Although Tanzania has made significant progress in reducing maternal, neonatal and child mortality, the number of deaths remains stubbornly high at 556 per 100,000 live births and 25 per 1,000 births respectively (MoHCDGEC). Evidence indicates that the majority of these deaths are correlated with home births – nearly half of which take place without the assistance of a skilled birth attendant. For births in hospitals and other health facilities, inadequate equipment and clinical training often undermine quality of care.
To help address these problems, VSO designed pilots to test a range of clinical tools for maternal and neonatal health and it then packaged them for use at the district level. The interventions included setting up low-cost Neonatal Intensive Care Units (NICUs), a Newborn Triage Checklist (NTC) that can be used by low-level health-care workers to identify at-risk infants, and the introduction of Vscans – portable, solar-powered ultrasound devices that screen pregnant women to identify those at risk.
The ACT! project aimed to reduce maternal and neonatal deaths in Lindi and Mtwara Regions by 30 per cent. ACT! introduced the intervention package to eight district hospitals, with a view to reaching 630 health-care workers (HCWs) and 150,000 mothers and their new babies. Due to a severe shortage of qualified HCWs in Tanzania responsibility for care often falls to underqualified lower-level HCWs in primary health-care facilities such as dispensaries and health centres. ACT! trained these HCWs to deliver quality and basic maternal and neonatal services such as newborn resuscitation, kangaroo mother care (KMC) and the use of NTC and Vscans.
The project also provided capacity building to mid-level HCWs and helped build the skills of local volunteer community health workers (CHWs) in order to increase referrals and create demand for services through community awareness.
CHWs were also trained to collect mobile numbers of the pregnant women in order to send SMS appointment reminders and health messages and record the number of women attending antenatal clinics (ANCs).
- The evidence from Health Management Information Systems (HMIS) data shows that survival rates for the neonates in the project’s target facilities increased from 35 per cent at the start of the project to 85 per cent at the end. Maternal deaths declined from 97 deaths to 52 deaths in the same period.
- Use of Vscans at lower-level facilities brought the services closer to the mothers. Currently, 90 per cent of pregnant women attending ANCs in
targeted health facilities are screened for pregnancy complications every month.
- 637 HCWs were trained to use the NTC .
- A total of 80,892 (18,237 in Lindi and 62,655 in Mtwara) pregnant women and mothers were registered on the SMS platform.
- The project contributed to an increase of ANC visits from 23 per cent to 30 per cent in Lindi and from 21 per cent to 57 per cent in Mtwara (HMIS).