GUEST COLUMNIST: A Successful Model for Maternal Health Care Delivery

Bringing new life into the world should not carry the risk of death. Yet, in Tanzania, a woman dies from complications of pregnancy and childbirth almost every hour. For every woman that dies, another 20 suffer an injury, illness or disability, often with life-long consequences.

The death or illness of a mother immediately threatens the health and survival of her newborn and her other children, causing a cascade of heartbreak for entire families. The good news is that we know how to prevent the vast majority of maternal deaths if pregnant women access high-quality obstetric care, including timely emergency care for potentially life-threatening complications.

Yet, as recently as fifteen years ago, pregnant women in Tanzania were not accessing such care. The situation in Kigoma was particularly troubling: according to the 2004/2005 Demographic Health Survey, only 39 per cent of births occurred at a health facility. Delivering in a health facility under the care of a skilled health professional is critical to ensuring good outcomes for both mother and baby, and ideally this figure should approach 100 per cent. Moreover, approximately 15 per cent of pregnant women will have a potentially life-threatening complication and because we can’t always predict who, it’s essential that all births are attended by a skilled health professional who can recognise and manage complications. In Kigoma, one number that suggested that many complications were going untreated was the low caesarean section rate of 1.5 per cent, well below the recommended minimum of 5 per cent. When asked why women weren’t accessing care around the time of delivery, lack of money, distance to a health facility, and the need to take transport were the most frequently cited reasons.

Bold policy decisions

To address these barriers and make high-quality obstetric care available to all women, the government of Tanzania made some bold policy decisions that would bring care closer to where women lived. The government was an early adopter of what’s known as “task-sharing,” which allows non-physician clinicians to provide certain types of care when there aren’t adequate numbers of physicians available. In addition, the Government established a plan to upgrade and equip community-level health centers, which were within reasonable reach of most women, so that these facilities were capable of treating obstetric complications.

Dual innovations

These dual innovations presented an important opportunity to test a new way of delivering health services in remote communities and, if it worked, to serve as a model for other places facing similar challenges. It was this opportunity that brought Bloomberg Philanthropies to Tanzania in 2006, where we have partnered with the Tanzanian government, local implementing partners Thamini Uhai and EngenderHealth, and other funders like Fondation H&B Agerup, to pilot a maternal and reproductive health programin Kigoma. When we began, Kigoma had among the poorest maternal health indicators in the country. Almost thirteen years later, we are proud to say that Kigoma now has among the best indicators, and the program we all built together was an extraordinary success.

One hundred health facilities, including hospitals, health centers, and dispensaries, were upgraded with new equipment, medicines, and supplies. Many of these facilities also received physical enhancements like the construction of new operating theatres, maternity wards, and examination rooms. In addition, hundreds of non-physician health care workers were trained to provide safe delivery care, emergency obstetric services like c-sections, anesthesia, and family planning services.

Independent evaluations conducted by the US Centers for Disease Control and Prevention reveal that across Kigoma Region the percentage of women delivering in a health facility with a skilled provider increased to 85 per cent in 2018 and the percentage of women who received a life-saving c-section increased to 4.5 per cent over the same period. Moreover, since we know that the best way to prevent a maternal death is to prevent an unintended pregnancy, the programme facilitated access to contraceptives for over 380,000 people, allowingthem to plan when to have children. All of this contributed to the prevention of nearly 2,200 maternal deaths in Kigoma.

This programme serves as an example for other health and development projects, where international donors can support the implementation of government’s priorities by pilot testing innovations that governments with limited resources may understandably be reluctant to do. If such pilot programs succeed, then governments will be much more likely to continue and scale them with their own resources. This has been our experience in Tanzania, and over the last two years we have been transitioning the project activities back to the Tanzanian government for long-term, locally-led oversight and financial support.

Additional budget

The government has already demonstrated their intention to sustain the programme by deploying an additional 369 health providers to Kigoma and by allocating additional budget for local councils to fund more essential maternal and reproductive health services. Still, additional efforts, such as increased and sustained funding and increased human resource allocation, is essential to ensure that life-saving services continue in the supported facilities and expand to other regions.

As international donors, our financial support for this programme is phasing out, but this cannot be the end of the story.

Together, we built a model proven to prevent maternal deaths, and we hope that other international donors and governments will glean lessons from this experience. Because, when women thrive, communities and whole nations thrive.

Dr Neena Prasad works with the Bloomberg Philantropies Public Health Team