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A Lean Management Approach towards Inclusive Maternal Healthcare Services

CCBRT aims to apply lean management to improve access to healthcare services for pregnant women with a disability in Dar es Salaam

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What problem does your idea solve?

Poor physical accessibility, communication problems and negative attitudes among service providers contribute to women with disabilities having limited access to maternal healthcare. Despite efforts addressing these problems, still few women and girls with a disability appear to utilise the public maternal healthcare services. The idea aims to address the problem of limited disability-disagregated data collection and solving the true problem women face in accessing services.

Explain your idea

CCBRT will use a lean management approach to solving the problem of under-utilisation of maternal healthcare services by women and adolescent girls with a disability in Dar es Salaam. Lean management includes a scientific problem solving method, which takes you through a cycle of steps in order to understand the problem, identify the root causes, design counter-measures, implement the measures, monitor the outcomes, sustain and continuously improve further. Key to success is the direct participation of service users, frontline service providers and managers. CCBRT will facilitate an improvement team to work on this problem and follow through all the steps. The aim is to develop a model for inclusive maternal healthcare addressing the barriers to service utilisation, while at the same time introducing the lean approach to problem solving.

Who benefits?

Dar es Salaam is one of the fastest growing cities in the world. Of the 300,000 babies born each year in the city and its outskirts, 1,500 are born to a mother with a disability (based on prevalence data). Per year, 1,500 expectant mothers with a disability will benefit from improved access to maternal healthcare. Service users, health service providers and managers directly involved in the implementation of the initiative will benefit from learning a new approach to solving problems.

How is your idea unique?

Lean management has proven its success in many different sectors and settings, from its origin in manufacturing to healthcare. In Tanzania, CCBRT has been pioneering this approach successfully, though still in infant stages. Applying lean to solving this problem provides an opportunity to apply a proven methodology, which places the service users at the centre and gives them a voice, empowers frontline workers, is data/facts/standards-based, makes problems visible and aims for continuous improvement, to promoting disability-inclusion in a low-resource setting. Whereas, the combination of “lean, disability-inclusion and maternal healthcare” in itself is unique, the uniqueness of the approach is that it can be applied to any problem in any sector.

Tell us more about you

CCBRT is a local NGO established in 1994 and the largest provider of disability & rehabilitative services in Tanzania. In 2010, in response to a request from the Government of Tanzania, CCBRT began to address poor maternal and newborn healthcare in Dar es Salaam, now collaborating with 23 public health facilities (80,000 deliveries annually). CCBRT supports changes in practice and systems to improve access, quality and efficiency of services and ultimately outcomes for mothers and babies.

What are some of your unanswered questions about the idea?

Lean management is all about asking questions. Some of CCBRT's unanswered questions are: - In reality, how many women and girls with disabilities give birth in Dar es Salaam and outskirts? - Where do they deliver? And why? - What are the underlying causes of the under-utilisation of public maternal healthcare services by women and girls with a disability? - What barriers exist in access to care for women with disabilities? - What does the ideal state of inclusive maternal healthcare services look like? - What is the added value of applying lean to disability-inclusion related challenges?

Where will your idea be implemented?

  • Tanzania

Experience in Implementation Country(ies)

  • Yes, for more than one year.

Expertise in Sector

  • I've worked in a sector related to my idea for more than a year.

Organizational Status

  • We are a registered non-profit, charity, NGO, or community-based organization.

Idea Maturity

  • Prototyping: I have done some small tests with prospective users to continue developing my idea.

How has your idea changed based on feedback?

New insights gained from a FGD with women with a disability, the OpenIdeo community/expert team and internal reflections, changed the idea as follows: - learned that women with disabilities are utilising the services but that disability disaggregated data collection is a challenge - this will get more attention, possibly using tools that another organisation in the OpenIdeo community has developed; - stories from end-users tell us that services have improved, yet attitudinal barriers remain and costs came up as barrier as a referral in the public system, even when based on a physical/medical condition, is no longer for free; - emphasised that the focus is on improving inclusiveness of “mainstream” services, not specialised services, thus very much replicable; - expanded scope to comprehensive maternal healthcare services including family planning; - elaborated on “why lean” - in general and specifically in low-resource settings.

Who will implement this idea?

CCBRT’s Maternal & Newborn Healthcare Capacity Building and Advocacy teams will jointly implement this idea. In total, six CCBRT staff members will be involved; all based in Dar es Salaam, where the pilot will be run. They will be working on this initiative on a part-time basis, and form a team together with representatives from the service users, providers and managers. The improvement team will be facilitated by CCBRT but all involved will assume equal responsibility in the implementation.

Using a human-centered design approach, you may uncover insights that lead to small or foundational changes to your organization’s existing strategy or processes in order to unlock the potential of your idea. How would your organization go about making such changes?

CCBRT already having decided to adopt a lean management approach, is moving into this direction of using a human-centered design approach. We are still far from being a lean organisation, but first steps have been made. The success of a major improvement project implemented at CCBRT using this approach has had a positive impact on how the organisation functions and changes are implemented. Getting buy-in is done through involvement of key stakeholders, and making them part of the whole process. There is a great level of delegated authority, and anything that does not fall within that scope, is signed off by the senior management team.

What is it that most attracted you to Amplify instead of a more traditional funding model?

We love developing, experimenting and learning! CCBRT has realised that looking outside the box and engaging with others is an area that needs improvement. The feedback phase of the Amplify process has already been great learning experience in this respect. We very much appreciate the approach of Amplify that it is accepted to make mistakes and change the idea based on new insights and lessons learnt in order to improve and get the best possible results.

What challenges do your end-users face? (1) What is the biggest challenge that your end-users face on a day-to-day, individual level? (2) What is the biggest systems-level challenge that affects your end-users?

Part of implementing our idea is finding out what the biggest challenge is that our end-users face, and not only the users but also those providing the services. From the information gathered thus far, attitudinal barriers, often due to ignorance, seem to be the biggest challenge at the individual level. This impacts on equal access to mainstream services and full participation in the community. At the system-level, the lack of understanding and adoption of the concept of inclusion is the biggest challenge.

Tell us about your vision for this project: (1) share one sentence about the impact you would like to see from this project in five years and (2) what is the biggest question you need to answer to get there?

IMPACT: By 2022, all women have full and equal access to quality maternal healthcare services in Dar es Salaam. QUESTION: How do we influence the management system in public healthcare institutions to adopt the continuous improvement approach in the most effective way?

How long have you and your colleagues been working on this idea together?

  • Less than 6 months

How many of your team’s paid, full-time staff are currently based in the location where the beneficiaries of your proposed idea live?

  • Over 50 paid, full-time staff

Is your organization registered in the country you intend to implement your idea in?

  • We are registered in all countries where we plan to implement.

My organization's operational budget for 2016 was:

  • Above $1,000,000 USD

If your team/idea/organization has a website, please share the URL below.


Join the conversation:

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Hi CCBRT Team,

We’re excited to share with you feedback and questions from the Amplify team and an external set of experts. We encourage you to think about this feedback as you continue to improve and refine your idea. You are welcome to respond in the comments section and/or to incorporate feedback into the text of your idea. Your idea and all associated comments will all be reviewed during the final review process.

-The idea openly recognises a lack of understanding of the needs of pregnant women with disabilities is at the core of the challenge, and addressing this should be at the base of how to tackle this issue. The LEAN method puts the users at the centre of the design.
-The specific issue of supporting pregnant women with disabilities in Dar Es Salaam to give birth safely is a crucial issue considering the population growth in Dar (one of the most rapid urban growth areas in sub-Saharan Africa).
-The data and analyses of root causes of potential access barriers will be really critical and important for the health and disability sector. There is so little data on this that it's challenging to make a case for health providers to address this area more specifically.
-It seems CCBRT works with the public facilities and may have a clear path to sustainability.
-Women with disabilities giving birth is a greatly overlooked area. CCBRT are well placed as an organisation to feasibly implement change.
-Have you considered a fully integrated solution approach with all other maternal health services (rather than just for women with disabilities)?
-How might you ensure this approach can be scaleable in less well-resourced or disability-specialist maternal health care providers in Tanzania, particularly outside Dar?
-Have you considered how this pilot might be scaleable?
-Have / do you plan to also consider family planning needs of women with disabilities to support women with greater choice over number of children and birth spacing?
-I have not heard about this approach to combining LEAN with improving access for women with disabilities before. There are quite a lot of efforts in primary care performance initiatives and the higher-level facility landscape to improve the performance of service delivery. I am curious why this project is combining these two elements specifically, and what the rationale is?

In case you missed it, check out this Storytelling Toolkit for inspiration for crafting strong and compelling stories: Storytelling is an incredibly useful tool to articulate an idea and make it come to life for those reading it. Don’t forget - June 4 at 11:59PM PST is your last day to make changes to your idea on the OpenIDEO platform.

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Looking forward to reading more!

Photo of Mike Grogan

I fully support this idea from CCBRT. Creating a model healthcare facility (the lives and breathes LEAN management thinking) will transform the quality of service to CCBRTs clients. Not only this but CCBRT will also serve as a proof of concept to other healthcare organizations in Tanzania and the entire continent of Africa that become a world-class continuous improvement organization is possible despite the challenges of lack of resources.

Perhaps the number one reason why healthcare organizations in the developing world fail to transform their culture is an underlining false belief that it is not possible. That these management practices are only applicable in Western Countries and could not be applied in the African context. I believe that CCBRT is showing the world that this is not true. With the right support, the right leadership and the right mindset this really can work in any organization. This is about doing more with less, it is about unleashing the potential of your people, and it is a perfect solution to the healthcare crisis in Africa.

The LEAN Management Philosophy has been around for a long time. It is known as the world’s most powerful approach to continuous improvement. We have evidence from 100’s of different industries from 100,000’s different companies of how LEAN has been the one thing that has helped them achieve breakthrough results and transform how the serve their client. Let us make CCBRT that data point that this way of thinking also can also work to fix healthcare in Africa.

Think about it. Imagine if CCBRT becomes the model healthcare organization for Africa. Proving that even in under-resourced environments you can still get the best of out of your people’s gifts. I envision CCBRT every year welcoming healthcare leaders from across the continent, showing them and teaching them on how they too can replicate this success in their organizations. This is what Thedacare (one of the first LEAN Healthcare organizations in America) is doing in North America ... I have no doubt this is what CCBRT can do for not only Africa but the entire Developing World.

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Thank you for your feedback!

We collaborate with 22 public health facilities (total 80,000 deliveries annually). Good point to analyse service features between these facilities and also consider other facilities (e.g. private) for comparison.

A problem we are facing is that record-keeping on women with disabilities using the services are not kept. We have managed to identify a small group of women with disabilities who have used the services and who are willing to give feedback.

We would love to hear your suggestions on how to institutionalise feedback mechanisms!

Photo of piyush

Hello. Nice idea.

Is there any parallel service provider on the same field? IF yes, then it would be important to study analyse the service features of both.
Do you record a feedback of those who use your service model? This would help the project in final phase.

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Dear community members!

CCBRT would love to get your feedback. Your questions, ideas, experiences etc will help us develop the idea further!