TANZANIA: Smart Healthcare Vital in Saving Mothers

January 2016 thecitizen; Health experts say advancing our future starts with safeguarding the well-being of pregnant women and newborn babies. They say investing in the health of women, newborns and children may yield economic and social benefits worth more than nine times the cost.

This message was also echoed at the Global Maternal Newborn Health Conference in Mexico City recently where health experts gathered to discuss ways to reach every mother and child with high quality health care.

And back home, the government has shown a strong political will to improve maternal and child health, according to Dr Mary Mwanyika-Sando, deputy chief executive officer of the Africa Academy for Public Health.

The maternal health expert says there is a lot that former President Jakaya Kikwete’s administration did in collaboration with development partners and various donors to improve the quality of care in our hospitals.

The current government is following suit.

The efforts have seen mothers and babies who would have otherwise died, survive. Simple efforts like initiation of breastfeeding at birth and easy-to-use antibiotics alongside the provision of comprehensive obstetric and newborn care.

The Kangaroo mother care method, for example, has given babies born prematurely, a chance to live. In the absence of incubators, all that the premature baby needs is its mother’s warmth through skin-to skin contact on the mother’s chest.

More women today deliver in health facilities and this has been made possible through sensitisation and availability of improved services.

Although Dr Mwanyika-Sando says there is still a lot more that has to be done to sustain the gains, especially in improving the care for both the mother and baby during the most critical moments around birth, progress made so far is significant and worth mentioning.

Involving traditional birth attendants

In Rukwa Region, for example, the involvement of Traditional Birth Attendants (TBAs) has resulted in more mothers seeking professional services in health facilities.

Initially, mothers preferred delivering at home, where they were assisted by TBAs due to a number of reasons. Long treks to health facilities, ignorance and the desire to have a much older woman help them deliver, were some of the reasons that made women shun hospitals.

Encouragingly, about 64 per cent of women in the region now deliver in health facilities. This is six per cent up from last years 58 per cent. The percentage was much lower before and Allice Tambala, who was the regional reproductive and child health coordinator at the time of interview last year, says maternal deaths used to be very high then.

The region recorded 177 maternal deaths per 100,000 live births in 2008 and 138 deaths per 100,000 live births in 2013.

Before TBAs involvement in 1989, there used to be some kind of competition between TBAs and health facilities. TBAs used to book pregnancies once they learnt a woman was pregnant, so they would attend to them at delivery.

They used to say negative things about hospitals and convinced women to shun them (hospitals). It was their way of earning an income.

Dr Emmanuel Mtika, Rukwa acting regional medical officer says the region is in transition from traditional to modern medicine.

“The transition period has been problematic since there has been competition between TBAs and health facilities.”

The region had to come up with a strategy to involve TBAs in maternal health programmes and the result has been impressive, according to the doctor.

“Instead of discouraging TBAs from delivering women, we encouraged them to advise women to deliver in health facilities, and in fact accompany them to a health facility to deliver,” says Dr Mtika. TBAs have since been of great help. There are areas where they bring women to health facilities in big numbers. TBAs who accompany mothers to a health facility are rewarded the same amount of money they would have been paid to deliver a woman.

Rewarding TBAs

The district reproductive and child health coordinator for Sumbawanga Municipality, Tizo says TBAs involvement is very important, especially as a way to prevent maternal deaths that would occur in the hands of unskilled attendants at home.

She says the municipality trained TBAs in 1995 on how to handle a woman, in case of an emergency while on the way to hospital.

“We pay them Sh3,000 per visit for every woman they accompany. Sometimes we give them bars of soap. Their job is to help us curb home deliveries,” says Tizo.

Their involvement has helped reduce the number of maternal deaths. In 2012 for example, only one death was recorded in a TBA assisted delivery in the municipality. Another death occurred in 2013.

Today, between two and three per cent deliveries are assisted by TBAs compared to 10 per cent before TBAs involvement.

In 2011, TBAs helped 401 women deliver, compared to 198 in 2014. The numbers were high in 2012 (415) and 2013 (389) because there was no budget to reward the TBAs.

Community health workers

Sumbawanga Municipality started rewarding TBAs in 2011, something that explains the high number of TBA deliveries years before. In 2008 and 2009, TBA deliveries were 1,006 and 1,038, respectively. Rukwa uses community health workers as another strategy to avert maternal and child deaths.

According to Dr Mtika, development partners helped in training community health workers who link the community with health facilities.

“They were trained on child and maternal health and help us in obtaining information and data from the community. In some areas, they register expectant mothers, those who have given birth as well as maternal and child deaths,” says the doctor.

They identify expectant mothers and educate them on the importance of attending ante-natal clinic and delivering in a health facility.

They also encourage mothers to take their children for immunisation and to post-natal visits.

According to Dr Mtika, the government is in the process of employing community health workers so they can fully become part and parcel of the efforts to curb maternal and child deaths.

Improved healthcare system

Dr Mtika says another reason for the increase in health facility attendance in the region is the increase in the number of health facilities and health personnel.

Because of assistance from development partners, the region has surpassed the government’s target of having 50 per cent health centres providing operation services.

“The region’s 10 out of 21 health centres have operating theatres. Six are operational and have to a great extent helped reduce congestion at urban health facilities,” says Dr Mtika.

The remaining four are at different stages of construction and the plan is to have operation theatres in all the 21 health centres.

Infrastructure improvement and construction of staff houses have enabled retain workers in areas once shunned due to poor work environment. The docto’r says the region had only 34 per cent of the required manpower, but the number is currently approaching 70 per cent.

According to new data released during the Global Maternal Newborn Health Conference in Mexico City, maternal mortality in Tanzania decreased on average of 3.5 percent per year over the past quarter-century. The number of children who die before their fifth birthday fell as well.

Maternal mortality ratio in Tanzania is 410 deaths per 100,000 live births and the under-five mortality rate is 49 deaths per 1,000 live births according to 2012 census data.


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