Global Citizenship

In 2001, the Abbott Fund and the Health Ministry identified Muhimbili National Hospital, located in Dar es Salaam and the country's leading teaching and reference hospital, as a starting point for a nationwide transformation. Muhimbili’s deteriorating facilities and services were often ill equipped to meet the needs of a new patient population – people with HIV who would receive long-term ARV treatment.

It was determined that any improvements made at Muhimbili would trickle down throughout the entire health system. A new outpatient department was built, containing a training facility for students and hospital staff. Hospital management received training to strengthen department organization and financial management, and a modern IT system was installed to track inventory, prescriptions and patient health history. These improvements helped to increase hospital-generated revenues by more than 50 percent in the first two years of the partnership.

From the initial work at Muhimbili grew an ambitious plan to modernize the country’s health care system and expand access to HIV testing and treatment throughout the country. This work included building new testing and counseling rooms to ensure patient privacy, renovating outpatient clinics and laboratories, donating laboratory equipment and creating local hospital HIV management teams. More than 15,000 health care worker trainings were conducted to support these improvements. The Abbott Fund also donated one million rapid HIV tests to support the Presidential effort to increase testing on a national scale.

The Muhimbili outpatient department was the first to integrate HIV treatment into its other outpatient services, helping to mitigate the stigma associated with HIV status. The partnership has extended to hospitals, clinics and rural health facilities across the country. This includes both training and physical renovations at more than half of the country’s regional hospitals. Facilities and systems were upgraded at more than 90 sites throughout the country to improve voluntary counseling and testing services and prepare for the availability of treatment programs.

Most public health laboratories, including Muhimbili's Central Pathology Laboratory, were inefficiently designed, understaffed and generally in poor condition – and physical infrastructure and equipment were in a state of disrepair – leaving a critical gap in patient services.

The Muhimbili hospital laboratory was modernized and computerized to provide accurate diagnostic testing that is crucial not only for lifelong monitoring of HIV patients, but for those with other chronic illnesses like diabetes. Muhimbili’s Central Pathology Laboratory has been modernized, allowing patients to get test results on the same day, rather than coming back days or weeks later to receive a diagnosis.

Most recently, the Abbott Fund/Ministry of Health partnership identified Emergency Medicine as a new area of focus. Emergency Medicine is not a recognized trained medical specialty in Tanzania and there is no formal emergency medical service system.

As a result, patients admitted to public hospitals for acute conditions generally receive limited care until a specialist is available to provide treatment. The lack of emergency care has now been recognized as a contributing factor to the country’s mortality and morbidity rates.

In 2009, the first public Emergency Medical Department in Tanzania to provide services meeting international standards was dedicated on the grounds of Muhimbili National Hospital. The building renovations, staff training and new equipment are supported by a grant from the Abbott Fund.

While the training and services provided at the new EMD will have an immediate impact in its region, the broader goal is to utilize the department as a training ground and create the first residency program in emergency medicine in the country.

Over the years, the Tanzania Government and development partners commissioned several assessments that reviewed the state of laboratory services in Tanzania. These assessments concluded that laboratory services were the weakest link to provision of quality healthcare, especially HIV/AIDS care. Most public health laboratories were understaffed and physical infrastructure and equipment were in a state of disrepair – leaving a critical gap in patient care.

In 2007, the Abbott Fund committed $10 million to modernize all 23 regional-level laboratories in Tanzania over three years.

The implementation team visited each site prior to intervention to consult the local management and to determine the scope and type of intervention. Pre- and post-intervention assessment tools were developed to measure results. The key objective was to build or renovate the laboratories to a standard design that focused on increasing efficiency and safety; providing equipment, enforcing preventative maintenance and quality assurance strategies and on site mentorship to laboratory staff.

The nationwide lab modernization project was completed on time (within three years) and on budget and is increasing the capacity and improving the quality of Tanzania’s 23 regional-level laboratories that support 121 district laboratories providing services to more than 200 care and treatment centers that are scaling-up care nationwide.

Results from the modernization of the first lab showed dramatic improvements, including increasing the number of tests from an average of 15,000 to 134,000 per year and reducing the turnaround time from an average of 3-14 days to less than 24 hours. The number of patients utilizing the laboratory facilities rose from an average of 5,000 to 38,000 per year indicating improved patient confidence. The modern working environment also has boosted staff morale and productivity.

A mentorship program for the laboratory staff was designed to address staffing issues, improve workflow, create and implement standard procedures and ensure lab quality assurance, as well as improve lab perception by doctors and hospital staff, market lab services and lay the foundation for accreditation.

Mentors have maintained contact with host labs, often providing troubleshooting advice remotely. Future plans include providing additional technological resources to support these communications. All of the mentors agreed that the experience and the technical exchange of information were priceless, providing growth for both the mentors and for their new friends from Tanzania. Exposure to international experts has improved staff buy-in and provided long-term support.

In Cochabamba, Bolivia’s third-largest city, more than 7 percent of the population suffers from diabetes. Clinica Vivir con Diabetes (CVCD), Abbott Fund’s and Direct Relief International’s local partner, diagnoses and treats patients with diabetes throughout the city while also working to raise awareness through a variety of activities, like the diabetes walk pictured here.

CVCD held a diabetes awareness fair in a park across the street from its clinic. The event offered free testing and counseling for those found to have Type I or Type II diabetes.

Many of those tested were young adults from low-income families. CVCD is the region’s only diabetes clinic, delivering care at little or no cost to patients.

Since 2006, CVCD has screened and cared for 66,500 diabetes patients in Cochabamba, including Type I and Type II diabetes. In addition to our financial support, Abbott donates blood-testing equipment for the clinic as well as for patients’ personal use.

We also help support CVCD’s lifestyle education courses for diabetes patients. Before CVCD began its educational outreach, health care practitioners in the region tended to treat diabetes as a temporary disease rather than a lifelong condition.

As part of its mission, CVCD sends trained social workers to visit diabetes patients at home to ensure that they know how to manage their condition.

Thanks to CVCD, the annual rate of detection of diabetes in Cochabamba has increased by 250 percent. Over the past five years, CVCD has served more than 66,500 diabetes patients, counseling them on disease management techniques and healthy living habits.

Recently, the Abbott Fund helped its Bolivian partner Clinica Vivir con Diabetes to obtain iPads and the specialized programming needed to track diabetes patients. A new record is created for each new patient at the diabetes clinic.

The patient’s name and home address are noted and stored, along with any available medical history. In addition to tracking individuals, the program consolidates medical data, allowing analysis of the information later.

The patient’s home address is instantly pinpointed on a map, and the location is saved as part of the record.

In the examination room, the patient’s blood glucose level is tested, and the number is noted on his electronic record, along with other medical notes.

Simple, bold graphics and a touchscreen help patients as they describe their medical histories. No reading or writing ability is required, and even the youngest and the oldest can understand the images.

After being examined, patients meet with an endocrinologist who has full, instantaneous access to individual records. The doctor interviews the patient and adds her notes directly to the file. No medical transcription is needed, lowering the chance of accidental errors.

On later visits or in case of emergency, staff can quickly access the records for each individual. That means faster response time and more accurate diagnosis, prescriptions and treatment. With diabetes sharply on the rise in Bolivia, the technology is an effective tool for helping patients manage their disease and live healthier lives.