MATERNAL HEALTH PROGRAM IN KIGOMA,MOROGORO AND PWANI
Since 2008, Thamini Uhai (formerly World Lung Foundation) has worked with the government of Tanzania in different levels to reduce maternal and perinatal mortality through establishing and supporting sustained provision of Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) services in 16 public health centers and five hospitals in Kigoma, Morogoro and Pwani regions. In the final phase of implementation, Thamini Uhai expanded its support in Kigoma to 29 dispensaries and two health centers offering BEmONC.
Three main strategies were implemented to increase the availability, access and demand for good quality CEmONC services; and these included; decentralization of care from hospitals to health centers, by upgrading health centers to provide CEmONC services, task-shifting of CEmONC service provision from obstetricians to non-physician clinicians and nurse-midwives and demand creation through multimedia communication campaign and community health workers to educate and sensitize communities on preparedness and utilization of improved facilities for routine and emergency obstetric care services(EmONC). Facility and community based surveys were conducted by Centers for Disease Control’s (CDC’s) reproductive health division annually to supplement the routine internal monitoring and evaluations.
Remarkable improvements in several process, outcome and impact indicators were reported in Kigoma during the years of implementation, surpassing the program’s targets. From 2011 to 2018, an estimated 2,200 maternal lives were saved through improved care in program-supported facilities.Facility delivery increased from 33% in 2010 to 85% in 2018, Caesarean section rate from 2.7% in 2011 to 4.5% in 2018, met need for EmONC from 42.8% in 2011 to 61.3% in 2018 and direct obstetric case fatality rate from 2.0% in 2011 to 1.4% in 2018.Total still birth rate was reduced from 28 in 2011 to 12.8 per 1000 live births in 2018, intrapartum still births rate from 16.3 in 2011 to 6.0 per 1000 live births in 2018, neonatal mortality rate from 20 in 2011 to 18 per 1000 live-births in 2018 and facility maternal mortality ratio from 364 in 2011 to 174 per 1000 live births in 2018 .
Key lessons learned include; (i) To achieve better results it is important to use a comprehensive package of right-mix of cost-effective and evidence based interventions together,(ii)In order to get sustained improvements in the facilities, facility based interventions must be bundled with community-based interventions and high-quality supportive supervision, mentoring,(iii) maternal and perinatal clinical audits are essential for maintaining the competency and confidence of health care providers for quality EmONC.