The May 2016 issue of the Bulletin of the World Health Organization was published today. The Volume 94, Number 5, May 309 – 404 journal has a special theme devoted to the health of women, adolescents and children, focused on the implementation of the Global Strategy (2016 – 2030).
South African social justice writer and Girls Globe blogger, Zanele Mabaso’s article is featured amongst the high-level editorial publications, which ascribes the inclusion of adolescent outcomes in the global strategy to young people’s participation titled “Young people’s contribution to the Global Strategy for women’s, children’s and adolescents’ health (2016 – 2030)” with contributions from co-authors Temitayo Erogbogbo and Kadidiatou Toure.
The issue additionally features young medical doctor from Benin, Dr Joannie Bewa sharing how campaigns for sex education and free contraception are changing reproductive health prospects for young people in Benin.
The Youth Editorial on Young people’s contribution on the Global Strategy for women’s, children’s and adolescents’ health(2016 – 2030) can be found here.
An integrated community health facility project to improve maternal and child health.
Pregnancy is such a dangerous time in a Malawian woman’s life that it is considered unlucky to tell people about it.
The majority of women in Malawi live in scattered villages and find it hard to reach health facilities. They lack the information needed to make informed health decisions and facilities struggle to provide the quality services needed to save mothers’ and babies’ lives.
Women and Children First (UK) has supported maternal, newborn and child health (MNCH) projects in Ntcheu District since 2005. This integrated community/facility project, implemented by the Malawi Ministry of Health’s Perinatal Care Project between 2010 and 2014, strengthened both the demand and supply sides of the health system to address maternal, newborn and under-fives’ health issues.
Overall, the project was very successful in enhancing the coverage of essential maternal, newborn and child health interventions in the target communities and health facilities.
The final evaluation showed 94% of women were delivering in health facilities, the percentage of newborns getting postnatal care within 2 weeks of birth had increased from 35% to 95% and the percentage of women attending ante-natal care in the first three months of pregnancy doubled. Women’s knowledge of good childcare practices increased from 12% to 96%.
Community women’s groups played a central role in the project. Through these groups. women identified their most pressing maternal and newborn health problems and devised strategies to address them, mobilising locally available resources to do so. Common strategies were: improving sanitation and village hygiene; village savings and loans associations; kitchen gardens to improve nutrition; drama groups to share MNCH information; and bylaws to discourage early marriages. Led by specially trained local facilitators, the women’s groups raised awareness of the value of antenatal (ANC) and postnatal care (PNC) and delivering with a skilled birth attendant.
“I’m 18, married and have four daughters. There weren’t any problems with the births. Now I use a contraceptive injection. In the group …. we learnt that when you are pregnant there may be problems, such as swelling of the feet, anaemia and nausea, and also that some women may still bleed during pregnancy. We have also been taught about some of the dangers of childbirth, for example eclampsia, blood loss and problems in removing the placenta. I share what I have learnt with other women, and encourage them to join the group.” Regina Ntebe, Daudi Village
Involving the wider community was important and the sensitisation of Village Chiefs, the training and deployment of growth-monitoring volunteers who promoted immunisation and improved nutrition, and encouraged men to accompany their wives to ANC and PNC contributed to the successful outcomes.
“We encourage all the women to join the groups. The … project has really helped us to ensure that almost all women now have their babies in health centres.” Group Village Headman Chipusile
Key interventions for improving the health services for pregnant women and newborns included training healthcare staff on care of women in labour, care of the newborn and emergency obstetric newborn care and the provision of medical equipment. Lack of consistent supervision for frontline staff was identified as an issue during the mid-term review and additional coaching and mentoring was provided to midwives and nurses during the final phase of the project.
The project findings provide a picture of “healthy communities” in Ntcheu, with population coverage indicators recording systematically higher rates than the country-level available estimates. The only indicators showing relatively unsatisfactory achievements were for male involvement in the postpartum period.
The women’s groups were highly regarded by all sectors of the community as key interventions contributing to improvements in maternal and newborn knowledge and care-seeking practices. Many of the community interventions have became embedded within the community infrastructure.
Whilst the demand for services increased, quality of care at the health facility level was often compromised due to staff shortages, inadequate emergency transport systems and poor facility infrastructure and resourcing. The supportive supervision and mentorship programme was rated very highly by health facility staff.
There was a positive improvement in women’s satisfaction with care received at facilities, resulting from education and empowerment of women in regards to their healthcare rights through the women’s groups, respectful care training for healthcare providers and the combined community/healthcare facility interface meetings.
“Nowadays women are supposed to report any bad treatment they receive at a health facility to the village leaders.” Village headman
However, maintaining high levels of satisfaction will be a challenge if health services cannot reliably provide the expected level of care.
By Samantha Bossalini, Communications and Development Associate, Kupona Foundation
The Challenges We Face:
In Tanzania we lose approximately 22 women1 and 106 newborns2 every day due to childbirth and pregnancy related complications. These deaths are, for the most part, preventable. For every woman that dies, 20 more will develop an injury, infection, or debilitating impairment like obstetric fistula3.
In Dar es Saalam, Tanzania’s largest city and one of the fastest growing cities in Sub-Saharan Africa, booming population growth puts a huge demand on the healthcare system. Unable to withstand the pressure, hospitals are left with severe staff and resource shortages. In some of the busiest maternity wards in the city, up to 5 women in labor can be found in a single bed, and in some cases women have no choice but to give birth on the floor. One-third of maternal deaths are a result of post-partum hemorrhaging, but access to a safe blood supply is severely limited. Equipment is often broken, or unavailable, and there are not enough trained professionals to give each mother and newborn the attention they need.
Understaffed, under-resourced, and overwhelmed, medical teams cannot meet the demand for high quality healthcare, resulting in staggering maternal and newborn mortality rates.
This is a complex issue, without a single, simple solution. In collaboration with our sister organization, CCBRT, and the Government of Tanzania, Kupona mobilizes resources and funds to support a comprehensive program designed to tackle Tanzania’s maternal healthcare crisis from many different angles. Through our collaborative, integrated approach, we are making critical improvements to the quality of care, and are seeing encouraging results.
Watch to learn more about CCBRT’s Maternal and Newborn Healthcare Program
Strengthening What We Have
Frontline healthcare workers in Dar es Salaam’s public health facilities bear the brunt of staff and resource shortages. In 2010, CCBRT began work to build the capacity of 22 public health facilities in the region. By placing highly skilled doctors to train, mentor, and empower medical workers at these facilities, CCBRT has equipped them with the skills and confidence they need to provide high-quality care. Since 2010, CCBRT, in partnership with the Regional Health Management Team, has trained hundreds of frontline healthcare workers in Basic Emergency Obstetric and Neonatal Care (BEmONC). The team has also conducted critical renovations in 5 facilities, and distributed life-saving equipment and resources.
Since the beginning of the program we have seen a marked decline in maternal mortality and stillbirth rates across the region, and an increase in the quality of care being provided across the 22 sites. In 2014 alone, colleagues at CCBRT supported facilities served over 105,000 mothers with higher quality care during delivery, trained 1,693 frontline healthcare workers, and saw the average quality of care scores4 increase from 9% in 2010 to 78% in 2014.
Building Something New
Recognizing the need to increase capacity to treat emergency and high-risk cases in the region of Dar es Salaam, CCBRT began construction on a 200-bed facility which, at full capacity, will conduct 15,500 deliveries per year, The facility will be a beacon of best practice, and will provide quality services across the entire spectrum of care, from family planning to treating sick newborns. The CCBRT Maternity and Newborn Hospital is in its final stage of construction, and is scheduled to open its doors to patients in 2017. The hospital will also be home to one of the few dedicated blood banks in Dar es Salaam, providing safe blood to mothers and newborns in need of emergency transfusions.
Join our Collaborative Community
Like any complex problem, we have to approach maternal and newborn mortality from many different angles. Our efforts may feel small at first, but we’ve seen that the impact is exponential. As Kupona and CCBRT advance, innovate, and grow to meet the needs of the population we serve, we’re motivated by stories of lives saved, and healthcare workers feeling empowered for the first time.
If you would like to join our collaborative community of donors, volunteers and advocates, please visit our website to learn more about how you can get involved. Follow us on Twitter and Facebook, or contact us directly for more information at email@example.com
Tanzania Demographic and Health Survey (TDHS) 2010, National Bureau of Statistics, Tanzania, April 2011, Dar es Salaam
In 2013, 39,000 neonatal deaths occurred in Tanzania; the neonatal mortality rate was 21/1,000 live births. UNICEF (2014). Committing to Child Survival: A Promise Renewed
Nanda, Geeta, Kimberly Switlich and Elizabeth Lule, Accelerating progress towards Achieving the MDG to Improve Maternal Health: A Collection of promising Approaches, World Bank, Washington D.C., April 2005, p4.
Measured by Standards-Based Management and Recognition (SBMR) assessments, developed by Jhpiego, an affiliate of Johns Hopkins University.
The UN Secretary General’s renewed Global Strategy for Women’s, Children’s, and Adolescents’ Health, to be launched in September 2015, will be a roadmap for improving the health and well-being of women, children, and adolescents. The first Global Strategy, launched in 2010, galvanized the Every Woman Every Child movement and achieved significant progress in reducing preventable deaths.
The Zero Draft of the updated Global Strategy was released earlier this month. Adolescent health is a focus area of the Global Strategy for the first time and we are calling on young people around the world to provide their input on adolescent health priorities. Yesterday, together with The Partnership for Maternal, Newborn and Child Health (PMNCH) we hosted the Calling on Youth Voices to Improve Adolescent Health Google+ Hangout to engage youth on their reflections of the UN’s Zero Draft.