The Tanzania Link is a partnership between Central and North West London NHS Foundation Trust and Mirembe Hospital and Nursing School, Tanzania.
It is a link between the services encouraging two way learning, supporting capacity building and enhancing professional development on both sides. The Link strives to strengthen mental health care and services for people of Tanzania.
Background to the Link
In 2008, CNWL began to consider supporting a mental health related project in a low/middle income country. Simultaneously, Mirembe Hospital and Nursing School and the Ministry of Health in Tanzania were seeking a Link partner to support its national referral mental health hospital. As a result of a tender process, the Link was officially launched in March 2010.
Tanzania is one of the poorest countries in the world. It faces major health challenges and suffers from severe health worker shortages. Mental health tends to be overlooked, with only seventeen psychiatrists to serve its population of 44 million. Work is progressing to integrate mental health into primary health care and in 2006 the National Assembly enacted a new Mental Health Act.
Mirembe Hospital is based in Dodoma, the administrative capital of Tanzania. Opening in 1926, it is Tanzania’s national referral psychiatric hospital.
It is a large facility providing the following services:
- Mirembe – general inpatient provision for 600 people
- Isanga – forensic inpatient provision for 250 people
- Hombolo – rehabilitation village
- Itega - substance misuse center (currently under construction)
Mirembe Staffing profile
- 2 psychiatrist
- 250 staff from a range of professions, including: occupational therapist, pharmacist, social worker, assistant medical officers, clinical officers, medical officers and nurses.
School of Nursing
The School of Nursing was built in 1973 and is on the same site as Mirembe Hospital. It is the primary school for mental health nursing and provides training in the following areas:
- Pre-service (undergraduate) & in-service (postgraduate) training
- Diploma course in general nursing
- Advanced diploma in mental health nursing
- Short continuing professional development courses
- Plans to introduce Tanzania’s first BSc in mental health nursing
- 6 nurse tutors for 120 nursing students
LINK COMMITTEE MEMBERS
Dr Graham Behr – Consultant Psychiatrist and Co-Chair of the Link
Dr Tami Kramer- Consultant Child & Adolescent Psychiatrist and Co-Chair of the Link
Shona French – Tanzania Link Project Manager
Chris Bumstead - Head of Patient & Public Involvement
Shelia Gallagher- Associate Director of Nursing
Emma Balfe- Assistant Director of Nursing
Kavita Balu – Link Administrator
Stephen Parker - Horton Programme Manager & Substance Misuse Lead
Paschal Ndelule – Nurse & Community Engagement Lead
David Gulbrandsen - Infrastructure Services Manager & IT Lead
Dorcas Gwata - Psychoroate Nurse & Nursing Capacity Lead
Marie-Claire Mendham - Consultant Psychologist
Laura Quinn – Occupational Therapist
Russell Zubrinich – Link Volunteer
Chloe Vaziri – Clinical Audit Facilitator
CNWL Link Committee
Dr Erasmus Mndeme- Hospital Superintendent & Psychiatrist
Anna Mangula- Head of Mirembe School of Nursing
Samuel Mbwambo – Head of Administration Services and Hospital Secretary
Dr Gema Simbee- Psychiatrist
Regina Ringo – Matron of Mirembe Hospital
Lymio Jovin – Chief Patron of Mirembe & Isanga Institution
Anewa Tumaini Sowani - Head of Social Welfare & TMVA Tutor
Julia Mdagwa- Occupational Therapist
Athanas Paul – Senior Nursing Tutor & TMVA Tutor
Elizabeth Francis- Senior Nurse
Goodluck Tumaini – Nursing School Tutor & Substance misuse lead
Priorities for the Link
Since the Link was established, much work has taken place to create good working relationships and agree a set of aims and objectives, which have evolved since the start of the Link. These include:
- 1. Therapeutic Management of Violence and Aggression Training (TVMA)
This is an immediate priority for the Link to positively impact on the recruitment and retention of staff at Mirembe. Stage one of this objective was completed in April 2011 when four CNWL staff travelled to Tanzania to train 50% of Mirembe staff in TMVA techniques.
In December 2011 the Link successfully secured a grant from the THET to support four Mirembe staff to become TMVA tutors. Three tutors successfully passed the TMVA tutor training in the UK and are currently training staff at Mirembe in these techniques. The tutors will also train staff in two other psychiatric units in Tanzania.
- 2. IT Development
This is a mid-term priority for the Link to develop the Hospital’s IT infrastructure, to facilitate improved communication, training and future IT projects e.g. clinical systems, financial systems and training facilities.
- 3. Substance Misuse
This is a mid-term priority for the Link looking to develop substance misuse within Mirembe Hospital focusing on three main areas of work: Infrastructure development, training & education and local partnership working.
- 4. Developing Occupation Therapy
This is a mid-term priority for the Link is to enhance capacity of the OT provision. It aims to do this through increasing the number of patients who engage in therapeutic activities, OT training and supporting the planning, organising and facilitating skills based groups.
- 5. Community Engagement
This priority area evolved from the 2012 bursary scheme (see below). It is a current priority of the Link, which supports Tanzania’s mental health strategy to develop Tanzania’s mental health community services. Together we aim to strengthen local community services and partnership working, as well as facilitating models of client centred care planning and discharge pathways.
- 6. Building Nursing Capacity and Practice
This is a new priority area for the Link, which aims to support nurses, which are the biggest staff group at Mirembe. This priority area aims to develop the knowledge and skills of this group through peer-to-peer support by CNWL nurses.
Progress to date
There have been seven productive visits to date.
- 2009 CNWL staff visited Mirembe to carry out a needs assessment and meet key staff
- 2010 senior Mirembe staff visited CNWL to explore a range of services offered, enhance Link working relationships, agree objectives and next steps for future Link work
- March CNWL staff trained 50% of Mirembe staff in TMVA techniques
- November a scoping visit to explore substance misuse, occupational therapist and the therapeutic activities available to inpatients; and to identify the IT provisions and infrastructure
- April Mirembe staff came to the UK to participate in TMVA tutor training
- October Mirembe staff came to the UK to participate in TMVA tutor training
- November TMVA monitoring and evaluation visit and community engagement scoping visit
The recent visits have been viewed as successful by both parties. They have contributed to a shared understanding of the work of the partner organisations, cemented relationships and crated a sense of commitment to the project with a shared vision for the future.
UK LINK WORK
CNWL acknowledges that UK staff develop and learn as much as Mirembe staff through Link work and in order to develop this further we are privileged to have a Bursary Scheme.
The Bursary Scheme gives CNWL staff a unique opportunity to enhance their skills and knowledge in a new setting. It is now in its second year and staff are encouraged to apply to complete a small project or research in one of our priority areas which supports their Continuing Personal and Professional Development.
There are a range of benefits for CNWL staff involved in The Link, these include:
- Better understanding of global mental health
- Increased staff morale by introducing new dimension and creating scope for innovation and creativity
- Better cultural awareness including use of interpreters
- Greater understanding of service users and families who originate from Tanzania/ Africa
- Greater awareness of how to avoid waste and work with few resources
- Enhanced leadership skills
- Improved presentation and communication skills
- Increased motivation and appreciation of the NHS
Feedback on the Link
“I realized how lucky I am to be working within the NHS where there are enough resources to manage patients, such as staffing level…… I feel quite motivated and have improved my clinical skills in terms of initiating and managing changes on the ward/unit.” (2012 CNWL bursary scheme winner)
“Mirembe has benefitted from the link as the visits by our link partners in the UK to our hospital ensure the workers are updated on what is happening in other parts of the world. Also the professionals from the UK have had the opportunity to give their advice on the operation of our organization….Patients are handled more professionally in this recent 6 months as the aggressive behaviours are handled before they escalate, because of the information the staff have being receiving from the link.” (Mirembe TMVA tutor)
Working at an Institutional Level
The Link has been fortunate to meet with Dr Hassan Mwinyi – Minister of Health and Social Welfare, Tanzania on a number of occasions and hopes to further build this relationship in the future.
Get in touch
We are keen to hear from other health links working in Tanzania or working in mental health.