Dar es Salaam. Why are maternal deaths still high in Tanzania? This question still lingers on the minds of health experts.
However, Dr Dismas Matovelo, a maternal health specialist based in Mwanza Region, believes among other reasons, “the power of communities hasn’t been fully exploited in improving maternal health.”
Apparently, communities are still glued on the receiving end of maternal health services for many years in Tanzania’s struggle against maternal mortality.
The government and stakeholders have been mainly mobilising resources, infrastructure and building the human resource capacity.
“We now have to look at things differently. Communities themselves have the potential to contribute significantly to reduction of maternal mortality and improve newborn and child health if they are empowered and sensitised,’’ says Dr Matovelo, a specialist at the Catholic University of Health and Allied Sciences(Cuhas).
Where the strategy has worked
The Permanent Secretary (PS) in the Ministry of Health, Community Development, Gender, Elderly and Children, Dr Mpoki Ulisubisya told The Citizen that a village in Mbarali District, Mbeya region known as Uturo has not had a case of maternal death since 2008.
“The local leaders and communities in that village realised that they have a big problem and decided to work on it earnestly.
They went ahead to create special registers in their village dispensaries whereby pregnant women are compelled to visit clinics otherwise thy risk being slapped with a fine up to Sh5000,” he said on Tuesday.
“The story of the Uturo village is inspiring and should be replicated across the country with a view to decreasing cases of maternal deaths,’’ said Dr Ulisubisya when responding to a question from this reporter, who sought to know how the government was engaging citizens in fighting maternal mortality.
Maternal mortality rate has remained high in Tanzania, having risen in recent years from 432 to 556 per 100,000 live births, according to the 2015/16 Demographic Health Survey (TDHS).
Little progress has been made, according to various United Nations Reports.
Dr Matovelo from Cuhas is now leading a team of researchers in Mwanza Region in implementing a strategy, which is expected to empower communities to contribute towards reducing maternal mortality and improving newborn and child health.
It is a collaborative project between the government and University of Calgary in Canada, Cuhas, Mbarara University of Science and Technology as well as the Canadian Pediatric Society. “We are looking at the opportunities that are available in communities and leveraging on them. It’s like saying; let’s pick the low-hanging fruits. That the communities themselves can devise solutions to challenges facing them. Our role is to lend them a helping hand,’’ he says.
“This can complement the efforts being invested by the government and stakeholders in maternal health,” says the principal investigator of the “Mama na Mtoto” research project, which is undertaken in Misungwi and Kwimba Districts, Mwanza Region.
Since 2016, Dr Matovela and a team of other health experts have been on the ground in Misungwi and Kwimba Districts, mobilising communities through their local leaders to develop health infrastructure closer to where they reside, instead of waiting for support from the government and stakeholders.
“Apart from empowering them to put up their own facilities and run them, we are trying to change their mindset. In most communities, having a health facility is one thing and using it is another thing,’’ he says.
Under the project, more than 20 studies have been conducted in the Lake Zone in trying to establish the burden and addressing key maternal health challenges.
“We are also working hand in hand with the government to improve the health infrastructure established by the government, especially in maternal health units,’’ says Dr Matovelo.
Misungwi and Kwimba, two of the eight rural districts of Mwanza Region, form part of the Lake Zone, which is considered to have amongst the worst indicators in maternal and newborn child health (MNCH) in the country.
The Zone has been identified by the Big Results Now (BRN) development policy as a priority for Maternal and Child Health interventions.
The Mwanza project being run by Dr Matovelo and co. is part of the wider strategy in curbing maternal deaths in the Lake Zone.
It is expected to provide direct training and mentorship of health staff. In ensuring that they reach the households, a network of Community Health Workers (CHWs) is expected to be developed.
The Health Ministry’s permanent Secretary, Dr Ulisubisya further told The Citizen that the Lake Zone was experiencing the highest maternal mortality rate because of its high population and geographical challenges.
“All stakeholders and the government have earmarked the zone for interventions and it’s highlighted in the 2016-2020 National Road Map Strategic Plan to improve reproductive, maternal, newborn, child and adolescent health,’’ said Dr Ulisubisya during an interview in Dar es Salaam. “The government and stakeholders have mobilised resources to supply ambulances, which will certainly reduce deaths that occur because of pregnant women failing to arrive in time for emergency obstetric care,’’ says Dr Ulisubisya.
According to the 2016-2020 Road Map Strategic Plan, the socioeconomic and geographic discrepancies in emergency life support services in the Lake Zone are impeding efforts towards achieving maternal health goals.
The aim is to reduce maternal mortality to 292 per 100,000 live births and neonatal mortality rate from 21 to 16 per 1,000 live births, and the under-five mortality from 54 to 40 per 1,000 live births.
By the end of 2015, Tanzania was expected to have cut down the maternal mortality ratio to 198 per 100,000 live births down from 410 in 2013, but the country’s target nose-dived, raising questions among stakeholders over what were the hindrances.
Dr Ulisubisya admits: “We really understand that deaths of women continue to occur in that zone despite all the interventions, but it’s always never too late to devise innovative ways of dealing with the problem,’’ he said.