Learning on TAP: improving access to assistive technology in Tanzania

As a child, Dr. Msafiri Kabulwa aspired to become an electrical engineer, but as there was no advanced mathematics teacher at his high school in Tanzania, he studied physics, chemistry and biology and aspired to become a schoolteacher instead. But soon, he was enrolled in medical school where he graduated as a dental surgeon, and he was eventually posted as a tutor to dental therapists, combining his new medical knowledge and previous teaching aspirations.

“In many low- and middle-income countries there aren’t enough health personnel, especially occupational therapists and physiotherapists who are often concentrated in urban areas, away from those who need them in rural towns and villages,” explained Dr. Kabulwa. “I knew that part of the solution had to include teaching and training non-specialist health workers who were the first point of contact for people – nurses, clinical officers and social workers.”

In 2022, as the Coordinator for Elderly Care and Persons with Disabilities in the Directorate of Curative Services in the Ministry of Health, Dr Kabulwa embarked on an ambitious project in collaboration with HelpAge Tanzania and the World Health Organization (WHO) – to support community and primary health care workers in two districts in the Morogoro region to fulfil a role in assistive technology, utilizing the WHO Learning on TAP blended learning resource.

“The project was the first time many of the primary health workers had taken online learning. But now that most health workers have a smartphone, the courses were not resource intensive and allowed people to learn in their own working situation,” said Dr Kabulwa.

In the WHO Africa Region the number of people in need of at least one assistive product, such as hearing aids, walking sticks and near vision spectacles, is currently over 200 million, and is projected to double by 2050. However, it is estimated that only 15-25% of those in need of assistive products in the region have access to them.

Learning on TAP, now available through the WHO Academy online learning platform, takes a four-stage approach – online learning, in-person learning, mentored practice and independent practice – to strengthen the health and care workforce in primary care and community settings to improve access to health services closer to home.

“The inclusion of mentors and peer organizers has been crucial, as they can help guide learners even after the initial training has ended. Learners have now helped establish referral pathways from the community to primary health centres and district hospitals - the most important factor in future assistive product provision,” noted Dr Kabulwa.

As part of the project, 179 primary and community level health personnel were trained to fulfil a role in assistive technology, and nearly 15 000 assistive products were provided at 31 health facilities. Post training, there was a 45% increase in health centre personnel having a role in provision of assistive technology.

Importantly, the project revealed which assistive products, and at what levels of the health system, were required, establishing the foundation for future supply chain management and highlighting the essential need to integrate assistive products into the lists of essential health products for primary health care. Learning on TAP training and resources have also been piloted in other countries, including Fiji, India, Papua New Guinea, Romania, Saudi Arabia, Tajikistan and Ukraine, demonstrating how the blended learning approach can be adapted to different contexts based on global WHO standards and guidance.

“Our experience with just two districts has provided the knowledge and evidence we need to adopt a country-wide approach to the provision of assistive technology,” enthuses Dr Kabulwa. “Sustainable learning and training solutions in health are available – working with WHO can help you find the right approach in your country.”