The Tanzanian Ministry of Health and Social Welfare requested our participation in their Twiga Initiative, a five-year proposal to enable better primary health care by training and retaining more health workers.

Working with a pro bono team from McKinsey & Company, we recently completed the initial, diagnostic phase of this initiative.

What we did
Over a three-month period, our team visited 39 of Tanzania’s 114 schools training doctors, assistant medical and clinical officers, nurses, and other medical technicians. We interviewed school principals, hospital directors, government officials, and public health experts.

What we found
Through our interviews, observations, and research, we first identified the primary constraints to expanding health worker training: shortages of classroom teachers and clinical supervisors, insufficient infrastructure (student housing, classroom space, teaching labs, and patient beds), and in some cases a shortage of applications from qualified students.

Based on these constraints, we developed a set of recommendations that we shared with the Tanzanian health ministry, focused around three key activities that we believe could enable expanded health worker training in Tanzania:

1. Invest in expanding each individual school, targeting the key obstacles to growth at each, for example

• Completing the top floor of a dormitory at one nursing school
• Using a rotation schedule to make efficient use of both faculty and classroom space at one medical school

2. Promote amendments to government regulations and creation of new incentive programs to relieve system-wide constraints, for example

• Increasing faculty by offering top students scholarships for advanced certification courses in exchange for a commitment to teach for 3 years 
• Targeting housing by permitting and encouraging off-campus housing

3. Introduce transformational ideas to further expand training capacity, for example

• Virtual learning – standardizing national curricula and video taping lectures from top Tanzanian faculty that can be played with minimal technology upgrade in facilities with insufficient faculty; upgrading regional and district hospitals and ensuring distribution of qualified staff to enable use of these facilities for clinical training.
• Condensed training curricula – identifying problems most commonly seen at the lowest level of the health system (dispensaries) and rapidly training a class of providers able to provide quality care for these ailments.