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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.

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 purpose of this paper is to identify factors that influence the implementation of the rollout of the 5S approach in public hospitals in Tanzania, and share the way to scale this up for similar setting in developing countries.

The effect size was calculated from pre- and post-assessment results of Training of Trainers (ToT) to examine the effectiveness of ToT. A questionnaire with 14 explanatory variables was developed and completed based on information collected during Consultation visits (CVs) and progress report meetings (PRMs). Then, data were analysed to identify the influencing factors in relation to outcome variables (CV average score).

Among 14 explanatory variables, five explanatory variables showed statistical significant association with the CV average score. Those are: “Feedback and information sharing,” (p=0.031), “Quality Improvement Team roles and responsibility” (p=0.002), “5S knowledge,” “Involvement and commitment,” and “5S guidelines use and availability,” (p=0.000). When the explanatory variables were controlled by levels of hospitals; “involvement and commitment” was the only explanatory variable for national level hospitals. For regional referral hospitals, “QIT roles and responsibility” (p=0.02) and “5S knowledge” (p=0.03) were statistically significant. For district hospitals, “involvement and commitment” (p=0.01) and “availability of guideline (p=0.001)” were statistically significant.

This study has the following limitations. The data were collected from existing reports and presentation materials only. There might be reporting bias, as PRM data is self-reported from the hospitals. Caution is therefore needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for designing and implementing QI programs in Tanzania and in other African countries.

The authors' conceptual framework is based on the existing literature on the science of diffusion and scale up of innovation in the health sector. Few studies are known from resource constrain settings in Africa which assess the determinants of the process of nationwide scale-up of proven interventions.

The importance of health care is growing world‐wide, and the health sector is receiving a good proportion of public funds. As health‐care costs are increasing, efforts have been made to assess the operational efficiency of hospitals in many countries.

In this paper, the efficiencies of operation of 20 hospitals in the Sultanate of Oman are evaluated using Data Envelopment Analysis (DEA). The hospitals selected are Regional and Wilayat hospitals under the Ministry of Health, the Sultan Qaboos University Hospital and the hospital of the Royal Oman Police. Four outputs representing out‐patient visits, in‐patient services and surgical operations, and three inputs representing the number of beds and manpower are used in the analysis.

Using data for the year 2000, ten of the 20 hospitals are found to be efficient. A ranking of performance of efficient hospitals has been provided by computing their super‐efficiency scores. The patterns of efficiency changes over the time period 1999‐2000 are studied using the Malmquist Productivity Index (MPI) approach. It has been found that there is a decline in the efficiencies of hospitals during the period. The (geometric) average MPI of the hospitals during the period has declined, and the average technical efficiency change declined less compared with the average technology change.

This paper is one of the few published studies that evaluates the performance of hospitals in countries of the Middle East.

Hospital-based quality improvement (QI) programs are becoming increasingly common in developing countries as a sustainable method of strengthening health systems. The aim of this paper is to present the results and lessons learned from a QI program in a large, rural, district hospital in Lesotho, Southern Africa.

Over a 15-month period, a locally-relevant, hospital-wide QI program was developed and implemented. The QI program consisted of: planning meetings with district and hospitals staff; creation of multi-disciplinary QI teams; establishment of a QI steering committee; design and implementation of a locally appropriate QI curriculum; and monthly consultation from technical advisers. Initial QI programming was developed in three distinct areas: maternity care, out-patient care, and referral systems.

Partogram documentation in the maternity department increased by 78 percent, waiting time for critically ill patients in the out-patient department was reduced by 84 percent, and emergency referral times were reduced by 58 percent.

The design and early implementation of QI programs should focus on easily achievable, locally-relevant improvement projects. It was found that early successes helped to fuel further QI gains and the authors believe that the work building sustainable QI skill sets within hospital staff could be useful in the future when attempting to tackle larger national-level quality of care indicators. The findings add to the existing evidence suggesting that an increased use of locally-relevant quality improvement programming could help strengthen health care systems in low resource settings.

This paper aims to examine lean thinking in medical commodities supply chains by considering its applications and success factors. It determines the drivers and wastes of medical commodity supply chain, and the existing lean tools and practices together with their application in the supply chain processes. The paper also examined the challenges and success factors for effective lean application in the medical commodities supply chains.

The study used qualitative approaches, in-depth interviews and focus group discussions with key informants to form the basis for data collection. Through thematic analysis, the collected data were analyzed by developing themes reflecting the objectives of the study.

The main drivers for waste associated with the supply chain were demand management, supplier development, institutional framework and governance. The wastes were observed at the level of inventory, operation costs, transaction costs, delays in terms of service, commodity delivery time and quality. Digitalization, information technology and standardization were the tools for medical supply chain. Poor infrastructure, unreliable internet supply, environmental uncertainty and poor management support were challenges to realizing an effective supply chain.

Although the qualitative approach used in the study provides detailed information, a quantitative study covers a larger sample for generalization.

Capacity building and professionalism should be given a priority because the philosophy of lean focuses on waste removal and continuous improvement, which highly depends on the quality of human resource (Brito et al., 2020). Limited human resource capabilities in supply chain management will, therefore, result into poor operational efficiency, which are wasted. Moreover, systems interoperability is key waste minimization and, therefore, demands interventions.

The government under the Ministry of Health and other key sector ministries such as local and regional governments should better understand the role of the waste drivers and adopt system-wide reforms to support improvements to remove waste in the medical supply chain. For example, the current institutional framework creates an administrative block and hence leads to wastes. This bureaucratic procedure should be removed to minimize wastes along the chain.

This study is among the first studies to determine applicability and implementation of lean in a resource-constrained context. The paper identifies contextual factors for lean implementation. This paper focused on a holistic view of the entire supply chains to enhance a well-functioning supply chain in delivering health commodities.

Child mortality has been a problem in developing countries for many years. This article summarizes the factors that were identified as contributing to the sustainability of a community‐based growth‐monitoring program for the prevention of child mortality in Honduras. The program used community volunteers to measure children's growth from birth until they reached two years of age. Honduras received support from the USAID to implement the program. The authors conducted an evaluation of the program that included responses from 32 health care workers, 45 weight monitors, 96 participating mothers and 32 non‐participating mothers. Individual, community, environmental and institutional factors that contribute to the sustainability of the program are summarized. The implications for program replication are discussed.

The purpose of this study sought to determine the characteristics that distinguish online from offline information seekers among people living with human immunodeficiency virus (PLHIV) in selected regional hospitals of Tanzania.

Questionnaire-based survey was conducted among 341 adults with human immunodeficiency virus (HIV) infection attending the HIV clinics in the regional referral hospitals in Mwanza, Mbeya and Dar es Salaam, Tanzania. The study used multivariate logistic regressions to determine factors that distinguish online HIV information seekers from offline HIV information seekers.

One in every five survey participants sought online HIV information (19.6 per cent, n = 67). Both higher level of education (odds ratio (OR) = 1.765, 95 per cent confidence interval (CI) = 1.208-2.58) and intention to use internet in future (OR = 1.566, 95 per cent CI 1.148-2.136) were predictors of online HIV information seeking behaviour at multivariate analysis. Respondents who sought online information reported to have gained knowledge such as; to understand their conditions better (77.4 per cent, n = 41) and understand information received from health care workers (66 per cent, n = 35), as well as acquisition of health promoting behaviour such as; asking questions during doctor’s visit (55 per cent, n = 35) and consulting a clinician when they have problems (64.3 per cent, n = 33). The offline HIV information seekers (n = 274) did not use internet due to lack of information seeking skills (44.3 per cent, n = 113) and lack of access to internet connectivity (30.2 per cent, n = 77).

This is a comprehensive study that differentiates online from offline HIV information seekers in the context of sub-Saharan Africa. The results suggest that interventions to improve online access information will empower patients and probably positively affect their health knowledge and health promoting behaviours.

This paper aims to examine the mediation role of behavioral intention in the relationship between attitude, subjective norm, perceived behavioral control and knowledge sharing behavior.

The study adopted a cross-sectional design to collect data used to carry out mediation analysis. Structural equation modeling was used to test for the mediation effect based on the theory of planned behavior.

The results reveal positive and significant relationships between attitude, subjective norm, perceived behavioral control and behavioral intention. There is a full mediation effect of behavioral intention between attitude, subjective norm, perceived behavioral control and knowledge sharing behavior. This implies that behavioral intention wholly processes planned behavior prediction.

The sample size was small, covering only two referral hospitals which affects the generalization of findings across all the hospitals in Uganda. The study was cross-sectional focusing on a one-off perception, which does not examine knowledge sharing behavior over time. This may necessitate follow-up studies in a longitudinal design to capture the trend of results.

Managers in referral hospitals should create opportunities for health professionals to enhance knowledge sharing behavior. Knowledge sharing practices should be embedded in the performance appraisal and reward systems which should promote positive knowledge sharing attitudes and norms and develop self-efficacy.

The study generates empirical evidence on less studied phenomena in the health sector focusing on behavioral intention mediation in predicting knowledge sharing behavior.

The purpose of this paper is to present the findings of research on mothers and midwives’ understanding of the concept of respectful care in the Ugandan public health settings. It focusses on one aspect of respect; namely communication that is perhaps least resource-dependent. The research found endemic levels of disrespect and tries to understand the reasons behind these organisational cultures and the role that governance could play in improving respect.

The study involved a combination of in-depth qualitative interviews with mothers and midwives together with focus groups with a cohort of midwives registered for a degree.

The findings highlight an alarming level of verbal abuse and poor communication that both deter women from attending public health facilities and, when they have to attend, reduces their willingness to disclose information about their health status. Respect is a major factor reducing the engagement of those women unable to afford private care, with health facilities in Uganda.

Access to quality care provided by skilled birth attendants (midwives) is known to be the major factor preventing improvements in maternal mortality and morbidity in low income settings. Although communication lies at the agency end of the structure-agency continuum, important aspects of governance contribute to high levels of disrespect.

Whilst there is a lot of research on the concept of respectful care in high income settings applying this to the care environment in low resource settings is highly problematic. The findings presented here generate a more contextualised analysis generating important new insights which we hope will improve the quality of care in Uganda health facilities.