Kathryn Lee
Cristy Gaskill

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14 June 2017
Implementation Case Study on SDG Targets 3.1 and 3.2: Boosting Maternal and Child Health by Improving Standard Practices and Showcasing Good Practice
UN Photo/Evan Schneider
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The Government of Tanzania aims to reduce the neonatal mortality rate (NMR) to 16 per 1000 live births and maternal mortality ratio (MMR) to 292 per 100,000 live births by 2020.

A comprehensive approach to assessing the system and addressing gaps has contributed to improved outcomes for mothers and babies at the supported facilities.

Introducing standards for improved service delivery and creating motivation has led to significant quality outcomes in maternal and newborn health.

The reduction of maternal and newborn mortality in Tanzania is a significant challenge, with a maternal mortality ratio (MMR) of 556 deaths per 100,000 live births (2015-2016), far above the Sustainable Development Goal (SDG) 3 target of 70 deaths per 100,000 live births (SDG target 3.1).1 2

While Tanzania has made significant progress in reducing its neonatal mortality rate (NMR) – now 25 deaths per 1,000 live births (2015-2016)1, down from a NMR of 40 in 19903, – it is still above the level in SDG target 3.2 – 12 deaths per 1,000 live births2. Within the country, these rates are higher in fast-growing urban settings like Dar es Salaam. A high adolescent fertility rate, a shortage of human resources in maternal and newborn healthcare, an increasing population, and poor infrastructure all contribute to this picture. The Government of Tanzania aims to reduce the NMR to 16 per 1000 live births and MMR to 292 per 100,000 live births by 20204.

CBM is supporting a partner organization, Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), to improve maternal and child health services in government hospitals, and to ensure that women with disabilities gain access to these services. The programme directly supports 23 health care facilities, provides training on managing emergency obstetric and neonatal care, and promotes access to services by women with disability. CCBRT also helps facilities to measure progress using the Standards-Based Monitoring and Recognition tool. The tool, which was developed by the Government of Tanzania in collaboration with the MAISHA programme, and Jhpiego, an affiliate of Johns Hopkins University, shows a substantial increase in all facilities’ scores on evidence-based, recommended standards of care for maternal and newborn health that have been developed for the Tanzanian context.

The program involves working with the government at district, regional and national levels (including the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) and Regional and District Health Management Teams) to assess the system and address identified gaps.

CCBRT has taken a comprehensive approach, comprising three aims:

1. Increased capacity of regional and district leaders to manage maternal and newborn healthcare initiatives:

CCBRT helped establish and strengthen regional quality improvement initiatives. They work with the Regional Health Management Team to review service delivery data, update on progress, address challenges, and follow-up on annual facility assessments. CCBRT has also helped enable annual assessments of Standards-Based Management and Recognition in maternal and child health care, and develop appropriate action plans to address gaps.

2. Increased capacity of healthcare workers at regional health facilities:

CCBRT has trained over 5,000 health care workers, strengthening capacity in the areas such as focused antenatal care, basic emergency maternal obstetric and newborn care, comprehensive emergency maternal obstetric and newborn care, newborn care, data use, referrals, blood use and anesthesia.

3. Strengthening ability of regional facilities to provide initial high risk antenatal and postnatal care:

CCBRT has equipped facilities with essential equipment and supplies including investing in building and equipping of seven operating theaters; outfitting four hospitals with essential equipment to manage and improve survival from the leading causes of neonatal death (prematurity, infection and birth asphyxia); and establishing a closed phone system between the 23 facilities for health workers to discuss the care of and refer patients safely to higher-level facilities.

This comprehensive approach to assessing the system and addressing gaps has contributed to improved outcomes for mothers and babies at the supported facilities, which have experienced:

  • maternal mortality rate reduction of 40%
  • stillbirth rate reduction of 14%
  • survival rate of premature babies increased by 19%

At one facility, which had a history of poor service for women giving birth, the monitoring score for standards of maternal and newborn health jumped from 31% to 75% in a 12-month period. CCBRT shares such results with the local government to help identify priority gaps and areas for improvement.

The monitoring score for standards of maternal and newborn health jumped from 31% to 75% in a 12-month period.

In recognition of these contributions to positive maternal and child health outcomes in the Dar es Salaam Region, in February 2017, the Minister of Health, Community Development, Gender, Elderly, and Children said the CCBRT partnership “…aligns with the priorities of our national strategic plan to address the gaps in maternal and newborn health here in Tanzania.”

The experience of CCBRT in engaging with the Ministry of Health, hospitals and clinics, has shown that introducing standards for improved service delivery and creating motivation has led to significant quality outcomes in maternal and newborn health.

1 Tanzania Health and Demographic Survey and Malaria Indicator Survey 2015-2016
2 United Nations Sustainable Development (2016). Sustainable Development Goal 3
3 The World Bank
4 The National Road Map Strategic Plan to Improve Reproductive, Maternal, Newborn, Child & Adolescent Health In Tanzania (2016-2020)

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