Developing an innovative international consulting model within a private health care system in Tanzania

This dissertation describes the development of an emerging international consulting model---the Kairuki Mikocheni Model (KMM)---that has led to the evolution of a telemedicine project in Tanzania, which will add to the body of knowledge about health care delivery in a developing African country. The KMM, which developed out of participative action research (AR), is an important tool with which Black Africans in Tanzania, and potentially elsewhere, can take control of, and participate in, their own development process. They can do so in a framework of mutual respect that encourages equality of participation and empowerment. The model provides the means for Black Africans, indigenous African consultants and members of the international community to solve some of the long-term problems of sustainability, generation of wealth and institutional strength within Tanzania, and at the same time provides a framework for international cooperation with all sides being equally empowered. The KMM consists of 5 elements: organization, materialized as a structure called the client consultant system infrastructure (CCSI); structural coupling as the means by which the CCSI evolved out of a disparate group of individuals; rules, resources and member characteristics that continually reproduce the CCSI as a social system; the use of AR as a process by which the members of the CCSI perform meaningful work; and the context as the overall system within which the CCSI functions. The research uses participative action research methodology to improve the health care delivery system through the consulting model that emerged out of the action project. The story of this intercultural project, collected and maintained through personal journals, serves as the data source of the study. It evolved first into an undertaking to improve the operations of a local hospital in Dar es Salaam, and grew to include the development of one of the first private medical and nursing universities in Tanzania. Participation expanded locally within Tanzania and internationally in the United States as plans were developed for an international telemedicine network linking the medical establishments in Tanzania and the United States. The planned network will allow the health care establishment to skip over an inadequate national infrastructure and deliver modern health care to underserved populations in rural areas.