From the outset of the Maternal Health Program, Thamini Uhai has engaged closely with all levels of the Ministry of Health, Community Development, Gender, Elder and Children (MoHCDGEC)as well as Council and Regional authorities to identify areas of the Program  which government will be in a position to absorb and sustain. The Program shares lessons learned in decentralizing CEmONC and task-shifting in order to inform Government’s scale-up of CEmONC across the country. Several NGOs are also adapting the Thamini Uhai model for their own efforts to establish CEmONC. Thamini Uhai and its donors are deepening their partnership with Government to expand CEmONC in the regions where Thamini Uhai works. 

Sustainability is a critical component of Thamini Uhai’s 
work. In 2015, Thamini Uhai engaged with regional and district governments of Morogoro and Pwani to plan for handing over of project activities in those regions by January 2017. Members of local government health management teams joined Thamini Uhai’s supportive-supervision visits in 2015 to build their capacity for overseeing staff after the handover.

Ensuring adequate trained staff in health facilities is essential for sustainability. In 2015 Thamini Uhai supported a human resources for health workshop in Kigoma and launched an e-learning platform to provide ongoing professional development and skills-building for trained staff. In addition, Thamini Uhai opened a Kigoma office and relocated a number of senior Thamini Uhai staff including obstetricians/gynecologists from Dar es Salaam to Kigoma to provide more intensive supervision and support.

Ultimately, Thamini Uhai aims to support the ministry in integrating this model into the national maternal health program and successfully replicating the model throughout the country.

Councils outside the Program areas are also taking the initiative to improve care: building a maternity waiting home; contributing to the costs of a new operating theatre; constructing staff houses; and, allocating an ambulance to a health centre. 

Engagement with MoHCDGEC, District (Council) and Regional officials  strengthens the role of the program as a national model and provides an opportunity to work with Government on the expansion of CEmONC more broadly. Discussions regarding district budgeting for CEmONC and on overall sustainability of the model are especially important to enable District Executive Directors to plan optimally for upgrading facilities, posting qualified health workers to them, and ensuring a continuous stream of supplies, commodities and medicines to sites.