Small Steps, Big Leap

Here’s how over a decade of global health investments made a difference for one little girl in Tanzania

Aflozia’s mother speaks with the doctor to explain her daughter’s symptoms. / Rachel Chilton, USAID/Tanzania

I recently visited Tanzania after a long absence, having first visited the country in 2006 to work with partners to launch the U.S. Government’s President’s Malaria Initiative. Things were different in those days. Malaria had a tight grip on the country. Most health facilities did not have laboratory capacity. There were no malaria rapid diagnostic tests and effective malaria drugs known as artemisinin-based combination therapies were just beginning to arrive in country.

Often, there were stock outs and I witnessed mothers with children who were very sick — usually from malaria, pneumonia or diarrhea — leave without needed medicines. Health records were handwritten. And the results were what one would expect — thousands of preventable deaths and illnesses in children under 5, with 1.5 of every 10 children dying before their fifth birthday.

Since then, USAID, together with Tanzanian and donor partners such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, have made significant investments in health systems, malaria and maternal child health.

To see the results for myself, I took a trip with my USAID/Tanzania colleagues to conduct site visits and review USAID’s Public Sector Systems Strengthening (PS3) program. Designed and funded by USAID’s mission in Tanzania, PS3 is a health systems program that works at the regional and local government level to strengthen and scale management information systems to improve health and education services. These systems manage finances and support human resources for health facilities.

Most recently, a system called GoTHOMIS was expanded to help health providers care for their patients by managing patient flow, providing prompts for diagnosis, keeping electronic patient records and managing drug stocks.

We visited a health dispensary outside of Mwanza that had been using the planning and budgeting system called PlanRep, financial management system called FFARS, and the electronic patient management system called GoTHOMIS.

Staff at Ilemela Dispensary in Mwanza region of Tanzania speak with Aflozia’s mother to check her in as a new patient. The receptionist illustrates how their new computer system has made patient tracking easier and more reliable. / Rachel Chilton, USAID/Tanzania

The health facility manager explained that since they began using PlanRep and FFARS, they are now able to manage their facility financial allotment better and, as a result, collect additional revenue to improve facility operations. With the additional revenue earned and ability to better plan expenditures, the facility purchased four additional computers, on which they installed GoTHOMIS, and received training on their use.

The practical application became apparent when we met Aflozia and her mom at the clinic.

Aflozia is 2 years old and appeared listless and lethargic. Her mom was clearly worried. The clinic receptionist first searched in GoTHOMIS to see if they already had a record for Aflozia.

Clockwise from top: Aflozia sits for a blood test with her mother in the health clinic lab. The lab is equipped with tools to run tests in a timely manner to ensure patients do not have to wait too long for results. The pharmacist writes instructions on each medication for Aflozia per the doctor’s orders. / Rachel Chilton, USAID/Tanzania

Finding no record, the receptionist created a new patient file for Aflozia. Next, she went to see the doctor in the examination room. The doctor pulled up her newly created patient record and asked her mom a series of questions about her symptoms.

The doctor then performed a clinical exam on Aflozia, and entered the reported symptoms and clinical exam findings into GoTHOMIS. Based on the exam and reported symptoms, the GoTHOMIS system also provided prompts to the doctor on potential diagnoses and lab tests to order. The doctor ordered a malaria rapid test, urine test and stool test — recorded in the system — and then Aflozia was off to the lab.

At the lab, the technicians pulled her file from GoTHOMIS and administered the tests that the doctor had ordered. Once the initial lab results were in and entered into the system, Aflozia was back to see the doctor in the exam room.

Aflozia and her daughter wait in the lab for tests to be performed. /Rachel Chilton, USAID/Tanzania

Based on the lab results and clinical exam, the doctor diagnosed Aflozia with pneumonia and prescribed antibiotics. Her mom was given instructions for her care and sent to the dispensing window to receive the antibiotics. The pharmacist again pulled up Aflozia’s file from GoTHOMIS, filled and recorded the prescription in the system, which also tracked inventory levels.

Aflozia’s mom left the clinic with confidence that her little girl would soon be well.

We also breathed a sigh of relief, knowing that Aflozia had received quality care and if she needed follow up, there would be a clear record of her medical history and the antibiotic she had been treated with the first time.

Aflozia’s mother takes medication from the pharmacist. / Rachel Chilton, USAID/Tanzania

The use of GoTHOMIS not only helps promote better care, but also helps prevent antimicrobial resistance through the rational use of antibiotics and antimalarials.

Back in 2006, I would have left the clinic with worry for the moms and children that I met in clinics and hospitals. This time, I did not.

USAID’s long term investments in health systems strengthening, maternal child health and malaria are paying dividends. Just ask Aflozia’s mom.

About the Author

Sonali Korde is the Director of the Office of Legislative Affairs at USAID headquarters in Washington. Contributing to this story from USAID’s mission Tanzania are Health Officer Elizabeth Williams, Public Health Specialist Godfrey Nyombi and Development Outreach and Communication Officer Rachel Chilton. Follow @USAIDTanzania for more.