BackgroundThe establishment of a functional information system for human resource for health (HRH) was one of the major challenges for the Tanzanian health sector. In 2008, the Ministry of Health and Social Welfare developed the HRH Strategic Plan, in which establishment of computerized information systems were one of the strategic objectives. In response to this objective, the Ministry developed two information systems, namely the Human Resource for Health Information System (HRHIS) and the Training Institution Information System (TIIS), to capture information from both the public and private sectors.Case descriptionThe national rollout of HRHIS and TIIS was carried out in four phases during a 6 year period between 2009 and 2014. Together with other activities, the rollout process included conducting system operation training and data utilization training for evidence-based planning, development and management of HRH and social welfare workers and health training institutions.DiscussionHRHIS was rolled out in all 25 regions of the Tanzanian mainland, including 171 districts, and TIIS was rolled out in all 154 health training institutions and universities. Information is captured from both the private and public health sectors with high-data coverage. The authors identified several key factors for the achievements such as using local experts for developing the systems, involvement of system users, positive attitudes among users, focusing on routine work of the system users and provision of operations and data utilization trainings. However, several challenges were also identified such as getting a consensus on sustainable HR information systems among stakeholders, difficulty in obtaining baseline HRH information, inadequate computer skills and unsatisfactory infrastructure for information and communication technology. We learned that detailed situation analysis and understanding of the reality on the ground helped to reduce the “design–reality gap” and contributed to establishing user-friendly systems and to improve sustainability of the systems.ConclusionsThis paper illustrates the successful development and national rollout of two information systems for HRH in Tanzania. The approaches used and activities conducted here and lessons learned could be useful for countries which are planning to establish HR information systems.

Purpose The purpose of this paper is to identify how the introduction and dissemination of the 5S-KAIZEN-TQM approach positively influence the Egyptian health sector and its sustainability. It also seeks to encourage effective and efficient introduction of the 5S-KAIZEN-TQM approach into the health sectors of low- and middle-income countries. Design/methodology/approach The pilot program introducing the 5S-KAIZEN-TQM approach into five Egyptian public hospitals spanned over 13 months from January 2016 to February 2017. During the pilot program, a series of interventions occurred to introduce the approach, such as seminars on the 5S and KAIZEN approach, consultation visits and progress report meetings. Data and information were collected through conducting interviews, observing directly and evaluating the implementation progress of 5S-KAIZEN-TQM activities. Findings The study identified the following factors in effective and efficient dissemination of 5S-KAIZEN-TQM activities in the Egyptian health sector: restructuring the quality management structure to establish Quality Improvement Teams and Work Improvement Teams in hospitals, generating strong leadership and commitment among leaders, conducting effective in-house trainings on the 5S-KAIZEN-TQM approach, monitoring and following up on 5S-KAIZEN-TQM activities and introducing the 5S-KAIZEN-TQM approach using non-clinical sections, which could also influence the sustainability of the activities. Originality/value This study holds value in its clarification of meaningful ways to disseminate and encourage the sustainability of the 5S-KAIZEN-TQM approach in Egyptian public health facilities. Moreover, officials from the Ministry of Health and Population and hospital managers in Egypt can use the findings to plan and disseminate this approach nationwide.

Purpose – The purpose of this paper is to identify factors that influence the implementation of the rollout of the 5S approach in public hospitals in Tanzania, and share the way to scale this up for similar setting in developing countries. Design/methodology/approach – The effect size was calculated from pre- and post-assessment results of Training of Trainers (ToT) to examine the effectiveness of ToT. A questionnaire with 14 explanatory variables was developed and completed based on information collected during Consultation visits (CVs) and progress report meetings (PRMs). Then, data were analysed to identify the influencing factors in relation to outcome variables (CV average score). Findings – Among 14 explanatory variables, five explanatory variables showed statistical significant association with the CV average score. Those are: “Feedback and information sharing,” (p=0.031), “Quality Improvement Team roles and responsibility” (p=0.002), “5S knowledge,” “Involvement and commitment,” and “5S guidelines use and availability,” (p=0.000). When the explanatory variables were controlled by levels of hospitals; “involvement and commitment” was the only explanatory variable for national level hospitals. For regional referral hospitals, “QIT roles and responsibility” (p=0.02) and “5S knowledge” (p=0.03) were statistically significant. For district hospitals, “involvement and commitment” (p=0.01) and “availability of guideline (p=0.001)” were statistically significant. Research limitations/implications – This study has the following limitations. The data were collected from existing reports and presentation materials only. There might be reporting bias, as PRM data is self-reported from the hospitals. Caution is therefore needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for designing and implementing QI programs in Tanzania and in other African countries. Originality/value – The authors' conceptual framework is based on the existing literature on the science of diffusion and scale up of innovation in the health sector. Few studies are known from resource constrain settings in Africa which assess the determinants of the process of nationwide scale-up of proven interventions.