How Tanzania is training hospital cleaners to improve hygiene

The Soapbox Collaborative

Triggers: The number of women delivering in health care facilities in Tanzania and across the world is increasing. However, overcrowding, an increase in obstetric interventions at the time of delivery, and overstretched staff are also increasing the risk of bacterial infections, contributing to about a third of newborn deaths in Tanzania.

What: Between 2013 and 2017, The Soapbox Collaborative worked with partners in eight LMIC to conduct needs assessments of WASH and infection prevention and control in maternity units. One of the key findings across these diverse settings was that inadequate training and supervision, insufficient resources, and poor infrastructure were preventing cleaners from helping to maintain a safe and hygienic health care environment. A participatory training package (TEACH CLEAN) was developed by Soapbox to specifically address the lack of training of hospital cleaners. In 2018, the TEACH CLEAN package was adapted by Tanzania’s national training institute as part of a funded research study. The study is evaluating changes in cleaning behavior of cleaners and levels of hygiene following implementation of TEACH CLEAN in three hospitals. A baseline assessment (including measurement of the prevalence of HCAI) has been made and a suite of evaluation techniques are being used, including post-training assessments and measurements of cleanliness, and questionnaires and interviews with staff. The findings will help inform the adaptation and implementation of TEACH CLEAN in other contexts.


  • Training and supervision needs identified and addressed. Tanzania’s national training institute adapted the TEACH CLEAN package and strengthened supervision with mentoring and regular follow-up.
  • Prevention became top priority. MOH prioritized prevention and reduction of HCAI in the national IPC programme, and invested in surveillance, outbreak investigation, laboratory research, and other prevention steps.
  • Stronger monitoring and accountability. Discussions have been held to incorporate the suite of evaluation tools into routine monitoring in hospitals across Tanzania and within existing quality improvement programme activities.

Who: Muhimbili University of Health and Applied Sciences, Ministry of Health (Infection Prevention Department at national and regional levels) and Ministry of Community Development, Gender, Elderly and Children, Ifakara Health Institute, with support from WaterAid, Soapbox Collaborative, and USAID.