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Friday, January 23, 2015

Potential for Implementation of “Lean” in a Healthcare Setting in Beira, Mozambique

This past November, I had the opportunity to visit a non-profit disabilities hospital called CCBRT in Dar-es-Salaam, Tanzania with some colleagues from Mozambique.  I prepared a photo album with some lessons from that visit.  CCBRT is applying a set of management principles called “Lean” that dramatically influenced my thinking on ways that healthcare delivery could be improved at the community level.  Mike Grogan was our host and coordinated one-on-one meetings with CCBRT’s leadership team over three days.  Mike has served as a Lean Management Consultant to help guide CCBRT through its first two years of a “lean transformation.”  Reflecting on his experience, he said that he should have “started smaller and slower” and “spent more time with the leaders” to foster greater capacity and sustainability.  I have taken his words to heart and envisioned the possibilities for the application of Lean in small primary healthcare settings in Mozambique.  Last week, Dr. Kathleen Walker, Fulbright Professor at Catholic University, suggested Beira as a possible setting.

Lean is a set of management principles and tools for continually eliminating waste and creating value in the process of delivering goods/services to a customer.  It was developed by the Toyota Motor Corporation during a time of post-World War II reconstruction in Japan to challenge the global dominance of U.S. mass-production car makers Ford, General Motors, and Chrysler.  In 1990, a book called "The Machine that Changed the World" presented hard evidence, acquired during a global study by researchers from MIT, which showed that Toyota’s lean-production system was far superior to Henry Ford’s widely adopted mass-production system.  At the time the book was released, Toyota was half the size of Ford by volume, but manufactured a greater variety of cars in essentially half the time, half the space, with half the defects, half the inventory, and half the workforce per car produced. The principles of Lean have been transferred into almost every industry, including healthcare.

Over the last 15+ years, adaptation of the Lean management approach to healthcare systems throughout the United States, Canada, and Europe has proven to be extremely successful, with notable examples being ThedaCare in Neenah, Wisconsin and Virginia Mason Institute in Seattle, Washington.  Lean is also applicable to Mozambique’s cultural context because it fosters organic dialogue and solutions.  This helps organizations pursue their unique mission while retaining core values.  It does not claim to provide an instant “fix”, but Lean does challenge organizations to continually identify problems and find ways to improve. 

Lean’s guiding principles include:
  •        Developing an attitude of continuous improvement
  •        Creating value and maximizing limited resources
  •        Striving for a unity of purpose among all involved
  •        Respect for the people who do the hands-on work
  •        Reliance on visual roadmaps and feedback
  •        Standardization with flexibility to redesign

I would like to meet with interested Mozambican healthcare professionals to understand the challenges that they confront in healthcare delivery and mutually decide if Lean could facilitate improvements for healthcare workers and patients.  To maximize resources and increase the value of services, the initial activities would involve assisting the clinic or department staff in identifying every step in their healthcare delivery process and then with consensus, eliminating activities that take away from service value and measuring the effects of such changes.

For example, a tool for measuring the effectiveness of HIV treatment programs for the prevention of mother-to-child transmission has been developed by Dr. Sarah Gimbel and a team of researchers from the University of Washington and Health Alliance International.  Dr. Gimbel published an article in October 2014 entitled “The prevention of mother-to-child transmission of HIV cascade analysis tool: supporting health managers to improve facility-level service delivery.”  Researchers tested the tool in five primary care facilities in Beira.  Dr. Gimbel et. al. call for training hospital management staff to use the cascade analysis tool to identify stages in the treatment process with the highest drop-off rates and then explore solutions to bolster retention.  The article highlights a specific case where only 20% of eligible newborns received prophylaxis therapy.  “Lean thinking” would systematically find out why, through multiple layers of explanations, to uncover the root cause, make an evidence-based change, and measure the effects for reevalutation.  I see a possibility to use the cascade analysis tool to assess the challenges of a small primary healthcare facility in Beira and use Lean to find appropriate solutions with the hospital team.

I regularly communicate with lean practitioners who are involved in international development efforts and wish to see the application of Lean to healthcare in Mozambique, including:


I have a variety of tools that will be utilized, such as:
  •        Work progress tracking

  •        A3 prioritization grids

  •        Quality visualization boards


And management exercises, like: 
  •        Gemba walks

  •        Team-building exercises

  •               Defining a True North

I am confident in the power of Lean and my abilities to collaborate with like-minded colleagues in a small healthcare setting.  I recently shared my proposal with Daniel Lee and Dr. Marcelo Castrillo with Abt Associates in Maputo.  We agreed that the Lean approach could help advance some work that Abt Associates has already begun in Beira.  Now, I plan to visit Beira for two weeks to meet with Mozambican healthcare leaders and seek to form a partnership based on mutual understanding and trust.  If real improvements are made, and we all agreed to continue collaborating, I believe that we can make a strong start to improving a facility’s quality of care this year.

If you are a healthcare professional and would like to learn more, please contact me by email: Silas.Dickie@gmail.com; or phone: +258 82 291-2329.  I would be delighted to hear from you!




Wednesday, September 10, 2014

The WakaWaka Power is a Bright Idea for Mozambique

If successfully distributed, the new WakaWaka Power could be a game changer in Mozambique.
The WakaWaka Power is a solar-powered lamp and back-up battery charger for cellphones, tablets, and laptops.  "Waka waka" means "shine bright" in Swahili.  This is an innovative product from a Netherland's based non-profit called Off-Grid Solutions, under the leadership of Founder and CEO Maurits Groen.  The purpose is to provide an indispensable, affordable, renewable energy solution for people in both developed and developing markets.  Their website says that about 1.2 billion of the world's population have absolutely no access to electricity.  So, I think, that instead of investing in clunky, unreliable, and messy electrical grid systems, through state-owned energy companies - the world's poor needs to be "off-grid".  

In the beginning, Off-Grid Solutions received incredible financial support through a kickstarter campaign: raising $419k - way past their initial goal of $50k.  According to @WakaWaka, as of September 8th, 2014, nearly 100,000 WakaWaka Powers have been distributed all over the world.  This is a groundbreaking tool for empowering low-income people in emerging markets - especially, Mozambique.

This advancement in energy technology presents a challenge for a non-profit business to navigate the dysfunctional and ineffective health system in Mozambique.  There's no doubt that the WakaWaka Power would be good for the environmental, educational, economic and physical health of all people in rural Mozambique.  The results from an independent 3rd party test on the kickstarter page shows that the WakaWaka Power far outperforms it's solar lamp competitors.  It's clearly better than any other portable solar lamp out there.  And, the ability to charge cell phones through solar power is an amazing new possibility.  Many rural Mozambicans currently have to pay a neighbor or small shop owner to charge their phones.  The challenge lies in making the WakaWaka Power available to people in a self-sustaining way.  Innovations like these serve humanity and accessing a development network in Mozambique can help kick-off a successful marketing campaign to generate interest among the target population.  For long-term success, I believe that an very recent project called WakaWaka's Virtual Grid Pilot needs to be developed into Mozambique.  


Off-Grid Solutions received an investment of EUR 600,000 from FMO (the Dutch development bank) to start the Virtual Grid Pilot in Rwanda for 12 months.  The way it works is: Off-Grid Solutions has installed a keypad on some of it's devices for users to dial a pre-purchased code and unlock it for limited use.  That way, Rwandan's can invest in a WakaWaka Power and buy credit, little-by-little, just like most currently buy phone credit.  It's a pay-as-you-go system that costs the same amount that Rwandan's are spending on kerosene fuel or mobile phone charging.  This could work.

WakaWaka CEO Maurits Groen said,

"WakaWaka considers the Virtual Grid as a key solution to modern and sustainable energy access to off-grid households worldwide, by using a model that is exactly in line with the current energy spending patterns of households."  

A keyword in Mr. Groen's quote is: "worldwide".  He's thinking big.  Really big.  And, I'm very interested to watch how the project unfolds in Rwanda.  If it's successful, I wonder whether Mozambique will be on the list of African countries for a bigger investment.

It's not too early to start planning for implementation in Mozambique's unique context.  I suggest that Off-Grid Solutions via Kim van der Leeuw in Cape Town, SA come together with international donor organizations, community leaders, and NGOs.  The U.S. Embassy has a Small Grants Program for innovative solutions to reduce poverty in Mozambique.  It could be a good way to start generating interests in the market.  An influential and possibly willing community leader could be the forward-leaning Mayor from Quelimane, Manuel de Araujo.


I was immediately captivated by the WakaWaka Power when I got my hands on one.  I believe that it has the potential to be a real game changer for the holistic health of people living off the electrical grid in Mozambique.  The tool exists - now, the challenge is to finance it's availability through a difficult system in a truly effective way.