Creating an own profile to strengthen self-reliance
The Tanzanian Training Centre for International Health in Ifakara

In the course of a few years, the Tanzanian Training Centre for International Health (TTCIH), officially inaugurated in April 2006, has transformed from a chronically under-resourced Clinical Officers’ Training Centre (COTC) into a high-quality training center in rural Africa. Under a partnership between the Novartis Foundation, the Tanzanian Ministry of Health and Social Welfare, the Swiss Tropical Institute and the Swiss Agency for Development and Cooperation, not only have the infrastructure and facilities been substantially improved, but both management and the quality of teaching have been strengthened and the center’s financial self-reliance given a significant boost. The future challenge will be to maintain the quality of facilities and equipment, build up new services, and, above all, develop the range of in-house courses offered that meet national and international demand. In short, it is vital for the center to create its own profile in health training that distinguishes it from other centers in (East) Africa.

The training center in Ifakara – a long-standing Basel initiative

The history of the creation of the training center dates back to 1961, when Basel-based zoologist Rudolf Geigy opened the Rural Aid Centre (RAC), the predecessor to the COTC, together with Julius Nyerere, who would later become President of Tanzania. Assistance was provided by the dedicated Basel Foundation for Developing Countries, an initiative of the Basel-based chemical companies at that time. Together with the neighboring institutions St. Francis Designated District Hospital and Swiss Tropical Institute Field Laboratory (also inaugurated by Basel zoologist Rudolf Geigy, in 1957) this led to the establishment of a unique triangle of health research, training and medical practice.

In 1973, the RAC was transformed into a Medical Assistant Training Centre (MATC). The institution was finally handed over to the Government of Tanzania in 1978. Following a change in the Tanzanian health education system, it was renamed COTC. 
Despite a complete renovation in 1990, the training and accommodation facilities were in a deplorable state again by the end of the 1990s. The reasons included sub-standard building materials and the tropical climate, as well as lack of maintenance work and managerial skills. This was further exacerbated by a lack of teachers, out-of-date teaching material and poor equipment. In 1998, in the hope of receiving fresh support, the school management turned to the Novartis Foundation. The latter sought to secure a further commitment to institutional and organizational change from the COTC and the Ministry of Health and Social Welfare in order to create a self-reliant center over the long term.

A comprehensive strategy toward greater self-reliance

Initially, the primary goal of the Novartis Foundation and its partners was to upgrade the center through renovation and new equipment so as to enable it to offer high-quality health training, facilities and additional services that meet both national and international demand. Whilst the basic renovation of the existing buildings complex was financed by the Swiss Agency for Development and Cooperation (SDC) and executed by the Swiss NGO Solidarmed, the Novartis Foundation covered the necessary upgrading and new constructions as well as the equipping the training rooms, offices, accommodation and laboratories.

In order to secure high-quality training for the long term, the partners sought specifically to strengthen the institutional and financial independence of the center. Consequently, the TTCIH was firstly converted into a semi-autonomous organization that still comes under the Ministry of Health and Social Welfare but is managed by a board of governors. While the foundation and the Swiss Tropical Institute are members of this board, the Ministry chairs it. This was possible thanks to reforms already implemented in the Tanzanian health sector whose main element is the decentralization and strengthening of regional and district-based health authorities and institutions. Secondly, the management underwent intense professionalization and was entrusted with more decision-making powers (E). In particular, the recruitment of a director who is a specialist in medical education with broad experience of different positions both in the Tanzanian health system and abroad has already boosted the profile of the center as a reliable organization with thematic expertise. Aside from improved financial and administrative management (E), the TTCIH also has a team which focuses on customer care as well as marketing of the center via its website, brochures and personal visits (C, D). A sustainable maintenance system with a core team of different craftsmen (e.g. electrician, plumber, carpenter, gardeners and cleaners) is also in place (F). The foundation not only assists the center through budget support as financial reward for achieved milestones mutually defined and derived from the center’s strategic plan; it also provides technical support in the areas of managerial skills development, finances, marketing and maintenance.

Progress to date

Progress to date is encouraging: The improvement of the center including the recruitment of teachers covering medical specialties such as gynecology and pediatrics enabled the center to upgrade the former Clinical Officer (CO) training to Assistant Medical Officer (AMO) training (A) in 2005. There are now around 80 full-time AMO students on the campus. This switch was an explicit wish of the Ministry of Health and Social Welfare with the aim of increasing the output of better-qualified AMOs working at district level, which would inevitably have a positive impact on the health situation of the rural population in particular.



Based on its “unique selling proposition” – the combination of training, research and medical practice in Ifakara - and, following the identification of thematic niches in health training, in 2008 the center embarked on extending its own course offering (B). Alongside AMO and clinical officer refresher training, it now offers, for the first time, a course on “Maternal mortality reduction in resource-limited settings: learning from evidence“, a thematic priority of the center. Moreover, a partnership with the US University of Columbia focusing on maternal and child health has been established. Last but not least, the TTCIH hosts courses delivered by third parties such as the Swiss Tropical Institute. The center has also tailored specific courses for clients such as the University of Athens or the Tony Blair Foundation.

The balance sheet for 2008 was extremely encouraging: The TTCIH generated USD 480,000 in gross revenue from course fees, rents (accommodation, seminar rooms, houses, etc.) and other services, not including the support through grants from the foundation and the Ministry of Health and Social Welfare. The center was virtually able to “offset” the support from the foundation through its own income. This means that running costs for preventive maintenance and repairs, staffing and educational material, as well as small-scale investments, were financed almost without external help.

In 2009, gross income even totalled USD 1,089,000 (USD 260,000 in net income). After costs, this means that by the end of 2009, the TTCIH had USD 477,000 cash at its disposal.

Future endeavors

Apart from further optimizing financial management and internal maintenance processes, the center will work on better aligning its human resources with the strategic objectives of the organization. The Corporate Learning section of the Human Resource Department at Novartis will help build leadership skills, optimize allocation of current human resources within the center and define additional human resource needs so that the center can achieve its strategic goals more efficiently.

Moreover, the center will continue to build its core thematic areas in health, i.e. maternal and child health and clinical medicine. A new project launched in collaboration with STI and supported by the foundation is the design of an E-learning module on maternal and child health within the AMO curriculum. Such an E-health strategy will not only allow the center to extend its range of own courses, but also to work toward the Ministry’s goal of increasing the output of qualified human resources for healthcare via distance learning.