'HEALCARe will have an impact on thousands of patients and hundreds of nurses, teachers and students across Tanzania’

In Tanzania, there is a hierarchical distance between patients and medical care. As a result, communication between clients and healthcare providers is sometimes inadequate. Often patients do not know exactly what their disease and treatment entails and what they can do themselves to live healthier lives. This can have detrimental effects on healing and recovery. That's why the Tanzanian government decided to set up the programme Respectful and Compassionate Care, with the aim to improve care through effective communication and ethical practice.

For about a decade, there has been a special relationship between the Academy of Nursing, the research group Nursing Diagnostics of Hanze University of Applied Sciences and the Ministry of Health, healthcare hospitals and training institutions in Tanzania. This is how Hanze UAS became involved when HEALCARe started in 2019. The programme was completed in January 2024, and the changes can now be clearly felt.

Project leader Joya Smit, professor Wolter Paans of the research group Nursing Diagnostics, and Judith Pellicaan, lecturer in Internationalisation, all from Hanze UAS, were closely involved. Wolter Paans: 'Various Tanzanian reports made it clear that patients' understanding of illness and care in Tanzania could be improved. How we could best support this, was an important component in our research on 'Health Literacy'.

Innovating the training curriculum

HEALCARe, an acronym for Health Literacy and Respectful, Compassionate Care, is an Erasmus+ project, in which the University Medical Center Groningen is also closely involved. Janine de Zeeuw, postdoc at the Department of Global Health, contributed to the development and implementation of the research plan. In Tanzania, the project is being carried out by the Ministry of Health, three university institutions with the associated hospitals, spread over different regions. Joya Smit: 'With this project, we want to improve the health literacy of patients in Tanzania by training nurses and midwives based on an innovative curriculum. This allows them to clearly explain the care and evaluate whether the patient has understood them.' The research group Nursing Diagnostics coordinated the project, but the policy makers, researchers and lecturers within the organisations in Tanzania remained in charge. It was here that decisions were made about which cases were carried out and how; the European partners were mainly providing advice and facilitation. Wolter Paans: 'Thanks to Joya's extensive knowledge and experience about the culture, language, politics, healthcare and above all, the people in Tanzania, a unique balance of cooperation was found here'.

HEALCARe: train the trainer

In the meantime, a curriculum with accompanying training materials has been developed for students and lecturers in Tanzania, which is used for both theory and practice. In addition, there is a training to train the trainers. Joya: 'We have developed new methods for this, partly based on how we offer education in the Netherlands. In Tanzania, teaching is still often head-on, in front of the classroom, but our method also includes role plays and reflection, a diversity of collaboration methods, interdisciplinarity and other communicative and didactic means. So this project also has an impact on how professionals practice their profession.'

Professionalisation of nurses and midwives

Lecturers, students and researchers in Tanzania have been busy developing the programme in recent years. There is now a card system for evaluating the new way of working. Also new is a survey for when someone is discharged from the hospital; a tool that generates a lot of data and that immediately benefits the hospital when it comes to indicators for quality improvement.

All new employees in the institutions involved in Tanzania are now following the 'Health Literacy' and 'Compassionate Care' programme. Wolter: 'What is also valuable is that Tanzanian nurses are now showing more professional leadership with their new knowledge. In this way, you create a professional attitude that was not there in the field of Health Literacy and Compassionate Care. It generates new ideas and new roles, which means that the profession of nurses and midwives is also professionalized. Future generations of patients will really benefit from this; It will have a long-lasting impact.’  

Effects can be felt in Tanzania

Lucas Dominic is involved in Tanzania as a nurse and manager of the Bugando Medical Center Mwanza. He participated in the development of the training courses and three modules: Health Literacy, Customer Care and Respectful and Compassionate Care. These have been used to train teachers and clinical instructors at Bugando Medical Center and the Catholic University of Health Sciences. This was followed by a training for 62 students and now all nurses at the Bugando Medical Center have also completed the training.

The positive effects of HEALCARe are clearly felt. Lucas: 'The care in the hospital has improved. There are fewer complaints from patients, because our practices have changed, such as the improved reporting of nurses' activities. Nurses also treat patients differently. We use new techniques, for example, determining the level of a patient’s Health Literacy, i.e. what patients understand about their own health. The roleplays and surveys offered a lot of support in this. And with our new approach, we are also better trained to guide students from Hanze UAS and the Catholic University when they come here. This applies to all the departments where they will be working.'

What has HEALCARe brought?     

Joya: 'A big difference is that all the regions now work together. With all parties involved in HEALCARe, there is now a real learning community. They do research together, there is exchange. It also means that the connection between universities and hospitals is much better. Previously, that exchange did not happen. Everyone did their own research, and kept track of the results. Then it could happen that they all did the same thing. We are used to working differently, to sharing. This new way of working has major advantages for everyone.'

Lucas: 'The biggest difference for us is how we approach patients now. With the new techniques of 'patient-centred care', the patient is central and we have a better understanding of someone's health skills. That has really improved healthcare. We can work more professionally and therefore we are able to supervise the students who do an internship with us better. In addition, the relationships with partners Muhimbili University and Muhimbili National Hospital and Kilimanjaro College and Kilimanjaro Christian Medical Centre have become stronger, which makes working together much easier.'

Wolter: 'The Ministry of Health in Tanzania has now developed an e-learning module that is accessible to everyone online and free of charge. Ultimately, this will also lead to an improvement in the quality of care for patients. Sometimes there are technological obstacles, such as limited internet options, or logistical problems such as the accessibility of hospitals. And some populations, such as the Maasai, literally live at a great distance from care. But in the meantime, many seeds have been planted for possible future projects.  HEALCARe will ultimately have an impact on thousands of patients and on hundreds of nurses, teachers and students across Tanzania.'

Joya Smit

Shortly after this interview was completed, we received the very sad news that Joya Smit had suddenly passed away at the age of 60. This is a huge loss to everyone, both in and outside Tanzania. We still find it difficult to comprehend. Joya felt very much at home in Tanzania, where she was loved enormously for what she did and also for who she was. Knowing that without Joya things will be forever different, we will do everything we can to maintain the ties with the partners in Tanzania.

A personal word from Lucas Dominic about Joya

When I visited the Netherlands for this project Joya welcomed me to her home and introduced me to her family and friends. And when she visited Tanzania she brought gifts for me and my siblings. We went to Bukumbi together to search for accommodation and clinical placements for students. And later we had zoom meetings to discuss students’ progress and ways to improve care. It felt like Joya was part of my family and I really miss her. I really appreciate the collaboration between Hanze University and Bugando Medical centre Tanzania and everything Joya did for us.

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