1. Improving working environment through introduction of 5S-KAIZEN-TQM approaches in public hospitals in Tanzania
Hisahiro Ishijma, Japan International Cooperation Agency (JICA) expert, assigned to Ministry of Health and Social Welfare, United Republic of Tanzania
Shizu Takahashi, Japan International Cooperation Agency (JICA) expert, assigned to Ministry of Health and Social Welfare, United Republic of Tanzania
Dr. Eliudi Eliakim, PMO, Ministry of Health and Social Welfare, United Republic of Tanzania

2. Background(1)
Asia – Africa Knowledge Co-creation Program (AAKCP), Improvement working environment and quality of health services through 5S-KAIZEN-TQM approaches was introduced into 8 African countries, and TZ participated.
MRH was selected as pilot hospital for AAKCP.
After AAKCP training in Japan and Sri Lanka, 5S was introduced MRH, and successful changed working environment at 6 pilot areas
The good practices was reported MoHSW, and MNH was added as another pilot hospital.
MRH and MNH good practices were reported, and MoHSW decied to rollout 5S-KAIZEN-TQM approaches to all national and regional referral hospitals since 2008
National guideline for implementation of 5S-KAIZEN-TQM approaches developed in 2009 and revised in 2011
It is now expanded to district hospitals level

3. National Rollout of 5S approach
Situation analysis on QI implementation in the country
Implementation guideline development
Advocacy poster printing
Training materials development
Training of master trainers
Conduct TOT
Biannual Consultation visit (1st Consultation visit is conducted after 6 months TOT)
Establishment of QIT
In-house training
Progress of 5S activities
Biannual Progress Report Meeting

4. National Rollout mechanism
Sharing good practice
Strengthen implementation through technical advices
Obtain knowledge and skills
for working environment and Quality service improvement through TOT
Progress Report Meeting (PRM)
Development to teaching materials and conduct TOT
Consultation Visit (CV)
Consultation Visit (CV)
Development of Implementation guideline
Progress Report Meeting (PRM)
Revise the guideline based on feedback from TOT, CV and PRM
Develop effective training materials through feedback from TOT, CV and PRM

5. Training of Trainers on 5S approach
Outline of TOT
Target group
Hospital Management Team
Regional Health Management Team
Council Health Management Team
Ministry of Health officials
Period of TOT
Central/Regional level：5 days
District level：3 days
Training method
Lectures and practical sessions
Training venue
Hospital that are implementing 5S and KAIZEN well
Master trainers
Person who participated overseas training on 5S and KAIZEN

6. Methodology
Effect size of 5S TOTs and KAIZEN TOTs , conducted between 2009 to 2011 were verified through results of pre- and post training assessment
Situation of 5S and KAIZEN implementation were evaluated at the time of first Consultation Visit.

7. Effects of 5S-KAIZEN TOT
1) Effects of 5S TOT
2) Effects of KAIZEN TOT
Over Δ=.50 as significant (Koizumi & Katagiri, 2007)
|.20|≦small<|.50|
|.50|<medium<|.80|
|.80|≦large

8. Follow-up after 5S TOT
Conduct Consultation visit after 6 months of 5S TOT, and evaluate progress of 5S activities
Hospitals trained between 2007 to 2011 were 47.
Slow implementation or below the average of progress was observed in 16 hospitals among the 47 hospitals

9. Follow-up after KAIZEN TOT
After 6 months of KAIZEN TOT, progress of KAIZEN activities were monitored in 13 hospitals through Consultation visit.
3 hospitals continue KAIZEN activities and have successful KAIZEN cases
6 hospitals continue KAIZEN activities but no successful KAIZEN cases yet
4 hospitals struggling to practice KAIZEN activities

10. Correlation between “Leadership” and 5S practices
During the Consultation visit, Leadership and progress of sorting, setting, shining, standardizing and sustain activities were evaluated.
Positive correlation was observed between “leadership” and “implementation of 5S activities” (R2= )

11. Findings
Knowledge and skills obtained on 5S-KAIZEN-TQM approaches through Training of Trainers is not always connected with daily practices of 5S-KAIZEN activities. Commitment from hospital management and leadership are the key for successful and sustainable QI program.
All hospital practicing 5S-KAIZEN-TQM approaches established QIT and WIT, and structuralize QI program implementation.

12. Lessons learnt
It is important to emphasize the following activities for sustainable practices of 5S activities:
Establish functional QIT in hospital
Improve training contents on monitoring and evaluation skills.
Strengthen internal monitoring and evaluation
Supportive Supervision from external organization such as MoHSW, RHMT, or CHMT

13. Thank you! Any question?