Karimu Health Program

Draft - September 2021

Karimu’s mission to fight poverty in order to enhance the well-being of rural villages in the developing world underscores its investment in health services. Poverty and poor health worldwide are inextricably linked. The causes of poor health for millions are often rooted in economic challenges. Poor health, in turn, traps communities in poverty because they cannot be as productive as healthy communities, decreasing the chances to move above the poverty line. Often, very poor families have to make hard choices – knowingly putting their health at risk because they cannot, for example, see their children go hungry. The cost of doctors’ fees, a course of drugs, or transportation to reach a health facility can be devastating for many families. In the worst cases, the burden of illness may mean that families sell critical assets or take children out of school to help complement the family income.

For this reason, improving the overall health of the communities with which Karimu works is a critical part of Karimu’s strategy to eliminate poverty.

Construction of adequate health facilities - including staff housing - availability of required furniture, equipment and medicines, and offering professional development opportunities, allow us to attract and retain high quality medical staff and therefore allows us to improve the overall health and the lives of every member of the communities in which we operate.

Definitions (or Glossary)

  • Health facilities: general term used for a dispensary, health center, or hospital.
  • Health clinic or simply clinic: any health facility with specialized medical services
  • Medical staff: a general term used for all the staff working in a health clinic: doctors, nurses, pharmacists, laboratorists, and janitors

Background

Health services in Tanzania are provided by government-owned or private health facilities. These facilities can be classified in three categories: dispensary, health center, or hospital.

Dispensaries, the simplest of the health facilities and the most common in rural areas, provide the most basic medical services to deal with minor illnesses (e.g., upper respiratory infections), treat minor injuries, to provide maternal and child health services, and monitor and treat chronic diseases (e.g., HIV). Dispensaries operate only during daytime hours. Health centers operate 24 by 7, perform simple operations (e.g., C-sections), deal with major injuries (e.g., fractures), provide services that require more sophisticated equipment (e.g., X-rays or ultrasound machines), and support overnight patient stays for treatment, recovery, or monitoring. Hospitals provide the widest range of medical services including the most sophisticated ones, such as surgery, complex procedures, or procedures requiring more sophisticated and expensive equipment . All health facilities that can provide specialized services are referred to as clinics. Typical specialized services of a dispensary include a maternity clinic or a tuberculosis clinic.

The qualification of the medical staff does not follow the accreditations known in the west. Nurses in Tanzania may have a 2 year training by a vocational school or a 4 year training in a college. Doctors’ qualifications vary even more. Depending on their role at a health facility, their qualification varies from a 2-year degree from a vocational school to a 4 year degree from a college plus, possibly, a Master or PhD and practical internships.

2020-05-04 Opening day - medical staff 02.jpg

Medical staff of Gajal Dispensary

Besides doctors and nurses, health facilities have laboratory technicians, medical attendants, midwives, pharmaceutical assistants, cleaning staff, security guards, etc. The higher the level of the health facility, the higher the number of staff and their qualifications.

Most of the medical staff have lived in the big cities, at least during their studies. For this reason, they are used to living in comfortable houses with running water and electricity. Moreover, they belong to the group of people with the highest living standards in Tanzania. As a consequence, it is a challenge to retain the most qualified medical staff in rural areas due to the lack of quality housing. To address this challenge, the government tries to provide housing for the medical staff working in rural health facilities. Dispensaries, in general, provide housing to the head doctor and head nurse and health centers tend to have four houses for their staff, covering all doctors and more highly qualified nurses.

Goals

The main objectives of the Karimu Health Program are to improve the overall health of the communities we support while reducing the mortality rate, particularly among pregnant women and young children. These objectives will be achieved by:

  • Expanding access to health services to everyone, including the poorest of the poor who, often, do not have the means to pay for transportation to reach health facilities.
  • Improving hygiene practices and other disease prevention measures.
  • Enhancing the quality and expanding the types of medical services provide.d
  • Retaining highly qualified nurses and doctors.

Karimu’s activities in the Health Program are tied to the following components:

1 - Construction, reconstruction and expansion of health facilities to ensure that every household within the communities we support has access to a high-quality, basic health service by walking no more than one hour and a health center by driving no more than 30 minutes.
2 - Donation of medical equipment and supplies.
3 - Retention and enrichment of medical staff based on quality housing, access to ongoing education via scholarships and seminars with volunteer doctors, and automation of reporting tasks using technology.
4 - Implementation of the most critical interventions identified by the World Health Organization (WHO) as having the largest positive impact on improving the overall health of communities in rural villages in the developing world.
5 - Training of midwives.

Overview of the Program

There are four phases in the Karimu Health Program.

1 - Creating the Foundation for a Healthy Community - The goal of this phase is to ensure that every household within the community has access to high-quality, basic health services by ensuring that no one has to walk more than an hour to the nearest health facility. Access to quality healthcare is supported by an agreement with the government to maintain a minimum level of staff, equipment, and medicines at health facilities. Improvements in community health and healthcare services will be achieved by implementing a set of interventions with broad and impactful applicability across the community. Once implemented, these interventions will enable a significant improvement in the health services provided by the dispensaries.
2 - Supporting Medical Staff Retention and Excellence - In order to sustain the health improvements achieved in Phase 1, it is critical that we maintain the medical staff long-term. Availability of housing for the medical staff is essential for their retention in rural areas. For this reason, this phase focuses on providing access to housing for the most critical members of the medical staff. Additionally, this phase continues the implementation of the most important interventions. Phases 1 and 2 ensure that basic health services are of high quality and widely available.

24 - Programs - Health program - Finished Construction 01.jpg

Doctor housing close to the Dareda Kati Clinic

3 - Expanding the Medical Services through a Health Center - This phase will be implemented when the households within the communities we support do not have access to a health center or hospital by driving at most 30 minutes. It will create a health center serving the community. It will also implement the healthcare interventions requiring facilities or equipment only available within health centers.
4 - Achieving Medical Excellence - This phase is optional and will be implemented only when there is the need to provide specialized services requiring highly sophisticated equipment and/or highly specialized medical staff within an existing health center or hospital. In this case, this phase will also implement the related interventions.

Throughout these phases, we will be implementing health interventions (see later in document) as outlined by the World Health Organization and prioritized by local medical professionals. These interventions are outlined in a later section.

Phases

Phase 1: Creating the Foundation for a Healthy Community

Karimu will work with the communities and the government to construct new dispensaries and/or upgrade and/or expand existing ones to ensure that all households can reach a health facility within a one hour walk. Karimu will also help implement a series of interventions whose combined effect will improve the overall quality of community health and of the health services provided by the health facilities available in the area.

Roles and Responsibilities

Karimu:

  • Build new dispensaries or upgrade existing ones to ensure every household in the ward has access to high-quality, basic health services by walking no more than one hour to the nearest health facility. For Ayalagaya Ward, Karimu will build one dispensary at Dareda Kati town and one dispensary at Gajal , provide furniture, and equipment as agreed to with the government in order to fulfill the requirements set by the Tanzanian Ministry of Health (which follow the recommendations of the WHO). The facilities include a main building with separate areas for general medicine and pregnancy services as well as laboratory, dressing, sterilization, and family planning rooms, an external bathroom for patients, laundry, incinerator, and placenta pit.

24 - Programs - Health program - Gajal Dispensary Main Entrance 01.jpeg

Main entrance at Gajal Dispensary

  • Support the medical staff, midwives, and community in the implementation of key interventions recommended by the WHO such as education on handwashing, safe disposal of children’s stools, and detection and management of acute severe malnutrition and referral in the presence of complications


Medical Staff:

  • Keep all Karimu donations and medical equipment in good condition and ensure its proper use.
  • Keep the health facility clean, including bathrooms, clean on a daily basis.
  • Ensure the proper disposal of waste, eliminating the need to openly burn material or to dispose of it in an open area by appropriate use of the incinerator and placenta pit.
  • Maintain the buildings, assets, equipment, and facilities ensuring that all repairs are completed within one month of first damage identification.
  • Promote hand washing and good hygiene practices at the health facility.
  • According to the recommendations set by the Minister of Health following the WHO guidelines, the Dispensary level shall comprise medical services such as: outpatient services, maternal and child health services, vaccination, minor illness and injuries, HIV, STD, malaria, and tuberculosis treatment.

24 - Programs - Health program - Vaccination week-007.jpeg

Vaccination week at the Dareda Kati Clinic

  • Fully participate in all training provided by Karimu and commit to fully implement and consistently follow the interventions recommended by the WHO.
  • Have a well specified and very visible opening, closing, and break times.
  • Commit to be at the health facility during all work hours unless sick or given permission for an absence.
  • Record all data required by the government and by Karimu and share it with Karimu monthly to assess the effectiveness of the program.
  • Ensure all medical supplies, including medicines, are locked in the medical storage room at all times and those in the dispensing room are kept safe and secure, eliminating the risk of being stolen, lost, or misused. Keep the medicines away from direct sunlight and excessive heat.
  • Ensure there are records of all supplies received, used, scrapped or sold. Such records must be shared with Karimu on a monthly basis.
  • Keep complete records on all patient visits at the Dispensary, all prescriptions, diagnoses, exams and laboratory results, as well as all other activities. These records must be shared with Karimu on a monthly basis.
  • Visit all areas farther than [45] minutes walking distance from the clinic at least once a month to provide specific medical services.
  • Ensure that all equipment (including TV and Media Player) remains in the Clinic at all times and is used only for showing the educational material prepared by the government and/or Karimu.

24 - Programs - Health program - TV Gajal.jpeg

TV running educational material at Gajal Dispensary

  • Run the educational material non-stop during all operating hours of the dispensary, following the schedule jointly prepared with Karimu.


Midwives:

24 - Programs - Health program - Midwives training.jpg

Training of the midwives of Ayalagaya and Arri wards

  • Commit to fully implement and consistently follow the interventions.


Government:

  • Staff the dispensary with qualified and sufficient medical staff and provide the furniture, equipment, supplies, and medicine as defined by the Minister of Health following the guidelines of the WHO.
  • Support the medical staff in the implementation of the interventions.
  • Provide the budget needed to maintain and operate the clinic services and maintain the clinic structures.

Phase 2: Supporting Medical Staff Retention and Excellence

In partnership with the community and the government, Karimu will construct or renovate medical housing for the most critical members of the medical staff. Additionally, this phase will complete the implementation of the most impactful interventions with broad applicability across the community.

Roles and Responsibilities

Karimu:

  • Build or renovate to an agreed minimum standard housing for at least the head doctor and head nurse of each dispensary.
  • Donate furniture and supplies as agreed to with the government in order to fulfill the requirements set by the Minister of Health following the guidelines defined by the WHO.
  • Provide scholarships for up to 70% of area nurses to reach a Diploma level in order to improve the quality of medical services. The nurse will sign a Memorandum of Understanding that requires that the nurse maintain employment at a ward-based health facility during the studies and will receive only 1 scholarship for education to be completed within 6 years.
  • Support the medical staff, midwives, and community in the implementation of the phase 2 interventions recommended by the WHO such as: treatment of diabetes, prevention and treatment of complex cases of HIV/AIDS, Malaria, and Tuberculosis, and prevention and treatment - complex cases, and management of neonatal sepsis and other neonatal infections.


Medical Staff:

  • Maintain the buildings, assets, and facilities of the staff housing ensuring that all repairs are completed within one month.
  • Fully participate in all training provided by Karimu.
  • Commit to fully implement and consistently follow the interventions as jointly rolled out based on the interventions plan.


Midwives:


Government:

  • Provide the furniture, equipment, supplies, and the necessary funds to cover all operational costs of the medical staff housing (e.g., electricity, maintenance, etc.).
  • Support the medical staff to implement interventions.

Phase 3: Expanding the Medical Services through a Health Center

Under development

Phase 4: Achieving Medical Excellence

Under development

Health Interventions

Much can be done to improve health and healthcare outcomes in the developing world. The
2018 Universal Health Coverage and Essential Packages of Care (published by Disease Control Priorities Network, and funded in 2010 by the Bill & Melinda Gates Foundation) defines a concrete set of priorities for universal health coverage grounded in the economic reality and health needs of low- and middle-income countries. Core to this work is the definition of the “highest-priority package” which defines those health interventions most essential and readily implementable, even for countries with few resources. The interventions range from family planning to childbirth and child care, from nutrition to sanitation, from disease specific interventions (e.g. malaria, TB, HIV,…) to mental health, from chronic illnesses to emergency procedures, and more.

In 2019, a Karimu volunteer tasked with driving an overall approach to improving community health studied the research and deeply analyzed the highest-priority package. Correlating the recommended interventions with publicly available Tanzanian health data, data from the local health clinics, and surveys of the local medical staff, he identified those interventions that seemed most pertinent for the local Ayalagaya and Arri wards. This work was then reviewed and refined in collaboration with the District Secretary of Health, Dr. Madama, and the head doctor at Dareda Mission Hospital, Dr. Lorri.

Drs Madama and Lorri.jpg

Dr. Madama works with Karimu over video conference and Dr. Lorri works with Karimu staff in person from Dareda mission Hospital

They eliminated interventions that they believed were already well implemented and changed the priorities of others based on their experience working directly with patients resulting in 92 interventions that can be rolled out as part of the Karimu Health Program based on existing or planned resources and capabilities. In some cases, the interventions may be partially rolled out based on government initiatives, but Karimu may be able to enhance the efficacy based on applying additional resources. In other cases, no work has been funded by the government.

We anticipate that it will take several years to roll all these interventions out, but we hope to complete them by the Sustainable Development Goal period (2030) referenced in the publication above. We also continue to work with local staff to identify opportunistic tactical interventions based on local medical treatment records.

Doctors Madama and Lorri prioritized the interventions into 3 major groups:

  1. Highest priority interventions that can be implemented with existing dispensary services
  2. Second priority interventions that can be implemented with existing dispensary services
  3. Highest priority interventions that require health center level services for implementation or are related to such services. For example, interventions related to C-sections cannot be rolled out until we have C-section capabilities within the ward in our proposed health center.

Within major groups, Karimu will prioritize interventions based on local medical input, Karimu volunteer and staff capacity, and available funding. Each intervention, once planning has completed, will have objectives, target audiences, funding needs, key metrics, and exit criteria which will be detailed in the linked project page.

Current Program Status (Sep 2021)

In Ayalagaya, we have completed Phase 1 construction of Karimu’s Health Program providing access to healthcare within a 1 hour walk.

Health facility maintenance: Maintenance inspections of Dareda Kati and Gajal health facilities are conducted quarterly and maintenance repairs are being handled in a timely fashion.

We are also half way through Phase 2 of Karimu’s Health Program - staff retention and excellence

  • Completed housing for the medical staff of the Dareda Kati dispensary in Aug 2020
  • Installed and rolled out an IT system to improve efficiency and reporting accuracy in March 2021
  • Construction of housing for the medical staff of Gajal is planned for 4Q2021
  • Scholarships for continuing education for the medical staff is planned for 4Q2021.

-
Finally, we are in the midst of Phase 3 of Karimu’s Health Program: transforming the Dareda Kati dispensary into a health center (a mini-hospital).

In Arri, we are still in the early stages. Working with the community, we completed the first five year strategic plan. Arri ward will reap the benefits of health interventions rolling out across both wards, but health construction projects are prioritized below water and sanitation projects.

Health Interventions

2021

Highest priority package interventions

  • Detection and treatment of childhood illnesses - Deliver education to medical staff based on the World Health Organization and UNICEF Integrated Management of Childhood Illnesses training.
  • Training on Delivery and Newborn and infant care - Provide curriculum targeting medical staff, new mothers, and students who care for infant siblings on sanitation practices for newborn umbilical care, breast or bottle feeding, infant cleaning and stool disposal, and safe spaces for infant mobility.

-
Karimu is also conducting a house to house health survey in 2021-2022. The survey should gather information about family health, nutrition, and sanitation that will influence detailed plans for health interventions and provide a baseline against which we can measure impact.
-
Tactical Interventions

  • Increase syphilis testing and treatment - Mother-to-child transmission of syphilis remains a leading cause of neonatal death and stillbirth. While most (but not all) expectant mothers are tested for syphilis, their partners are not routinely tested. We are working with clinics and the government to test both expectant mothers and their partners and increase availability of testing supplies from the government.
  • Expand TB testing and treatment - Tanzania is one of the 30 countries with the highest burden of tuberculosis (TB) in the world. We are assisting the Babati District in its TB campaign to broaden community outreach and education efforts.
  • Detect anemia during pregnancy - A 2021 study found anemia (a hemoglobin (Hb) deficiency) in pregnancy to be persistently high and prevalent among 57% of pregnant women in Tanzania. With the aim of improving maternal and newborn health, Karimu is purchasing Hb meters for clinics that don’t have them as well as Hb test strips to use with the meters while we work with the government to supply them routinely.

-
2020

COVID-19 Collage.jpg

Our first intervention implementations were in 2020 and driven by the COVID pandemic response. We rolled out interventions on:

  • COVID transmission and prevention
  • Hand washing
  • Patient intake, triage, and isolation

Karimu Health Program

Draft - September 2021

Karimu’s mission to fight poverty in order to enhance the well-being of rural villages in the developing world underscores its investment in health services. Poverty and poor health worldwide are inextricably linked. The causes of poor health for millions are often rooted in economic challenges. Poor health, in turn, traps communities in poverty because they cannot be as productive as healthy communities, decreasing the chances to move above the poverty line. Often, very poor families have to make hard choices – knowingly putting their health at risk because they cannot, for example, see their children go hungry. The cost of doctors’ fees, a course of drugs, or transportation to reach a health facility can be devastating for many families. In the worst cases, the burden of illness may mean that families sell critical assets or take children out of school to help complement the family income.

For this reason, improving the overall health of the communities with which Karimu works is a critical part of Karimu’s strategy to eliminate poverty.

Construction of adequate health facilities - including staff housing - availability of required furniture, equipment and medicines, and offering professional development opportunities, allow us to attract and retain high quality medical staff and therefore allows us to improve the overall health and the lives of every member of the communities in which we operate.

Definitions (or Glossary)

  • Health facilities: general term used for a dispensary, health center, or hospital.
  • Health clinic or simply clinic: any health facility with specialized medical services
  • Medical staff: a general term used for all the staff working in a health clinic: doctors, nurses, pharmacists, laboratorists, and janitors

Background

Health services in Tanzania are provided by government-owned or private health facilities. These facilities can be classified in three categories: dispensary, health center, or hospital.

Dispensaries, the simplest of the health facilities and the most common in rural areas, provide the most basic medical services to deal with minor illnesses (e.g., upper respiratory infections), treat minor injuries, to provide maternal and child health services, and monitor and treat chronic diseases (e.g., HIV). Dispensaries operate only during daytime hours. Health centers operate 24 by 7, perform simple operations (e.g., C-sections), deal with major injuries (e.g., fractures), provide services that require more sophisticated equipment (e.g., X-rays or ultrasound machines), and support overnight patient stays for treatment, recovery, or monitoring. Hospitals provide the widest range of medical services including the most sophisticated ones, such as surgery, complex procedures, or procedures requiring more sophisticated and expensive equipment . All health facilities that can provide specialized services are referred to as clinics. Typical specialized services of a dispensary include a maternity clinic or a tuberculosis clinic.

The qualification of the medical staff does not follow the accreditations known in the west. Nurses in Tanzania may have a 2 year training by a vocational school or a 4 year training in a college. Doctors’ qualifications vary even more. Depending on their role at a health facility, their qualification varies from a 2-year degree from a vocational school to a 4 year degree from a college plus, possibly, a Master or PhD and practical internships.

2020-05-04 Opening day - medical staff 02.jpg

Medical staff of Gajal Dispensary

Besides doctors and nurses, health facilities have laboratory technicians, medical attendants, midwives, pharmaceutical assistants, cleaning staff, security guards, etc. The higher the level of the health facility, the higher the number of staff and their qualifications.

Most of the medical staff have lived in the big cities, at least during their studies. For this reason, they are used to living in comfortable houses with running water and electricity. Moreover, they belong to the group of people with the highest living standards in Tanzania. As a consequence, it is a challenge to retain the most qualified medical staff in rural areas due to the lack of quality housing. To address this challenge, the government tries to provide housing for the medical staff working in rural health facilities. Dispensaries, in general, provide housing to the head doctor and head nurse and health centers tend to have four houses for their staff, covering all doctors and more highly qualified nurses.

Goals

The main objectives of the Karimu Health Program are to improve the overall health of the communities we support while reducing the mortality rate, particularly among pregnant women and young children. These objectives will be achieved by:

  • Expanding access to health services to everyone, including the poorest of the poor who, often, do not have the means to pay for transportation to reach health facilities.
  • Improving hygiene practices and other disease prevention measures.
  • Enhancing the quality and expanding the types of medical services provide.d
  • Retaining highly qualified nurses and doctors.

Karimu’s activities in the Health Program are tied to the following components:

1 - Construction, reconstruction and expansion of health facilities to ensure that every household within the communities we support has access to a high-quality, basic health service by walking no more than one hour and a health center by driving no more than 30 minutes.
2 - Donation of medical equipment and supplies.
3 - Retention and enrichment of medical staff based on quality housing, access to ongoing education via scholarships and seminars with volunteer doctors, and automation of reporting tasks using technology.
4 - Implementation of the most critical interventions identified by the World Health Organization (WHO) as having the largest positive impact on improving the overall health of communities in rural villages in the developing world.
5 - Training of midwives.

Overview of the Program

There are four phases in the Karimu Health Program.

1 - Creating the Foundation for a Healthy Community - The goal of this phase is to ensure that every household within the community has access to high-quality, basic health services by ensuring that no one has to walk more than an hour to the nearest health facility. Access to quality healthcare is supported by an agreement with the government to maintain a minimum level of staff, equipment, and medicines at health facilities. Improvements in community health and healthcare services will be achieved by implementing a set of interventions with broad and impactful applicability across the community. Once implemented, these interventions will enable a significant improvement in the health services provided by the dispensaries.
2 - Supporting Medical Staff Retention and Excellence - In order to sustain the health improvements achieved in Phase 1, it is critical that we maintain the medical staff long-term. Availability of housing for the medical staff is essential for their retention in rural areas. For this reason, this phase focuses on providing access to housing for the most critical members of the medical staff. Additionally, this phase continues the implementation of the most important interventions. Phases 1 and 2 ensure that basic health services are of high quality and widely available.

24 - Programs - Health program - Finished Construction 01.jpg

Doctor housing close to the Dareda Kati Clinic

3 - Expanding the Medical Services through a Health Center - This phase will be implemented when the households within the communities we support do not have access to a health center or hospital by driving at most 30 minutes. It will create a health center serving the community. It will also implement the healthcare interventions requiring facilities or equipment only available within health centers.
4 - Achieving Medical Excellence - This phase is optional and will be implemented only when there is the need to provide specialized services requiring highly sophisticated equipment and/or highly specialized medical staff within an existing health center or hospital. In this case, this phase will also implement the related interventions.

Throughout these phases, we will be implementing health interventions (see later in document) as outlined by the World Health Organization and prioritized by local medical professionals. These interventions are outlined in a later section.

Phases

Phase 1: Creating the Foundation for a Healthy Community

Karimu will work with the communities and the government to construct new dispensaries and/or upgrade and/or expand existing ones to ensure that all households can reach a health facility within a one hour walk. Karimu will also help implement a series of interventions whose combined effect will improve the overall quality of community health and of the health services provided by the health facilities available in the area.

Roles and Responsibilities

Karimu:

  • Build new dispensaries or upgrade existing ones to ensure every household in the ward has access to high-quality, basic health services by walking no more than one hour to the nearest health facility. For Ayalagaya Ward, Karimu will build one dispensary at Dareda Kati town and one dispensary at Gajal , provide furniture, and equipment as agreed to with the government in order to fulfill the requirements set by the Tanzanian Ministry of Health (which follow the recommendations of the WHO). The facilities include a main building with separate areas for general medicine and pregnancy services as well as laboratory, dressing, sterilization, and family planning rooms, an external bathroom for patients, laundry, incinerator, and placenta pit.

24 - Programs - Health program - Gajal Dispensary Main Entrance 01.jpeg

Main entrance at Gajal Dispensary

  • Support the medical staff, midwives, and community in the implementation of key interventions recommended by the WHO such as education on handwashing, safe disposal of children’s stools, and detection and management of acute severe malnutrition and referral in the presence of complications


Medical Staff:

  • Keep all Karimu donations and medical equipment in good condition and ensure its proper use.
  • Keep the health facility clean, including bathrooms, clean on a daily basis.
  • Ensure the proper disposal of waste, eliminating the need to openly burn material or to dispose of it in an open area by appropriate use of the incinerator and placenta pit.
  • Maintain the buildings, assets, equipment, and facilities ensuring that all repairs are completed within one month of first damage identification.
  • Promote hand washing and good hygiene practices at the health facility.
  • According to the recommendations set by the Minister of Health following the WHO guidelines, the Dispensary level shall comprise medical services such as: outpatient services, maternal and child health services, vaccination, minor illness and injuries, HIV, STD, malaria, and tuberculosis treatment.

24 - Programs - Health program - Vaccination week-007.jpeg

Vaccination week at the Dareda Kati Clinic

  • Fully participate in all training provided by Karimu and commit to fully implement and consistently follow the interventions recommended by the WHO.
  • Have a well specified and very visible opening, closing, and break times.
  • Commit to be at the health facility during all work hours unless sick or given permission for an absence.
  • Record all data required by the government and by Karimu and share it with Karimu monthly to assess the effectiveness of the program.
  • Ensure all medical supplies, including medicines, are locked in the medical storage room at all times and those in the dispensing room are kept safe and secure, eliminating the risk of being stolen, lost, or misused. Keep the medicines away from direct sunlight and excessive heat.
  • Ensure there are records of all supplies received, used, scrapped or sold. Such records must be shared with Karimu on a monthly basis.
  • Keep complete records on all patient visits at the Dispensary, all prescriptions, diagnoses, exams and laboratory results, as well as all other activities. These records must be shared with Karimu on a monthly basis.
  • Visit all areas farther than [45] minutes walking distance from the clinic at least once a month to provide specific medical services.
  • Ensure that all equipment (including TV and Media Player) remains in the Clinic at all times and is used only for showing the educational material prepared by the government and/or Karimu.

24 - Programs - Health program - TV Gajal.jpeg

TV running educational material at Gajal Dispensary

  • Run the educational material non-stop during all operating hours of the dispensary, following the schedule jointly prepared with Karimu.


Midwives:

24 - Programs - Health program - Midwives training.jpg

Training of the midwives of Ayalagaya and Arri wards

  • Commit to fully implement and consistently follow the interventions.


Government:

  • Staff the dispensary with qualified and sufficient medical staff and provide the furniture, equipment, supplies, and medicine as defined by the Minister of Health following the guidelines of the WHO.
  • Support the medical staff in the implementation of the interventions.
  • Provide the budget needed to maintain and operate the clinic services and maintain the clinic structures.

Phase 2: Supporting Medical Staff Retention and Excellence

In partnership with the community and the government, Karimu will construct or renovate medical housing for the most critical members of the medical staff. Additionally, this phase will complete the implementation of the most impactful interventions with broad applicability across the community.

Roles and Responsibilities

Karimu:

  • Build or renovate to an agreed minimum standard housing for at least the head doctor and head nurse of each dispensary.
  • Donate furniture and supplies as agreed to with the government in order to fulfill the requirements set by the Minister of Health following the guidelines defined by the WHO.
  • Provide scholarships for up to 70% of area nurses to reach a Diploma level in order to improve the quality of medical services. The nurse will sign a Memorandum of Understanding that requires that the nurse maintain employment at a ward-based health facility during the studies and will receive only 1 scholarship for education to be completed within 6 years.
  • Support the medical staff, midwives, and community in the implementation of the phase 2 interventions recommended by the WHO such as: treatment of diabetes, prevention and treatment of complex cases of HIV/AIDS, Malaria, and Tuberculosis, and prevention and treatment - complex cases, and management of neonatal sepsis and other neonatal infections.


Medical Staff:

  • Maintain the buildings, assets, and facilities of the staff housing ensuring that all repairs are completed within one month.
  • Fully participate in all training provided by Karimu.
  • Commit to fully implement and consistently follow the interventions as jointly rolled out based on the interventions plan.


Midwives:


Government:

  • Provide the furniture, equipment, supplies, and the necessary funds to cover all operational costs of the medical staff housing (e.g., electricity, maintenance, etc.).
  • Support the medical staff to implement interventions.

Phase 3: Expanding the Medical Services through a Health Center

Under development

Phase 4: Achieving Medical Excellence

Under development

Health Interventions

Much can be done to improve health and healthcare outcomes in the developing world. The
2018 Universal Health Coverage and Essential Packages of Care (published by Disease Control Priorities Network, and funded in 2010 by the Bill & Melinda Gates Foundation) defines a concrete set of priorities for universal health coverage grounded in the economic reality and health needs of low- and middle-income countries. Core to this work is the definition of the “highest-priority package” which defines those health interventions most essential and readily implementable, even for countries with few resources. The interventions range from family planning to childbirth and child care, from nutrition to sanitation, from disease specific interventions (e.g. malaria, TB, HIV,…) to mental health, from chronic illnesses to emergency procedures, and more.

In 2019, a Karimu volunteer tasked with driving an overall approach to improving community health studied the research and deeply analyzed the highest-priority package. Correlating the recommended interventions with publicly available Tanzanian health data, data from the local health clinics, and surveys of the local medical staff, he identified those interventions that seemed most pertinent for the local Ayalagaya and Arri wards. This work was then reviewed and refined in collaboration with the District Secretary of Health, Dr. Madama, and the head doctor at Dareda Mission Hospital, Dr. Lorri.

Drs Madama and Lorri.jpg

Dr. Madama works with Karimu over video conference and Dr. Lorri works with Karimu staff in person from Dareda mission Hospital

They eliminated interventions that they believed were already well implemented and changed the priorities of others based on their experience working directly with patients resulting in 92 interventions that can be rolled out as part of the Karimu Health Program based on existing or planned resources and capabilities. In some cases, the interventions may be partially rolled out based on government initiatives, but Karimu may be able to enhance the efficacy based on applying additional resources. In other cases, no work has been funded by the government.

We anticipate that it will take several years to roll all these interventions out, but we hope to complete them by the Sustainable Development Goal period (2030) referenced in the publication above. We also continue to work with local staff to identify opportunistic tactical interventions based on local medical treatment records.

Doctors Madama and Lorri prioritized the interventions into 3 major groups:

  1. Highest priority interventions that can be implemented with existing dispensary services
  2. Second priority interventions that can be implemented with existing dispensary services
  3. Highest priority interventions that require health center level services for implementation or are related to such services. For example, interventions related to C-sections cannot be rolled out until we have C-section capabilities within the ward in our proposed health center.

Within major groups, Karimu will prioritize interventions based on local medical input, Karimu volunteer and staff capacity, and available funding. Each intervention, once planning has completed, will have objectives, target audiences, funding needs, key metrics, and exit criteria which will be detailed in the linked project page.

Current Program Status (Sep 2021)

In Ayalagaya, we have completed Phase 1 construction of Karimu’s Health Program providing access to healthcare within a 1 hour walk.

Health facility maintenance: Maintenance inspections of Dareda Kati and Gajal health facilities are conducted quarterly and maintenance repairs are being handled in a timely fashion.

We are also half way through Phase 2 of Karimu’s Health Program - staff retention and excellence

  • Completed housing for the medical staff of the Dareda Kati dispensary in Aug 2020
  • Installed and rolled out an IT system to improve efficiency and reporting accuracy in March 2021
  • Construction of housing for the medical staff of Gajal is planned for 4Q2021
  • Scholarships for continuing education for the medical staff is planned for 4Q2021.

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Finally, we are in the midst of Phase 3 of Karimu’s Health Program: transforming the Dareda Kati dispensary into a health center (a mini-hospital).

In Arri, we are still in the early stages. Working with the community, we completed the first five year strategic plan. Arri ward will reap the benefits of health interventions rolling out across both wards, but health construction projects are prioritized below water and sanitation projects.

Health Interventions

2021

Highest priority package interventions

  • Detection and treatment of childhood illnesses - Deliver education to medical staff based on the World Health Organization and UNICEF Integrated Management of Childhood Illnesses training.
  • Training on Delivery and Newborn and infant care - Provide curriculum targeting medical staff, new mothers, and students who care for infant siblings on sanitation practices for newborn umbilical care, breast or bottle feeding, infant cleaning and stool disposal, and safe spaces for infant mobility.

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Karimu is also conducting a house to house health survey in 2021-2022. The survey should gather information about family health, nutrition, and sanitation that will influence detailed plans for health interventions and provide a baseline against which we can measure impact.
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Tactical Interventions

  • Increase syphilis testing and treatment - Mother-to-child transmission of syphilis remains a leading cause of neonatal death and stillbirth. While most (but not all) expectant mothers are tested for syphilis, their partners are not routinely tested. We are working with clinics and the government to test both expectant mothers and their partners and increase availability of testing supplies from the government.
  • Expand TB testing and treatment - Tanzania is one of the 30 countries with the highest burden of tuberculosis (TB) in the world. We are assisting the Babati District in its TB campaign to broaden community outreach and education efforts.
  • Detect anemia during pregnancy - A 2021 study found anemia (a hemoglobin (Hb) deficiency) in pregnancy to be persistently high and prevalent among 57% of pregnant women in Tanzania. With the aim of improving maternal and newborn health, Karimu is purchasing Hb meters for clinics that don’t have them as well as Hb test strips to use with the meters while we work with the government to supply them routinely.

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2020

COVID-19 Collage.jpg

Our first intervention implementations were in 2020 and driven by the COVID pandemic response. We rolled out interventions on:

  • COVID transmission and prevention
  • Hand washing
  • Patient intake, triage, and isolation