[NOTE: This is an UPDATE to a case study initially published in 2009. Read the original case study for appropriate context.]
As part of a comprehensive program to help Tanzania modernize its health system, the Abbott Fund earmarked $10 million in 2007 to revamp 23 regional-level hospital laboratories and design four others in the country within three years. This ambitious program—launched in partnership with the Ministry of Health and Social Welfare (MoH), the U.S. Centers for Disease Control and Prevention, and the Association of Public Health Laboratories—called for a complete redesign and reconstruction of laboratories. It also involved the installation of appropriate equipment as well as the preparation of a full brigade of new medical laboratory technologists and the training and mentoring of existing ones.
The Abbott Fund, the philanthropic foundation of the global health care company Abbott, drew extensively on its experience revamping the laboratory at Muhimbili National Hospital, which sits at the apex of Tanzania’s hospital referral system. When the first volume of the Case Studies for Global Health was published in late 2009, the project was roughly half done.
Since then, all of the new laboratories have been rebuilt and equipped, within budget and on time. Beyond that, the program has launched a major information technology project to connect the laboratories and set up a data center, which should be operational in 2012. This IT backbone will address a number of remaining challenges at the labs. It will also help the MoH to better monitor the incidence of disease and standards of health care across the country, adding to the accomplishments of the health system strengthening project that the Abbott Fund started in 2001 and in which it has so far invested a total of US $90 million.
Already, the productivity and efficiency of the redesigned regional labs has improved dramatically. For one thing, the standardized redesign tore down the walls between laboratories, so that all tests are now done in one area, patient service in another, and administration in a third. This has allowed technologists to conduct multiple tests and medical assays in parallel. “As a result,” says Larry Wood, Program Manager, Abbott Fund Tanzania, “all of the laboratories and the technologists themselves have become much more efficient. There’s no more running around. Technologists don’t have to go from room to room or building to building in the hospital to get different tests done.”
Personnel have also benefited from a steady stream of expert laboratory mentors from Abbott's global diagnostics business. Several have returned for shorter rotations to make sure the skills they shared have been retained and applied. Meanwhile, to address a need for trained personnel to staff the new labs, the Abbott Fund has sponsored the education of about 100 medical technologists in Tanzania. Eighteen will have been placed in three previously understaffed labs by the end of 2011. Another 42 will follow in 2012.
The Abbott Fund’s efforts appear to be paying off. Seventeen of twenty laboratories surveyed in 2011 reported better patient care as a result of the mentorship. That survey also revealed dramatic reductions in the time taken to turn out results of malarial smears, full blood workups, CD4 counts for HIV positive patients, automated chemistry and urine and stool analysis. As significantly, eleven of the 20 labs surveyed reported having expanded services offered by an average of four tests per laboratory.
To sustain these improvements, the project is establishing a system for monitoring and evaluation that will rely heavily on the capabilities of a new IT backbone, which will ultimately connect all 23 of the regional-level labs to each other and a data center at Muhimbili Hospital. This will permit the MoH to actively monitor such things as human resources and instrument use, performance and maintenance needs. The system will also provide instant alerts when instruments break down, and help improve the management of lab inventories.
Historically, supplies were sent to the regional labs on the basis of average patient volumes and diagnostics performed at all laboratories. With more granular information in hand, the central medical stores department will be able to see what’s on the shelf in each of the 23 labs, and so use its own resources more effectively, sending the right amounts of the right materials to the right laboratories. “The IT backbone,” says Wood, “will help us address many of the issues we had identified early in this program. We have had some success in addressing those issues, but the key is knowledge, and the ability to use that knowledge to impart change.”
That capability has implications for patient care. In Tanzania’s tiered hospital referral system, patients enter at the lowest level—at the health centers, and at the nation’s 121 district hospitals—and are shuttled up the system’s strata depending on their needs. “The majority of lower level hospitals,” says Deo Mtasiwa, Tanzania’s Chief Medical Officer, “lack appropriate equipment and supplies to provide even some general diagnostic services and, certainly, specialized services. So patients often have to be transferred to regional-level hospitals, which can be very inconvenient.”
Those with the most complex conditions go to Muhimbili, where specialists can oversee their diagnosis and treatment. But with the IT backbone in place, and improved instrumentation and technical capacity at the regional labs, patients could be spared such expense and inconvenience. “We can also save patients a lot of trouble traveling to Dar es Salaam to see a specialist for something that could have been done simply by flashing the results over to Muhimbili and soliciting his advice,” says Mtasiwa.
Faster turnaround of lab results has also helped Tanzania establish its first emergency medical department (EMD) at Muhimbili with support from the Abbott Fund. After constructing and equipping the facility, the Abbott Fund launched, in partnership with medical schools in the U.S. and South Africa, Tanzania’s first Emergency Medicine Residency program. Eight physicians are currently in training, and should be qualified by 2013. The EMD served about 100 patients a day in 2010—75 percent of them critically ill—and well over 30,000 in total through 2011. “It’s a big, quick impact,” notes Andy Wilson, Vice President, Abbott Fund Tanzania. “You can save lives starting the first day when you enable procedures like intubations and defibrillation.”
Expanding that program will take time, and perhaps support from other donors. But, for now, with refurbished labs and a sophisticated IT system linking them, more hospitals in Tanzania could begin to improve their standards of general patient care. The Abbott Fund and its partners hope for nothing less. “The idea,” says Wood, “is that we can help revolutionize how health care is delivered in Tanzania.”
By Unmesh Kher