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Project Background

From the lack of life-saving medications and access to skilled birth attendants to the cost of transportation, the barriers to rural health-care facilities for antenatal
care and delivery in Tanzania are numerous and well documented. For women living in Mara Region, the situation is no exception. About half of all births take
place away from health facilities and post partum haemorrhaging (PPH) and infection (puerperal sepsis) account for 35 per cent and 15 per cent of the region’s total maternal deaths, respectively (TDHS-MIS). Shirati and its partners introduced the Saving Mothers project to pregnant women in 202 villages in Tarime and Bunda Districts, Mara Region. The project aimed
for a 30 per cent reduction in the number of women who might otherwise die of PPH by distributing clean delivery kits containing misoprostol to prevent infection and stem heaving bleeding.

Project Description

The kits were distributed by trained community health volunteers (CHVs) and district nurses to women who were between 34 and 36 weeks pregnant. The women were instructed to seek a health facility for birth, but the kits could be used for home births, delivery en route, or at the facility where supplies were lacking CHVs were given mobile phones equipped with an m-health app to register the women, send them reminders to attend antenatal clinic appointments, warn them about danger signs, and track their delivery outcomes. The app also provided information on staff workflows and stock levels.

Project Results

  • 191 CHVs and 64 district nurses were trained to provide safe pregnancy education.
  • CHVs and nurses distributed 14,000 clean birth kits with misoprostol to pregnant women in 191 villages.
  • According to data from the District Medical Offices, the facility birth rate in Tarime District rose from 48.3 per cent in 2015 to 67 per cent in 2016 while in Bunda District, the facility birth rate increased from 70 per cent in 2015 to 84 per cent in 2016.
  • Advisory team meetings and site visits were conducted, and policy dialogue sessions were initiated with the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) to share on the project model and to lobby for its adoption. ‘Women were so grateful for receiving the birth kits at the facility. Their happiness could not be hidden from their faces and that’s why they turned up in large numbers for the birth kits.’ (Nurse, Tarime District).
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