Programs

Working toward our ultimate goal of a fully operational floating clinic, the LTFHC has already served hundreds of thousands of Congolese and Tanzanians by completing a number of outreach programs, focused on the most urgent local challenges.

We have conducted large-scale mosquito bed-net distributions, integrated malaria prevention education programs and cholera treatment, as well as spearheaded a comprehensive VVF repair outreach in Tanzania’s remote southern region of Rukwa treating both Tanzanian and Congolese women. We are currently expanding essential communications infrastructure and introducing the region’s first electronic medical record and developing a safe cesarean section training program.

In the process, we have succeeded in establishing strong, trustworthy relationships with the lakeside communities, as well as key stakeholders in the region – from tribal chiefs to multinational executives and ministers of state.

Active Programs

Iroko EMR:

For several years, LTFHC has been developing a digital solution to capture community health center level data in DRC. This is an incredibly complex task in a country that has one of the lowest mobile phone penetration rates on the African continent, covers a vast geographic area, where many health care workers (HCW) have little to no experience with computer or touch screen technologies, and where insecurity and lack of infrastructure make the flow of paper records highly fraught.  Our resulting application called “Iroko” was built from the ground up in partnership with the Ministry of Health (MOH), applying user-centric design principles and creating a robust framework that takes into account all the realities on the ground and is something HCWs like and find easy to use.

Our original pilot of this program, which digitalized the paper register for the prenatal clinic (a scheduled clinic that takes place in all health centers (HC) across the country), has already enhanced the care of over 14,000 pregnant women in seven HCs in the Kalemie Health Zone (HZ) in Tanganyika Province of the Democratic Republic of Congo (DRC). The promise of this app platform lead to our current activity which focuses not on implementation but rather the creation of a digital system of the DRC’s paper medical records. This work effectively enables data flow that is applicable country-wide, to the benefit of DRC’s many millions of people. Given that infrastructure, connectivity, geo-political, and climate challenges are especially profound and limiting, electronic data acquisition, reporting, tracking, and usability is particularly powerful in this context.

This technology has the potential to reach more than 500 health zones in DRC. Beyond our engagement in app development, we are also working on a longer-term endeavor to identify and engage larger partner organizations to scale the roll out of the Iroko app country-wide to the benefit of DRC’s many millions of people.

 

High Frequency Radios

In the absence of viable alternatives, the LTFHC has been installing HF radios along the Lake Tanganyika coastline to establish robust and inexpensive voice communication from rural communities in disconnected and far-flung Health Areas.  Bridging the gap in data acquisition from the level of the community to where policy decisions are made has been a focus of the LTFHC, yet remains ignored or unknown by large aid agencies. Pre and post radio installation data, collected by the BCZ of Nyemba Zone, show on time data reporting went from 19% to 67%.

The Tanganyika MoH has requested an expansion to the HF Radio Network to plateau areas also experiencing grave barriers to data reporting.

 

Data Mapping:

Data gathering is a powerful tool that is crucial to the upstream challenge of understanding the drivers behind a complex web of problems found in fragile communities along the Congolese coast of Lake Tanganyika. Nuanced understanding lays the foundation for real change to occur because it describes the actual reality on the ground, instead of a projected or simplified version that so often guides large aid programs.

In 2016, LTFHC was successful in collecting rigorous cross-sectoral data on 94 indicators in 41 villages in South Kivu Province with a combined population of over 400,000. As a result of this herculean effort, we now have baseline data covering environmental, socio-economic, health (with particular focus on malaria), fisheries, political- and food security, and demographic indicators, all of which are geo-located using GPS coordinates. These data help us understand the relationships between public health outcomes, hunger, disease, environmental and security related factors, and what inexpensive and targeted approaches might achieve to alleviate suffering in the communities we serve, as well as the risks to existing programming deployed by large agencies that often don’t have our level of visibility on the situation.

Building upon this data set, we subsequently created a data analytics and visualization platform which is helping us tell an authentic story of people’s experiences in the lake basin.  These powerful, clear visuals help foster a broader understanding of local realities— the barriers and the possible solutions and with them, we are beginning to show granular community-level data, gaps in data flow that mean the severity of certain problems remain hidden or not well-understood, and maps of longitudinal data sets showing changes over time and through various shocks (e.g. eruptions of insecurity or extreme weather events).

Our rigorous and dynamic methods, coupled with clear maps, graphs, and narratives from the local population, are helping us to both continue to serve people effectively and be accountable to those same people by measuring the efficacy of current interventions (our own and those of other organizations).

 

Collaboration with Chicago Booth School of Business – Innovation in Last Mile Supply Chains:  

Since 2018, LTFHC has been collaborating with operations management researchers at the University of Chicago Booth School of Business to use the aforementioned data set to develop a robust supply chain model for household distribution of a spatial mosquito repellant in South Kivu Province. In this setting, the profound lack of infrastructure, limited warehousing options, insecurity, and seasonal weather variations affecting distribution routes pose significant barriers for private companies and international organizations delivering lifesaving supplies to reach the people most in need.

Last mile delivery difficulties have been a consistent barrier to how the aid and development space thinks about what products/medications/equipment to make available for hard to reach communities.  As a result, many products are never considered for deployment, despite promising evidence of their use and efficacy. Large organizations are good at shipping to ports and warehouses and along highway systems; however, that is not the challenge we must face to reach communities with the greatest disease and socioeconomic burdens.

For this reason, LTFHC has partnered with Booth to look rigorously at all aspects of the supply chain in our context, in order to develop more useful models for providing ‘last mile’ logistics in complex communities. Our modeling includes more informal transportation methods which include local workers and their small businesses which include private motorbikes, pirogues, and simply walking certain distances.  Incorporating this informal sector is a key to successful and affordable household delivery and helps to promote community resiliency in a part of the world that has 85% unemployment in many places.  Only actors with deep knowledge and connections to the communities served know how to implement a supply chain using local resources – we are proud to count ourselves in this group.

These efforts have laid the groundwork for the operations research on alternative vector control strategies, described in detail below, but also have positive implications for supply chain strategies in general. Our models can be used to inform logistics and supply chain planning for a multitude of products for many diseases, as well as addressing broader WASH issues.

 

Past Programs

Family Planning Outreach:

In the Lake Tanganyika Basin, reproductive health care access is a challenge. The LTFHC is committed to accessible contraception to empower local women, save lives, and prevent disease.

In continuation of our grant from Hivos International focusing on maternal and reproductive health in the Lake Tanganyika Basin, we successfully conducted a comprehensive family planning outreach in Uvinza District, Kigoma Region, Tanzania. During phase one of our contraceptive program in Rukwa, Tanzania, we provided family planning information during one-on-one counselling to rural men and women and at a community festival; trained rural HCWs in family planning service delivery; performed IUD and implant insertions; and distributed free contraceptives. The combined activities of this outreach impacted over 90,000 people.

In September 2016, we expanded this program to rural Kigoma Region, Tanzania. The LTFHC trained ten rural HCWs in Uvinza District in comprehensive family planning over 14 days, including both classroom and practical work. Training focused on insertion of long lasting reversible contraceptives, which we also provided to patients at the time of training and during separate outreaches. This work will both increase patient access to contraception in rural areas of Uvinza District, Kigoma, as well as increase community knowledge of family planning through community meetings. These activities impact a population area of over 170,000.

 

Family Planning Outreach- Phase 1
Tanzania – 2015-2016 

In the Lake Tanganyika Basin, reproductive health care is nearly non-existent. Contraceptive and prenatal care is inaccessible, childbearing often begins in teen years, and extreme poverty is the norm. The LTFHC/WAVE is committed to addressing high birthrate in the region through accessible contraception, not only as a means of empowering local women but also to save lives and prevent disease.

In May 2015, the LTFHC/WAVE completed phase 1 of a comprehensive family planning project, funded by Hivos International, in Rukwa, Tanzania. During this outreach, the LTFHC provided information on family planning during one-on-one counseling and at a community festival (produced by LTFHC and our partner Femina HIP), trained 12 rural health care workers in family planning topics and insertion of implants and IUDs, and distributed free implantable contraceptives.

The combined activities of this outreach impacted over 90,000 people. We look forward to expanding this program to other regions in Tanzania next year.

 

Radio Network Expansion
Democratic Republic of the Congo and Tanzania – 2012-2015

Over the past two years, the LTFHC has created an innovative hardware and software solution, in collaboration with iilab, that bridges the massive communications gap that exists across most of the Lake Tanganyika Basin.

Our system enables voice and data communication between remote health centers and provides a solution for gathering epidemiologic data among the three million people living around the lake. This represents a critical milestone in the development of the region’s healthcare infrastructure, including its first electronic medical records.

Already deployed in an area covering 158,000 people, the LTFHC will expand its radio network to support over a million people in the DRC and Tanzania over the next two years.

 

DRC Radio Network Expansion and Electronic Medical Record Pilot
Kalemie and Nyemba, DRC – Fall 2014

In 2014, the LTFHC, in partnership with iilab, expanded its data-transfer technology and Electronic Medical Records (EMR) platform in the Democratic Republic of Congo (DRC).

This involved initially installing High Frequency (HF) radios and EMR hardware in seven new locations in Kalemie and Nyemba Health Zones: at the two zonal head offices at Kalemie General Hospital and five ultra-rural health centers. We will then extend the network further by installing HF voice only radio units in three additional locations, for a total of ten new sites added to the network. The regional hospital serves some 460,000 people while the eight rural health centers reach almost 60,000 more.

We have already witnessed the dramatic impact our HF voice only network (piloted March 2012) has had on required reporting to the Ministry of Health in Moba. Now we anticipate seeing those same benefits extended to Kalemie and Nyemba, with the EMR system enabling improved epidemiologic data collection as well as better treatments, preventative practices and healthcare outcomes.

 

Kirando Health Center Facilities Upgrade
Kirando, Tanzania – July/August 2014

Kirando is a large health center in Nkasi District, Tanzania, located along Lake Tanganyika, serving 250,000 residents. Despite having recent renovations to their operating theater, Kirando was still unable to perform surgical procedures consistently as it had no reliable electricity, no oxygen concentrators, and no fully equipped, manually adjustable operating tables.

The LTFHC prioritized this location because the population it serves suffers from a high maternal mortality rate and it is one of the few health centers in the area that provides comprehensive emergency obstetrical care. In addition, our organization has completed previous projects at Kirando and thus has a good working relationship with its health care workers. The LTFHC frequently communicated with local staff leading up to and during the project to ensure upgrades and interventions effectively met their needs.

For outcomes of the project, please read the full report and see our video overview of the upgrade.

 

Tanzania Radio Network Expansion and Electronic Medical Record Pilot
Nkasi District, Tanzania – October/November 2013

In October 2013, the LTFHC beta tested its innovative HF radio hardware and software system, developed in partnership with iilab, in Nkasi District of Tanzania’s southern coastline.  This pilot enabled us to validate our newly-developed data transfer technology, commissioned by the LTFHC to meet the specific communication and reporting needs of Ministries of Health in this remote region. HF radio and EMR systems were installed at four strategic health centers and clinics along 130km of shoreline, as well as the District Health Offices in the town of Namanyere. Altogether, this project brings new healthcare possibilities to almost 80,000 people.

 

Project Fabio
Democratic Republic of the Congo, 2013-
Tanzania expansion: TBD

In early 2013, the LTFHC began conducting research in the DRC under “Project Fabio,” named for an Italian doctor interested in naturopathy and ethnobotany and in whose name funds were donated. Through this research initiative, we have created a database cataloging hundreds of indigenous plants used by traditional healers, as well as mapped the sources of these commonly-used botanical medicines and the ways they are prepared.

Crucially, Project Fabio has allowed the LTFHC to build relationships with trusted traditional healers in the community. Project Fabio will be immensely useful in providing baseline data for future evaluation of the significance and magnitude of traditional healers’ contributions to the public healthcare system in the DRC. This project also intends to assess the acceptability and feasibility of the introduction of botanical gardens as a way of conserving the biodiversity of the Lake Tanganyika Basin.

 

DRC High Frequency Radio Pilot
Moba, DRC – March 2012

As part of a pilot program funded by HP, the LTFHC installed High Frequency (HF) Long Wave Radios at eight health centers in Moba Territory, DRC, serving a population of 80,000. These radios are the only practical and affordable way to overcome the communications gap in the region, enabling Moba’s health centers to connect with each other and the Moba Regional Hospital.

This new communication brings faster life-saving medical services to women in complicated labor, increased disease reporting rates by 60%, and supported the outreach and monitoring of the DRC’s Ministry of Health 2012 polio vaccination campaign.

 

Women’s Reproductive Health Outreach
Rukwa, Tanzania and Moba, DRC – October 2011

Supported by HP, the Fistula Foundation and private donors, the LTFHC provided fistula repair along Lake Tanganyika in the remote region of Rukwa, Tanzania in 2011. This outreach was the first of its kind in the basin, bringing dozens of Congolese and Tanzanian fistula patients and several healthcare providers together for surgical repair, education seminars and counseling.

To carry out this work, the LTFHC upgraded the Kirando Health Center that serves some 250,000 people living in Nkasi District in Tanzania and donated equipment and supplies to the Sumbawanga Regional Hospital in Tanzania and the Moba Regional Hospital in DRC.

All this was in line with LTFHC’s commitment to improve local infrastructure.

Read the full report here.
Watch footage of these efforts here.

 

Katanga Kicks Malaria
Moba, DRC – 2010

Harnessing the excitement and energy that surrounded the FIFA World Cup 2010, the LTFHC created and implemented Katanga Kicks Malaria (KKM), a unique, innovative, and multi-phase anti–malaria educational outreach program tailored specifically for the Great Lakes Region of Katanga Province.

The program’s curriculum, co-designed by Grassroot Soccer in close collaboration with the LTFHC, engaged professional Congolese football players and community role models to educate and engage youth and community leaders in a football–based malaria education project in rural communities along Lake Tanganyika. Twenty-five local community role models and four professional Congolese football players were trained as KKM coaches to educate adults and young people in their communities, distributing some 15,000 Long Lasting Insecticidal Nets.

Read the full report here.