Background: Project ECHOTM (Extension for Community Healthcare Outcome) is a telehealth initiative that aims to improve access to medical knowledge among healthcare workers (HCWs). Infection Prevention and Control (IPC) ECHO Clinic was implemented from April 2022 to January 2023 in Tanzania where HCWs from ten referral hospitals shared their experiences. This study aimed to evaluate the implementation of the IPC ECHO clinic, by assessing enablers and barriers; and elicit recommendations for improvement and further scale-up. Methods: A descriptive study design was conducted whereas both quantitative and qualitative methods of data collection were used. Results: A total of 472 (47.2%) out of 1000 targeted HCWs attended scheduled IPC ECHO sessions. Availability of infrastructure; facility management support; good coordination from the national team and availability of internet bundle were the enablers for the implementation of the clinic. Barriers included: lack of motivation among attendees; lack of Continuous Professional Development (CPD) points; shortage of staff; and poor internet connectivity. To improve the implementation of IPC ECHO clinic it was recommended to: include IPC ECHO clinic in CPD initiatives; review time for the sessions; provision of incentives for attendees; improve facilitation techniques; improve network connectivity; enhance HCWs participation in IPC ECHO Clinic: and scale up of IPC ECHO clinic. Conclusion: Implementation of IPC ECHO clinic was successfully conducted. Scale-up of IPC ECHO clinic to other referral health facilities and primary health care facilities is recommended to facilitate knowledge sharing in the areas of IPC during this era of emerging and re-emerging diseases.
References
[1]
Bahegwa, R. P., Hokororo Joseph, C., Msigwa, Y. S., Ngowi, R. R., German, C. J., Marandu, L., Nasoro, O. A., Kinyenje, E. S., Degeh, M. M., Masuma, J. S., Lutkam, D. S., & Eliakimu, E. S. (2024). Infection Prevention and Control Compliance during COVID-19 Pandemic Era: Assessment of 26 Regional Referral Hospitals in Tanzania. Discover Health Systems, 3, Article No. 21. https://doi.org/10.1007/s44250-024-00078-6
[2]
Baldridge, A. S., Goldstar, N., Bellinger, G. C., DeNoma, A. T., Orji, I. A., Shedul, G. L., Okoli, R. C. B., Ripiye, N. R., Odukwe, A., Dabiri, O., Mobisson, L. N., Ojji, D. B., Huffman, M. D., Kandula, N. R., & Hirschhorn, L. R. (2023). Formative Evaluation and Adaptation of a Hypertension Extension for Community Health Outcomes Program for Healthcare Workers within the Federal Capital Territory, Nigeria. Global Heart, 18,Article 64. https://doi.org/10.5334/gh.1277
[3]
Bikinesi, L., O’Bryan, G., Roscoe, C., Mekonen, T., Shoopala, N., Mengistu, A. T., Sawadogo, S., Agolory, S., Mutandi, G., Garises, V., Pati, R., Tison, L., Igboh, L., Johnson, C., Rodriguez, E. M., Ellerbrock, T., Menzies, H., Baughman, A. L., Brandt, L., Struminger, B. et al. (2020). Implementation and Evaluation of a Project ECHO Telementoring Program for the Namibian HIV Workforce. Human Resources for Health, 18, Article No. 61. https://doi.org/10.1186/s12960-020-00503-w
[4]
De Morgan, S., Walker, P., Blyth, F., & Huckel Schneider, C. (2021) Evaluation of Project ECHO (Persistent Pain): Final Evaluation Report. Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, the University of Sydney. https://hdl.handle.net/2123/30094
[5]
Diffin, J., McTernaghan, T., McMullan, A., Hayes, M., Watson, M., & Jenkins, C. (2021). P-177 Exploration of Attendance across 28 ECHO Project ECHO Networks in the Context of Everyday Practice. BMJ Supportive & Palliative Care, 11, A73. https://doi.org/10.1136/spcare-2021-Hospice.193
[6]
Gomes, D. J., Hazim, C., Safstrom, J., Herzig, C., Luvsansharav, U., Dennison, C., Ahmed, Y., Wesangula, E., Hokororo, J., Amone, J., Tekle, B., Owiso, G., Mutayoba, R., Lamorde, M., Akello, E., Kassa, G., Feleke, B., Ndegwa, L., Kazaura, K., Musisi, D., Bancroft, E. et al. (2022). Infection Prevention and Control Initiatives to Prevent Healthcare-Associated Transmission of SARS-CoV-2, East Africa. Emerging Infectious Diseases, 28, S255-S261. https://doi.org/10.3201/eid2813.212352
[7]
Hariprasad, R., Arora, S., Babu, R., Sriram, L., Sardana, S., Hanumappa, S., & Mehrotra, R. (2018). Retention of Knowledge Levels of Health Care Providers in Cancer Screening through Telementoring. Journal of Global Oncology, 4, 1-7. https://doi.org/10.1200/JGO.18.00048
[8]
Hokororo, J., Eliakimu, E., Ngowi, R., German, C., Bahegwa, R., Msigwa, Y., Kazaura, K., Simbeye, D., & Komba, A. (2021). Report of Trend for Compliance of Infection Prevention and Control Standards in Tanzania from 2010 to 2017 in Tanzania Mainland. Microbiology & Infectious Diseases, 5,1-10. https://scivisionpub.com/abstract-display.php?id=1598
[9]
Hokororo, J., Mohamed, H., Ngowi, R., German, C., Bahegwa, R., Msigwa, Y., Nassoro, O., Marandu, L., Kiremeji, M., Lutkam, D., Habtu, M., Lusaya, E., & Eliakimu, E. (2021). Evaluation of Infection Prevention and Control Compliance in Six Referral Hospitals in Tanzania using National and World Health Organization Standard Checklists. Preventive Medicine, Epidemiology and Public Health, 2, 1-9. https://researchopenworld.com/evaluation-of-infection-prevention-and-control-compliance-in-six-referral-hospitals-in-tanzania-using-national-and-world-health-organization-standard-checklists/# https://doi.org/10.31038/PEP.2021232
[10]
Jenkins, C., Webb, H., McAuley, L., McTernaghan, T., & Watson, M. (2022). Operational Reflections on What Contributes to Building a Successful Project ECHO Network. BMJ Open Quality, 11, e001711. https://doi.org/10.1136/bmjoq-2021-001711
[11]
Kasper, T., Yamey, G., Dwyer, S., McDade, K., Lidén, J., & Lüdemann, C. (2023). Rethinking How Development Assistance for Health Can Catalyse Progress on Primary Health Care. The Lancet Journal, 402, 2253-2264. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01813-5/abstract https://doi.org/10.1016/S0140-6736(23)01813-5
[12]
Kessy, S. J., Gon, G., Alimi, Y., Aryio Bakare, W., Gallagher, K., Hornsey, E., Sithole, L., Victoria, E., Onwekwe, C., Okwor, T., Sekoni, A., Vahanian, A., Vorndran, A., Niyoyitungira, T., Raji, T., Ihekweazu, C., Abdulaziz, M., & Ogunsola, F. (2023). Training a Continent: A Process Evaluation of Virtual Training on Infection Prevention and Control in Africa during COVID-19. Global Health: Science and Practice, 11, e2200051. https://www.ghspjournal.org/ https://doi.org/10.9745/GHSP-D-22-00051
[13]
Kinyenje, E., Hokororo, J., Eliakimu, E., Yahya, T., Mbwele, B., Mohamed, M., & Kwesigabo, G. (2020). Status of Infection Prevention and Control in Tanzanian Primary Health Care Facilities: Learning from Star Rating Assessment. Infection Prevention in Practice, 2,Article ID: 100071. https://doi.org/10.1016/j.infpip.2020.100071
[14]
Larson, R. S., & Medved, C. (2022). Selecting and Implementing a Telementoring Program: Case Studies of Project ECHO. Metropolitan Universities, 33, 91-109. https://doi.org/10.18060/25689
[15]
Marandu, L. E., & Masika, G. M. (2023). Healthcare Workers’ Level of Adherence to Infection Prevention and Control and Its Impact on Puerperal and Neonatal Sepsis among Delivering Women and Neonates in Central Tanzania: A Protocol for a Prospective Cohort Study. BMJ Open, 13, e066701. https://doi.org/10.1136/bmjopen-2022-066701
[16]
Mghamba, J. M., Oriyo, N. M., Bita, A. A. F., Shayo, E., Kagaruki, G., Katsande, R., Hussein, A., Kishimba, R. S., Urio, L. J., Lema, N., Camara, N., Makundi, V., Mengestu, T. K., Saguti, G. E., Habtu, M. M., Kwesi, E., Bakari, M., Mfaume, R., Makubi, A., & Subi, L. (2022). Compliance to Infection Prevention and Control Interventions for Slowing down COVID-19 in Early Phase of Disease Transmission in Dar es Salaam, Tanzania. The Pan African Medical Journal, 41, Article 174. https://doi.org/10.11604/pamj.2022.41.174.31481
[17]
Moghnieh, R., Al-Maani, A. S., Berro, J. et al. (2023). Mapping of Infection Prevention and Control Education and Training in Some Countries of the World Health Organization’s Eastern Mediterranean Region: Current Situation and Future Needs. Antimicrobial Resistance & Infection Control, 12, Article No. 90. https://doi.org/10.1186/s13756-023-01299-9
Mohamed, Y., Hezeri, P., Kama, H., Mills, K., Walker, S., Hau’ofa, N., Amol, C., Jones, M., du Cros, P., & Lin, Y. D. (2023). Evaluation of an Online Training Program on COVID-19 for Health Workers in Papua New Guinea. TropicalMedicineandInfectiousDisease, 8, Article 327. https://doi.org/10.3390/tropicalmed8060327
[20]
MoHCDGEC (2018). National Infection Prevention and Control Guidelines.
[21]
MSHP, CDC, & EGPAF (2019). Global Cooperative Agreement for Technical Assistance Services, Assignment 028: Replicating the ECHO Model for HIV/AIDS Mentorship in Cote D’ivoire, Final Evaluation Report.
[22]
Mubanga, B., Fwoloshi, S., Lwatula, L., Siamwanza, N., Zyambo, K., Sichinga, H., Tappis, H., Mulenga, L. B., Moonga, A., Ziko, L., Simushi, F., Massamba, H. M., Hapunda, G., Sichimba, F., Mtonga, H., & Kalubula, M. (2023). Effects of the ECHO Tele-Mentoring Program on HIV/TB Service Delivery in Health Facilities in Zambia: A Mixed-Methods, Retrospective Program Evaluation. Human Resources for Health, 21,Article No. 24. https://doi.org/10.1186/s12960-023-00806-8
[23]
Nhung, L. H., Kien, V. D., Lan, N. P., Cuong, P. V., Thanh, P. Q., & Dien, T. M. (2021). Feasibility, Acceptability, and Sustainability of Project ECHO to Expand Capacity for Pediatricians in Vietnam. BMC Health Services Research, 21, Article No. 1317. https://doi.org/10.1186/s12913-021-07311-5
[24]
Panda, R., Mishra, N., Lahoti, S., Prabhu, R. R., Mishra, A., Singh, K., & Rai, K. (2022). Evaluation of COVID-19 ECHO Training Program for Healthcare Workers in India—A Mixed-Method Study. BMC Health Services Research, 22, Article No. 883. https://doi.org/10.1186/s12913-022-08288-5
[25]
Penna, A. R., Hunter, J. C., Sanchez, G. V., Mohelsky, R., Barnes, L. E. A., Benowitz, I., Crist, M. B., Dozier, T. R., Elbadawi, L. I., Glowicz, J. B., Jones, H., Keaton, A. A., Ogundimu, A., Perkins, K. M., Perz, J. F., Powell, K. M., Cochran, R. L., Stone, N. D., White, K. A., & Weil, L. M. (2022). Evaluation of a Virtual Training to Enhance Public Health Capacity for COVID-19 Infection Prevention and Control in Nursing Homes. Journal of Public Health Management and Practice, 28, 682-692. https://doi.org/10.1097/PHH.0000000000001600
[26]
Powell, C. (2023). HowDigitalHealthTechnologySupportsUniversalHealthCoverage. https://www.frontlinehealthworkers.org/blog/how-digital-health-technology-supports-universal-health-coverage
[27]
Powell-Jackson, T., King, J. J. C., Makungu, C., Spieker, N., Woodd, S., Risha, P., & Goodman, C. (2020). Infection Prevention and Control Compliance in Tanzanian Outpatient Facilities: A Cross-Sectional Study with Implications for the Control of COVID-19. The Lancet Global Health, 8, E780-E789. https://doi.org/10.1016/S2214-109X(20)30222-9
[28]
Tanzania Invest (2023). Tanzania’sPresidentSignsUniversalHealthInsuranceBillintoLaw. Insurance. https://www.tanzaniainvest.com/finance/insurance/president-signs-universal-health-insurance-law
[29]
URT (2023). Sheria ya Bima ya Afya kwa Wote ya Mwaka 2023.
[30]
Walters, S. M., Li, W. P., Saifi, R., Azwa, I., Syed Omar, S. F., Collier, Z. K., Amir Hassan, A. B., Haddad, M. S., Altice, F. L., Kamarulzaman, A., & Earnshaw, V. A. (2022). Barriers and Facilitators to Implementing Project ECHO in Malaysia during the COVID-19 Pandemic. Journal of the International Association of Providers of AIDS Care, 21. https://doi.org/10.1177/23259582221128512
[31]
Wanjiku, G., Dreizler, L., Bell, G., & Wachira, B. (2022). Feasibility of Project ECHO Telementoring to Build Capacity among Non-Specialist Emergency Care Providers. African Journal of Emergency Medicine, 12, 352-357. https://doi.org/10.1016/j.afjem.2022.07.012
[32]
WHO (2016). GuidelinesonCoreComponentsofInfectionPreventionandControlProgrammesattheNationalandAcuteHealthCareFacilityLevel. https://www.who.int/publications-detail-redirect/9789241549929
[33]
Wilson, K., Dennison, C., Struminger, B., Armistad, A., Osuka, H., Montoya, E., Padoveze, M. C., Arora, S., Park, B., & Lessa, F. C. (2021). Building a Virtual Global Knowledge Network during COVID-19: The Infection Prevention and Control Global Webinar Series. Clinical Infectious Diseases, 73, S98-S105. https://doi.org/10.1093/cid/ciab320
[34]
Wright, J., Tison, L., Chun, H., Gutierrez, C., Ning, M. F., Morales, R. E., Lopez, B., Simpungwe, J., Masamaro, K., Usmanova, N., Mutandi, G., Bunga, S., & Agolory, S. (2022). Use of Project ECHO in Response to COVID-19 in Countries Supported by US President’s Emergency Plan for AIDS Relief. Emerging Infectious Diseases, 28, S191-S196. https://doi.org/10.3201/eid2813.220165
