Worldwide situation analysis on antimicrobial resistance (AMR) released in 2015 by the World Health Organisation (WHO) has revealed inadequate capability to respond to AMR in…
Abstract
Purpose
Worldwide situation analysis on antimicrobial resistance (AMR) released in 2015 by the World Health Organisation (WHO) has revealed inadequate capability to respond to AMR in African region. Report of antibiotics use and resistance in Tanzania revealed rising levels of healthcare associated Methicilin Resistant Staphylococcus aureus infections; while other studies have reported high prevalence of Expanded Spectrum Beta-Lactamase (ESBL). The purpose of this paper is to review the current situation of antimicrobial stewardship (AMS) in Tanzania using strengths, weaknesses, opportunities and challenges (SWOC) analysis.
Design/methodology/approach
General literature review was done on use of antimicrobials in Google Scholar, websites of key organisations including WHO, and grey literature. Conceptual framework designed by the authors was used to inform SWOC analysis of the Tanzanian health sector.
Findings
The SWOC analysis has revealed much strength in the Tanzanian health sector indicating that increasing investments in laboratory services, in medicines Regulatory Authority and Pharmacy Council, and strengthening management teams at all levels of service delivery, including Medicines and Therapeutics Committees; and strengthening advocacy on rational use of antimicrobials both in humans and livestock will improve AMS.
Research limitations/implications
This is a general literature review. No interview of experts or use of questionnaires was used. However, based on the literature found and author’s experience in the health sector, the information contained is valid for consideration in making policy decisions about AMR in Tanzania.
Practical implications
Designing policy interventions to prevent development of AMR to commonly used antimicrobials.
Social implications
Improving social wellbeing in the community through prevention of morbidity and mortality resulting from multi-resistant pathogens.
Originality/value
This is the authors original idea backed by available literature.
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Hisahiro Ishijima, Eliudi Eliakimu and Jonathan Mcharo Mshana
The purpose of this paper is to assess causal relations between the implementation of the 5S approach and the reduction of patients’ waiting time at out patient departments (OPDs…
Abstract
Purpose
The purpose of this paper is to assess causal relations between the implementation of the 5S approach and the reduction of patients’ waiting time at out patient departments (OPDs) of hospitals in Tanzania.
Design/methodology/approach
Patients’ waiting time was measured under the cluster randomized control trial (c-RCT). In all, 16 hospitals were chosen and divided into treatment and control groups using block randomization. Before the intervention, a baseline study was conducted at OPDs in all 16 hospitals. After one year of the intervention, the end-line study was carried out in both the groups. A comparison of the average waiting time reduction and Difference-in-Difference (DID) analysis was carried out to see the effect of the 5S approach on the reduction of patients’ waiting time.
Findings
Statistical significance in reduction of patients’ waiting time was seen in the medical records sections (p=0.002) and consultation rooms (p=0.020) in the intervention group. The same trend was also seen using DID analysis (−15.66 min in medical record, −41.90 min in consultation rooms).
Research limitations/implications
This study has the following limitations in terms of the data. The data were collected for only three days at the time of baseline survey, and again for three days at the time of the end-line survey from 16 hospitals. Moreover, piloted areas for the implementation of the 5S approach vary from hospital to hospital. There might be a bias in the measurement of a patient’s waiting time. Caveats are therefore needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for implementing quality improvement programs in Tanzania and in other African countries for improvement of time factors.
Originality/value
This study used c-RCT, and has proven the effectiveness of the 5S approach in improving the working environment and reducing patients’ waiting time at OPDs in several hospitals at district level in Tanzania.
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Hisahiro Ishijima, Eliudi Eliakimu, Shizu Takahashi and Noriyuki Miyamoto
The purpose of this paper is to identify factors that influence the implementation of the rollout of the 5S approach in public hospitals in Tanzania, and share the way to scale…
Abstract
Purpose
The purpose of this paper is to identify factors that influence the implementation of the rollout of the 5S approach in public hospitals in Tanzania, and share the way to scale this up for similar setting in developing countries.
Design/methodology/approach
The effect size was calculated from pre- and post-assessment results of Training of Trainers (ToT) to examine the effectiveness of ToT. A questionnaire with 14 explanatory variables was developed and completed based on information collected during Consultation visits (CVs) and progress report meetings (PRMs). Then, data were analysed to identify the influencing factors in relation to outcome variables (CV average score).
Findings
Among 14 explanatory variables, five explanatory variables showed statistical significant association with the CV average score. Those are: “Feedback and information sharing,” (p=0.031), “Quality Improvement Team roles and responsibility” (p=0.002), “5S knowledge,” “Involvement and commitment,” and “5S guidelines use and availability,” (p=0.000). When the explanatory variables were controlled by levels of hospitals; “involvement and commitment” was the only explanatory variable for national level hospitals. For regional referral hospitals, “QIT roles and responsibility” (p=0.02) and “5S knowledge” (p=0.03) were statistically significant. For district hospitals, “involvement and commitment” (p=0.01) and “availability of guideline (p=0.001)” were statistically significant.
Research limitations/implications
This study has the following limitations. The data were collected from existing reports and presentation materials only. There might be reporting bias, as PRM data is self-reported from the hospitals. Caution is therefore needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for designing and implementing QI programs in Tanzania and in other African countries.
Originality/value
The authors' conceptual framework is based on the existing literature on the science of diffusion and scale up of innovation in the health sector. Few studies are known from resource constrain settings in Africa which assess the determinants of the process of nationwide scale-up of proven interventions.