tanzania trained in counseling – an essential service for women recovering from obstetric fistula, most of whom have experienced great emotional trauma before accessing treatment.

We recognize that women and girls recovering from fistula require a comprehensive team of health professionals – from surgeons to counselors – for holistic recovery. That’s why we invest in training for nurses like Damaris. Before joining the team on the fistula ward, Damaris completed training at a nearby university to become a counselor. She explains: “Working with women recovering from fistula is emotional. After training, I can be strong to help carry their burden and help them move past their painful experiences.”

Damaris adds, “Even if women are physically healed from fistula, without counseling they are only halfway toward recovery. They need to know that there is life after fistula. They can return to their communities. They can connect with friends and family. They can start their own business.”

Meet Damaris

Damaris recalls one patient specifically, with a complicated case of two fistulae. Damaris noticed her patient’s distress – she didn’t talk to anyone and spent all of her time alone. In counseling, she began to open up to Damaris about her experience of abandonment: “I’m not even wanted by my own mother and father,” she revealed. But Damaris knew her future was bright. “I told her that everything was possible, that she would go back happy. And that I would support her every day until she went home dry.” The woman made a full recovery, and months later, she and Damaris still talk on the phone.

What inspires Damaris’ commitment to women with fistula? “They are women just like me. Their stories should be heard. Even though I can’t solve everything, I know that talking makes a big difference.”

There is great need for psychological support for women recovering from fistula in Tanzania. Damaris hopes that CCBRT can continue to train more fistula nurses in specialized counseling skills – “especially nurses on the night shift!”

April 20, 2018

CCBRT Academy: Tackling Human Resources for Health Challenges in Tanzania

Did you know that there is a severe shortage of healthcare workers globally? The shortage is estimated to reach 18 million by 2030.

Did you know that this shortage is hitting countries like Tanzania particularly hard? Sub-Saharan Africa is home to 11% of the world’s population. The region shoulders 24% of the global burden of disease, yet only accounts for 3% of the world’s health workers. Tanzania alone can count on just 5.2 clinical health workers per 10,000 people: one fifth of the optimal ratio recommended by the World Health Organization. The country also lacks sufficient numbers of trained specialists, with only 177 specialist surgeons and fewer than 22 anesthesiologists available to serve a population of over 55 million. The health workforce that does exist has limited access to medical education and professional development.

These shortages have a particularly damaging effect on the health and wellbeing of the most vulnerable, including women, children, and people with disabilities. It also makes it hard for providers, like our partner, CCBRT, to serve their patients, as they struggle to recruit and retain the skilled teams they need to deliver high quality, specialized services. Without well trained, well equipped healthcare workers people simply cannot access the quality of care they need and deserve. And without adequate healthcare, people’s access to education, employment and economic opportunity is limited too.

With the support of the Kupona community, our colleagues at CCBRT have been taking action to train and build the capacity of healthcare workers in Tanzania and further afield for many years. The maternal and newborn healthcare capacity building program empowers nurses like Ladness to save newborn lives. CCBRT’s expert fistula surgeons are sharing their skills with surgeons from around the world. CCBRT also gives its own staff many opportunities for continued professional development.

Until now, CCBRT’s efforts to strengthen the health workforce have been implemented in both CCBRT’s hospital in Dar es Salaam and at partner facilities across the country. They had no dedicated training facility, and no formalized central training program.

That’s all about to change.

Since 2015, with the support of Kupona partners Johnson & Johnson and the UCLA Anderson School of Management, CCBRT has been developing detailed plans for a Center of Excellence in Clinical Education. We’re delighted to announce that these plans will soon become a reality, with the opening of the CCBRT Academy next month.

“[The CCBRT Academy] is the realization of a vision that we have had for a long time here,” says Technical Advisor for Training and Capacity Building Tilman Hannig. Through a unique combination of in-person training, online education and practical, hands-on experience, “it will allow us to better professionalize and develop our own staff, as well as health workers from beyond CCBRT.”

When it’s ready, the training center will include room for meetings, small workshops, large trainings and simulations in a lab mimicking a real hospital setting, and will use CCBRT’s existing computer lab for online courses and digital education. The Academy will be a learning environment of the highest quality to enrich educational experiences for the region’s healthcare heroes.

Indeed, training through the Academy has already launched, starting with a Training of Trainers on clubfoot casting techniques for participants from around world, including 20 from Africa last week. In the coming weeks, the Academy will provide and host trainings on topics ranging from ophthalmology equipment and small incision cataract surgery to customer care and breastfeeding.

We are excited to see the CCBRT Academy thrive, and address one of the most serious challenges facing the healthcare system in Tanzania. As Tilman says, “We have the space. Now we need to fill it with life.”

 
April 6, 2018

Mapping CCBRT’s Impact: Why Do Patients Come From All Over Tanzania?

Originally posted on the CCBRT blog

Last year, CCBRT’s Ophthalmology Department provided more than 70,500 consultations and conducted more than 7,500 surgeries in the main hospital in Dar es Salaam. As you can see on the maps below, the patients who received these services came from all over Tanzania – and even beyond, from other countries in East Africa.

Why do patients come from so far to get eye services at CCBRT?

Since CCBRT first opened in 2001, the hospital has built a nationwide reputation as a provider of high quality eye services. Although options for eye services are gradually becoming more widespread, Tanzania still faces a serious shortage of eyecare professionals: the country currently has only 0.8 ophthalmologists for every one million people.

From the U.S., Kupona is proud to support efforts that increase access to high quality eye health services through fund and awareness raising, and through collaborations with esteemed partners like Lavelle Fund for the Blind. This partnership will support critical financial and technical investments over the next two years, enabling the CCBRT team to scale the provision of low cost, high quality services to people living with blindness or visual impairment in Tanzania, and to sustain these critical services for future generations. 

At CCBRT, the Ophthalmology Department team has decades of experience, including team members like Dr Cyprian Ntomoka, Eye Department Head and Vice President of the Tanzania Ophthalmology Society; Dr Sonia Vaitha, one of only three ophthalmologists in the country specializing in treating children; and Rehema Semindu, Tanzania’s only prosthetic eye technician. Each exemplifies the dedication and specialized knowledge of the department’s 3 specialist ophthalmologists, 2 ophthalmologists, 7 Medical Doctors and Assistant Medical Officers, 5 optometrists, one low vision therapist, and 50 nurses.

This unique expertise is why doctors around Tanzania refer their eye patients to CCBRT, and why people travel from places as far away as Mbeya and Mwanza to seek treatment in our main hospital. 

We are proud of the work the Ophthalmology Department does, and we are committed to leveraging in-house expertise as we continue to fight against avoidable blindness in Tanzania.

January 18, 2018

Recognition Matters for Maternal & Newborn Health

Originally posted on the CCBRT blog

At the end of last year, CCBRT hosted a ceremony to recognize the top performing maternal and newborn health facilities in Dar es Salaam.

CCBRT’s Maternal and Newborn Healthcare Capacity Building Program coordinates a lot of activities: coaching, mentoring and training of health professionals; delivering life saving equipment and supplies to maternity wards; working with hospital management teams to identify problems and find solutions; and so on. But if you ask Manager and Technical Advisor, Dr. Brenda D’mello, about the program’s most unique feature? “Efforts to recognize the extraordinarily hardworking doctors and nurses on the front-line,” she says.

“In order to measure progress in quality of care, we use a tool called SBMR (Standards-Based Management and Recognition). Our program – particularly the ultrasound initiative – truly puts the ‘R’ in ‘SBMR,’” Dr. Brenda explains.

Indeed, last November CCBRT hosted a ceremony to recognize the top performing maternal and newborn health facilities in Dar es Salaam. The ten facilities that received the highest marks in CCBRT’s composite score – measuring everything from target delivery numbers to inclusion of women with disabilities – were awarded ultrasound machines from the Honorable Regional Commissioner of Dar es Salaam.

This “competition” motivated facilities to improve their services for mothers and babies. As one hospital in-charge stated at the ceremony: “Everyone is working very hard and everyone wants to work as hard as they can. Recognition drives us to move forward and brings us to excellence. As Dr. Brenda always says, ‘even a small thing you can do for a health worker will mean everything to them’.” Dr. Brenda sees recognition of healthcare workers as a crucial component of Respectful Maternity Care, describing it as “care for the caregiver.”

Individual healthcare workers were also recognized for excellence in performance. 81 nurses scored above 80% in performance assessments, meeting recognition criteria. Notably, 26 of these nurses scored 100%! CCBRT’s capacity building team is proud of the sites’ accomplishments and incredible progress in the past seven years. In total, average scores on quality of care assessments have increased from 10% in 2010 to 82% in 2017 – leading to a 40% reduction in maternal deaths and 14% reduction in stillbirths.

December 5, 2017

Life Saving Priorities: Capacity Building

Originally posted on the CCBRT blog

Tanzania is home to seven health professionals per 10,000 population. The World Health Organization recommends 45 per the same number of people. This workforce shortage overwhelms health professionals, leading to poor working conditions, poor quality of care and poor health outcomes. Facing these challenges, how does Kupona’s partner in Tanzania, CCBRT, save lives? By prioritizing capacity building.

Capacity building can take many shapes and forms. It can focus on the needs of CCBRT, like sponsored trainings for doctors to specialize in anesthesiology. It can focus on the needs of partner facilities, like newborn health equipment donated to Temeke Hospital. Or it can focus on the needs of the greater Tanzanian health workforce, like planning for the CCBRT Centre for Excellence in Clinical Education.

Perhaps the greatest example of CCBRT’s efforts in the past five years lies in their Maternal & Newborn Health Capacity Building (MHCB) Program, currently working in 23 sites across Dar es Salaam. MHCB aims to strengthen the skills of health professionals to improve health outcomes for mothers and babies. From 2013 to 2017, this included training, coaching and mentoring of more than 5,000 healthcare workers.

The results for health services? An increase in the use of life saving interventions, like vacuum delivery (used when labor has not progressed adequately), Cesarean section (used when vaginal delivery would risk the life of mother or baby) and Kangaroo Mother Care (used when a baby is born premature).

The results for quality of care? A 720% increase – from 10% to 82% – in quality of care, according to standards-based performance assessments. These measure adherence to standards related to labor, delivery and newborn care, infrastructure, human resources, education, communication and support systems.

And the results for patients? As of 2016, a 40% reduction in maternal deaths and a 14% reduction in stillbirths across facilities – with further reductions expected in 2017.

As one nurse reported, “If I can now save children, it is only because of what I have learned from CCBRT. Before I was not fully aware of what to do, for example, with premature kids, but now it is a pleasure for me to see them grow through Kangaroo Mother Care!”

A new mother of twins echoed this statement: “I was scared, as I had never experienced premature babies. But doctors and nurses advised on taking care of them. I am grateful for their help because, without it, I would have lost them.”

Providers and patients agree: the MHCB model works. The achievements of this program from 2013 to 2017 pave the way for additional activities in the upcoming strategy period, from 2018 to 2022. Following the success of supporting frontline health workers, the next phase of capacity building will support leaders in the regional health system.

November 26, 2013

Why I care

A bit more background on me, for those of you who have supported us in the past, and will hopefully continue to support us in the future. My husband Mike and I spent five months living in Dar es Salaam in early 2012, when Mike had the opportunity to work on a project in Tanzania. I took a sabbatical from my work with Deloitte’s Human Capital Consulting practice. Through a series of strange connections, including my soccer coach and the former Board President of Kupona, I was connected to CCBRT. They gladly accepted the “free” management consultant, and gave me the opportunity to lead the development of CCBRT’s 2013-2017 Strategy. And by “led,” I mean that I helped create a framework, researched, interviewed, and facilitated discussions. Consultants come and go – the strategy needed to be something that was owned and developed by CCBRT. You can read CCBRT’s 2013-2017 Strategy on our website.

IMG_7723_v2

Neemah is being treated for obstetric fistula

The more I learned about CCBRT, the more impressed I was by the impact they were having on over a million people each year in Tanzania… The high quality services provided equally to the poorest and to those who could afford to pay more. The comprehensive approach to Community Based Rehabilitation – bringing care for children and adults with disabilities directly to the communities. The focus on sustainability through their Private Clinic and the establishment of Kupona Foundation in 2009. The leadership and staff in Dar es Salaam and Moshi. The public-private partnership with the government of Tanzania. The innovative approaches that CCBRT was not afraid to take – such as using mobile money to transport fistula patients to the Disability Hospital, breaking the transport barrier that prevented the poorest from being cured. I could go on.

When I learned that Kupona’s Executive Director was going to step down with the birth of her second child, I thought that perhaps I could help with the transition. And then I thought, maybe this is the time. As an undergraduate Sociology major and even through Business School, I had maintained a long-term career interest in working in the nonprofit/development world, which was based on my fundamental belief that everyone deserves to have access to opportunity.

Tanz-CCBRT-ClubFeet1f

Kaspar was born with club feet, a correctable disability

We are very fortunate in the United States. We take things for granted sometimes. In the U.S., if I broke my leg playing soccer, I wouldn’t spend the rest of my life with a disability. Friends who had complications giving birth won’t spend the rest of their lives with obstetric fistula, as outcasts in their communities. When my grandmother developed cataracts, she didn’t spend the rest of her life blind.

By preventing and curing disability, CCBRT gives people the opportunity to live – not only changing the lives of patients, but also of their families and communities. This is why I made the decision to join Kupona.

I am optimistic about our future, and of the expanding impact we will have through CCBRT. At this time of year, as we give thanks for our family, friends, and health, consider helping others have the same opportunities through a gift that will change lives.

Abbey

AKocan4_Oct 2013

Abbey Kocan, Executive Director

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