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Improvements to healthcare waste management at regional referral hospitals in Tanzania using the KAIZEN approach

Hisahiro Ishijima (Reserach and Planning, Fujita Planning Co., Ltd., Tokyo, Japan)
Noriyuki Miyamoto (Reserach and Planning, Fujita Planning Co., Ltd., Tokyo, Japan)
Fares Masaule (Regional Referral Hospital Management Project, Dar es Salaam, United Republic of Tanzania)
Raynold John (Policy and Planning, Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, United Republic of Tanzania)

The TQM Journal

ISSN: 1754-2731

Article publication date: 11 May 2021




The purpose of this study is to see how the 5S-KAIZEN-TQM approach can contribute to improve the management of healthcare waste (HCW) in the regional level public hospitals in Tanzania.


This study employed an explanatory case study framework and focused on improvement of HCW management by assessing the information obtained through the direct observation and systematic interviewing during the consultation visits and external hospital performance assessment (EHPA) and the self-administrated questionnaires as sources of evidence.


Based on the observations, 100% adoption of the 5S approach was observed in 25 of 28 regional referral hospitals (RRHs). At these RRHs, segregation of HCW management has been improved by applying color codes and symbols for establishing self-explanatory system on proper segregation. In addition, seven out of 28 RRHs applied the KAIZEN process and reduced occurrences of improper waste segregation.

Research limitations/implications

This study has the following limitations in terms of the information. The data were collected through the direct observation. Moreover, areas for the implementation of the KAIZEN vary from hospital to hospital, and only 25% of RRHs completed the KAIZEN processes for improvement of HCW management. Caveats are, therefore, needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for implementing the 5S-KAIZEN approach in Tanzania and other African countries for improvement of HCW management.


This is an original study to provide evidence about the usefulness of the 5S-KAIZEN-TQM approach for improving HCW management in a low-income country in Africa.



The authors thank all who contributed to completing this study, especially the Directorate of Policy and Planning and the Directorate of Curative Services in the MoHCDGEC in Tanzania. Without those strong supports from them, it would not have been possible to commence the project activities related to resources and quality management through the 5S-KAIZEN-TQM approach, which included training of trainers, consultation visits and EHPAs. The authors would also like to give special thanks to the Japan International Cooperation Agency for funding the Regional Referral Hospital Management Project in Tanzania.

Authors' contribution: HI managed the entire implementation of project activities from 2015 to 2020, designed the study and drafted and revised the manuscript. NM carried out different activities and collected data and helped to revise the manuscript. RJ coordinated different quality improvement activities during the project period. FM helped to carried out different activities and helped to draft the manuscript.


Ishijima, H., Miyamoto, N., Masaule, F. and John, R. (2021), "Improvements to healthcare waste management at regional referral hospitals in Tanzania using the KAIZEN approach", The TQM Journal, Vol. ahead-of-print No. ahead-of-print.



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Copyright © 2021, Emerald Publishing Limited

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