Tanzania Link

The Tanzania Link is a mental health partnership between the Trust and Mirembe Hospital & School of Nursing, Tanzania’s national referral psychiatric hospital.

Launched in 2009, the Link’s initial focus was to develop a mutually beneficial relationship with a health service in a low or middle income country. Tanzania is a low income country with a critical shortage of mental health professionals and only 17 psychiatrists to serve its population of 44 million people. Furthermore, mental health is neglected in Tanzania because of stigma and competing health demands.

Launched in 2009, the Link's initial focus was to develop a mutually beneficial relationship with a health service in a low- or middle-income country. Tanzania is a low-income country with a critical shortage of mental health professionals and only 17 psychiatrists to serve a population of 44 million people. Furthermore, mental health is neglected in Tanzania because of high levels of stigma and lack of awareness and considerable competing health demands. Of the 6% of the Tanzanian GDP spent on health generally only 2.4% of the total health budget is spent on mental health. This results in very limited resources for people with mental health problems, so that practically all services are hospital-centred and here is little support in the community.

From the outset, the Link aimed to build the skills and capacity of staff at Mirembe Hospital & School of Nursing. However, both CNWL and Mirembe recognised that the Link was mutually beneficial and could make a significant difference to and impact on their services and staff.

The Tanzania Link project has now been running successfully for 5 years and has gained recognition at the level of the Department for International Development (DfID) and the Tanzanian Ministry of Health and Social Welfare as a model of good practice.

Mirembe Hospital & Nursing School

Mirembe Hospital is based in Dodoma, the legislative capital of Tanzania, and opened in 1926. It is Tanzania’s national referral psychiatric hospital with provision for general and forensic inpatients and a rehabilitation village. There are 600 patients with two psychiatrists and 250 staff from a range of professions. There is commonly one nurse to 60 patients on a ward.

Since 1973, the School of Nursing has provided training for mental health nurses. It offers a diploma course in general nursing, an advance diploma in mental health nursing and short continuing professional development courses. The school hopes to introduce Tanzania’s first BSc in mental health in the next couple of years.

Benefits to CNWL

Through the Link, Trust staff have benefited in the following ways:

  • Improved morale and motivation, and greater appreciation of the Trust and NHS.
  • Gaining a better understanding of the Trust’s services and teams through workstream and committee meetings. 
  • Enhanced knowledge and skills, including project management, global mental health, problem solving skills, fundraising, budgeting, writing grant applications, service monitoring and evaluation, and managing resources efficiently.
  • Having the opportunity to work with staff outside of their usual day jobs.
  • Improved leadership skills with innovative and creative ways of working.
  • Greater awareness of how to avoid waste and work with fewer resources.
  • Greater understanding of global mental health and service delivery in low income countries.
  • Learning and enhancing (new) skills in research, project management, communication, negotiation and presentation.
  • Better cultural awareness and understanding of cultural differences and attitudes, including the use of interpreters.

Benefits to Mirembe Hospital

Since the Link was established, much work has taken place to create good working relationships and agree a set planned priority areas. These include:

Therapeutic management of violence and aggression training (TMVA): This was an immediate priority for the Link to positively impact on the recruitment and retention of staff at Mirembe, where there were no formal approaches to managing violent and aggressive behaviour despite high levels within the hospital.

In April 2011, four CNWL staff travelled to Tanzania to train 50% of Mirembe staff in TMVA techniques. The Link successfully secured further funding to enable Mirembe staff to become TMVA tutors and train the remaining 50% of hospital staff, plus staff in two other regional hospitals.

The project finished in 2014. It has led to a decrease in violence and aggression in the hospital and has helped to improve morale within the hospital. Furthermore, communication between staff and patients has increased and Mirembe’s first staff and patient council was established.

Supporting the opening of a substance misuse (SMS) centre: In 2014, Mirembe received funding from the Ministry of Health to complete a building for the treatment of substance misuse, due to open in July 2014. The Link aims to support this specialist service by focusing on three key areas: infrastructure, training and education for staff and students, and partnership working. 

IT development: This objective  focuses on developing the hospital’s IT infrastructure to facilitate improved communication, training and future IT projects e.g. clinical systems, financial systems and training facilities. The majority of staff at Mirembe have limited IT knowledge/ skills and access to computers. The Link is now looking at resources and funding to develop these areas, as well as Skype supervision and training.

Developing occupation therapy (OT) at Mirembe Hospital: Currently, there is one qualified occupation therapist who runs activities in agriculture, carpentry, tailoring and weaving with a small number of service users. In the long term, the Link hopes to develop the knowledge and skills of the OT and increase capacity through student placements.

Community engagement: In November 2012, two staff completed a project to scope community services and ascertain the discharge process at Mirembe Hospital. They found that community services were previously active at Mirembe but that they have decreased over the last decade. There is limited follow-up for patients, mainly due to low staffing levels and capacity, which has led to 90% of discharged patients returning to Mirembe within one month. The Link aims to strengthen community services in the Dodoma region, and is hoping to secure funding from the Ministry of Health & Social Welfare in Tanzania to achieve this.

Building nursing capacity and practice: Nurses are the biggest staff group at Mirembe. In January 2014, a scoping visit took place to identify nurses for a “buddying” project and to review nursing practice and supervision. A number of nurses from Mirembe were keen to take part in the project and CNWL is currently recruiting nurses from the UK to participate.

Achievements

Since its inception, the link has achieved a great deal both as a result of the planned priority areas but also from some unexpected outcomes. It has helped to raise morale at Mirembe Hospital; staff and hospital management feel proud to be linked with CNWL. This gives the hospital management confidence, which helps them to raise the profile of Mirembe Hospital and mental health within Tanzania.

As a neutral partner, CNWL helps to facilitate difficult discussions between staff and management, and staff and patients. As a result of these discussions, hospital management has implemented positive changes, such as fixing the ward lighting and telephones so that patients and staff feel safe at night.

By linking with CNWL, Mirembe has become a more attractive place to work, which is likely to help recruit and retain staff and students in the future. Feedback from the Matron at Mirembe Hospital in January 2014 said:

“The experience that I gained from CNWL has helped me to improve my practice in the management of mental patients, especially those with violence and aggressive behaviour. Also it has helped me in the supervision of my junior staff, to provide proper and safe care to patients.”

Fundraising

The Tanzania Link regularly raises funds to support its work. In the past CNWL staff have taken part in running and triathlon challenge events. The Link also holds events, stalls and promotes payroll giving within the Trust. In 2013 the link successfully raised £12,000 to support its activities.

 

Volunteering for the Link 

Periodically volunteers from the Link make visits to Tanzania to support the various work-streams. In order for this to be a fair and transparent process and to ensure that as many suitable volunteers as possible have the opportunity to visit the Tanzanian partners, there needs to be a set of criteria which is used to select staff for each visit. These include:

• The current priorities of the Link
• The purpose of the visit, as agreed by the Tanzania Link Committee
• The skills of the interested volunteers
• Maintaining continuity and consistency of approach
• Agreed approval from line managers
• Availability at the proposed dates of the visit
• Commitment to ongoing work with the Link beyond the visit
• Commitment to pre planning and preparation of materials to be used on the visit
• Commitment to writing a full report of the visit, and to assist with any follow-up work
• Valid passports and eligibility to obtain a visa.

Where there are more potential volunteers than spaces available there will be an interview for selection. The decision of the Tanzania Link Chairs will be final. 

CNWL staff can find more information about volunteering on the staff intranet. 

Non-CNWL staff interested in volunteering should contact Chris Bumstead, Tanzania Link Manager 

Making a donation  

If you are interested in supporting the Tanzania Link you could make a regular donation through Virgin Giving When you use this method you can also choose to donate Gift Aid which means that an extra 25p will be added by the taxman.

 

Make sure when you have chosen how much and how frequently you wish to donate that you enter in the Comment section TANZANIA LINK PROJECT so that your donation goes into the correct part of the CNWL Charitable Funds Account.

 

Future plans

In November 2014, the link will hold a summit in Tanzania to review and evaluate the priority areas over the last five years, and to create a strategic plan for the next five to 10 years.

The link aims to further engage with the East African/Tanzanian diaspora to support the work of the link. This highlights best practice and is also an excellent resource, whilst potentially ensuring the Link’s future sustainability.

 

Further information

For further information, or for ways to support the Tanzania Link, please telephone Chris Bumstead, Tanzania Link Manager, on 020 3214 5765 or email c.bumstead@nhs.net