Category Archives: Health Worker Safety

Expanding Health Workforce Safety in Tanzania

Hot, tired and dirty, my first thought upon arrival in Tanzania was how much I had missed Africa. The 35-minute drive from the airport to my hotel provided moving snapshots of life in Mwanza. The streets were busy and bustling with colors, people, traffic, the sound of horns honking and motorbikes roaring. I sank back into the shuttle’s seat, feeling completely and utterly elated.

Hours later, I awoke with excitement, knowing that I would soon see first-hand our Health Workforce Safety (HWS) program at Bugando Medical Centre (BMC), a three-year initiative aimed at addressing the health and occupational hazards for both health workers and hospital patients.  As I walked through BMC’s vast hallways during a hospital tour, the program’s impact was clearly visible.  I saw the AmeriCares logo on doors, waste bins, equipment, supply cabinets–simply put, everywhere. Health workers appeared content and devoted to their daily task of providing patient care.  The hospital provides a clean and safe environment for patients and health workers alike.

Seeing these accomplishments made me look forward to the program’s scale-out to three selected hospitals.

While working closely with our local consultant team and the HWS program’s technical advisor, my expectations of what we would observe at these selected hospitals during the baseline were formed. We would undoubtedly find shortages in the availability and supply of personal protective equipment; safety engineered devices; gaps in the hospitals’ ability to vaccinate all of their health workers; infrastructural challenges, and much more.

However, what we did observe was more unsettling than I had anticipated. I was struck by the lack of sanitation in some of the hospitals—some more so than others. It was disturbing to see the mingling and mixing of infectious waste such as used needle-sticks with non-infectious waste, as well as the evident lack of waste segregation practices. During my conversations with health workers at these sites, it became apparent that many were unhappy, demotivated and felt stagnant in their positions. Much of this was attributed to the unavailability of necessary resources to aid them in effectively carrying out their responsibilities—a direct consequence of considerably limited funding available to support hospital operations. Glaring was the realization that health workers held little regard for themselves and their safety.

There is a clear, crucial need for the HWS program at these institutions.

Although my take-aways from the baseline assessments were numerous, one stuck with me: essential aggressive behavior change interventions, coupled with ensuring the safety and wellbeing of health workers, will revitalize and empower these most valued members of the workforce.

Promoting Health-Focused Human Development

Our long-standing gift-in-kind model may lead people to believe that delivering medical aid for disasters is what AmeriCares is all about, when in reality, we do so much more to champion health-focused human development.

At its core, human development is about expanding and improving people’s opportunities to lead lives they value. The human development model — access to health, access to education, and access to resources — lines up perfectly with AmeriCares work at home and abroad.

Access to Health

Good health is a prerequisite for almost all life improvements, and AmeriCares goal is to help many more people live longer, healthier lives. This is accomplished through donations of medicines and medical supplies to help people in times of disaster — along with ongoing global medical assistance to help people living in communities with little or no access to basic health care.  Here in the United States, we support a growing network of 400+ safety net clinics.  AmeriCares takes the health focus a step further by supporting access to health care during long-term recovery efforts following major disasters, targeted donations of relief and personal care items for disaster survivors, nutritional supplements to help people in danger of malnutrition, and in some instances, monetary grants.

AmeriCares approaches primary health care by operating three free clinics to treat uninsured residents of southern Connecticut, and another clinic in  El Salvador that serves a large population of underserved families. AmeriCares India supports primary care with mobile medical vans that deliver care to impoverished patients throughout the slums of Mumbai. The efficient, professional and welcoming nature of all AmeriCares direct patient care facilities highlights our ability to generate widespread community engagement as well as our strong commitment to the dignity of every person.

Health worker training creates a lifesaving culture of change.

Access to Education

The successful Health Worker Safety Initiative, piloted at Bugando Medical Centre in Tanzania, trains medical staff in the use of best practices to help protect health care workers, prevent occupational hazards and reduce the spread of hospital-related infections. Along with targeted gift-in-kind support, this  intiative encourages a self-reinforcing, collaborative environment that increases the staff’s job motivation and contributes to sustainable, positive behavioral change.

Access to Resources

Free Clinics Today is an online resource for U.S. safety net clinics. With numerous how-to guides, tools, case studies, and suggestions for improving and enhancing volunteer and staff management, pharmaceutical access, and specialty health programs, this site helps clinics navigate the tricky waters of resource acquisition and program management. Gathering and hosting such resources in a user-friendly, accessible way allows AmeriCares to fill an otherwise lonely gap in the mentorship of these crucial health care institutions.

This practical support and knowledge-based training helps update program operations, lower risk, and improve patient outcomes. By providing the products necessary to practice health care, and also supporting efficiency and improvement in program operations, AmeriCares contributes to a more sustainable model of health-focused human development.

World Day for Safety and Health at Work

In January, 2012, Justine MacWilliam, project manager for AmeriCares Health Worker Safety Initiative, traveled to Bugando Medical Centre in Tanzania to see first-hand the remarkable achievements that Bugando’s workers have made in improving hospital safety during the three-year pilot initiative. Here, Justine provides a glimpse of the life-saving culture of change the initiative has created among hospital staff.

Health workers wear protective gear in the Neonatal Intensive Care Unit at Bugando Medical Centre in Tanzania. Photo: Phil Farnsworth

“Many of Tanzania’s health workers haven’t had adequate training on preventing the spread of hospital-related infections and injury.”

Saturday, April 28th, is World Day for Safety and Health at Work, a day to raise awareness about the importance of preventing injury and disease related to workplace hazards. Hospitals everywhere pose workplace hazards, especially in developing countries, where health workers risk their lives each day on the job.

In Tanzania, where AmeriCares has its longest-standing Africa partnership, infectious diseases are still the leading cause of death, and access to vaccines is extremely limited. Many of the country’s health workers don’t have consistent access to safety-oriented supplies to protect themselves and most health workers haven’t had adequate training on preventing the spread of hospital-related infections and injury. Tanzania also has the lowest rate of physicians per capita of any country in the world, with only one doctor per 100,000 people. In an effort to protect Tanzania’s sparse and underequipped health care workforce, in 2008 AmeriCares launched the Health Worker Safety Initiative (HWSI), with a goal to develop a center of excellence in safety at  Bugando Medical Centre, a teaching and referral hospital staffed by 1,200 health workers and nearly 1,000 medical students who care for nearly 250,000 patients each year.

“During my most recent visit, all of Bugando’s health workers had already attended safety trainings, and big changes were evident.”

Through the HWSI, all of Bugando’s health workers participated in two-day safety trainings. These workshops include critical occupational safety topics ranging from infection prevention and control to proper use of personal protective equipment and fire safety. Trainings are led by a team of 40 Bugando health workers from different departments who were themselves trained at the launch of the project, using a special curriculum developed specifically for the HWSI. AmeriCares also supports the project with regular donations of safety-oriented supplies and equipment, vaccines against hepatitis b, tetanus, and yellow fever, and grants for infrastructure upgrades to improve hospital conditions.

During my most recent visit, all of Bugando’s health workers had already attended safety trainings, and big changes were evident. “Everyone is more aware of occupational hazards from what they’ve learned in the trainings and from seeing what happens when other people are injured,” explained Nurse Gemetilda Katongo, a health worker safety trainer who has 20 years of experience as a nurse at Bugando. “Since the project and the trainings began there have been less injuries and needle pricks among health workers. Also, when people are injured they now understand the consequences, so they follow proper procedure and use post-exposure prophylactics more strictly.”

 Photo: Phil Farnsworth 

“One of the greatest successes of the HWSI is the way that it has transformed the work environment for Bugando’s staff.” 

What struck me the most in my discussions with nurses at Bugando was how empowering the project has been for the hospital’s health workers, and the level of enthusiasm among health workers for applying the lessons of the trainings. Nurse Katongo explained “I know the hazards that can appear and I am teaching people and they respect me.” Nurse Deborah Mollel, a 30-year veteran of Bugando agreed, “All health workers are reinforcing good behaviors with one another. We work together as a team. The changes in behavior are the most important part of the project—these will be long-lasting.”

One of the greatest successes of the HWSI is the way that it has transformed the work environment for Bugando’s staff. Health workers told me that they feel more confident when treating patients now that they have been vaccinated against hepatitis B and have the gloves and other important pieces of equipment that keep them safe on the job. These improvements have changed the attitudes of health workers about coming to work each day. Nurse Mollel told me, “Now we are proud to say that we work at Bugando. Our safety and working conditions are now so much better compared to other hospitals, and we are well-stocked with the supplies to keep us safe.”

I know that this year on World Day for Health and Safety at Work, I will think about the hugely dedicated health workers at Bugando Medical Centre, and celebrate the great achievements that AmeriCares and Bugando have made together in building a safer, healthier place to work.