Saving Women's Lives:
The Skilled Care Initiative in Tanzania
In Tanzania, the Skilled Care Initiative was implemented in Igunga District, located in Tabora Region in central-western Tanzania. Recent WHO estimates suggest that approximately 21,000 women die each year in Tanzania from pregnancy-related causes, and maternal mortality constitutes a major health problem in this part of Tanzania, where only slightly more than a third of women deliver with a skilled attendant.
FCI, in partnership with the Ministry of Health (MOH), worked to improve the availability and quality of maternity care through health systems interventions. These interventions included upgrading the health infrastructure, equipment and supplies; improving clinical and interpersonal skills; strengthening the communication and the referral systems and strengthening health management systems.
To encourage women and their families to plan for delivery and seek skilled care, and to educate them about dangerous obstetric complications, FCI and the MOH worked with local health workers to conduct meetings in every village, engaging community members in a dialogue. Skilled care messages were also spread through performing arts events, including a mamanju song and dance performance—a three-day festival that drew over 10,000 people. In addition, khangas (traditional cloths worn by women and used to carry their babies) with printed skilled care messages were given as a promotional gift to women who delivered at local health facilities.
Overall, evaluation results showed that there were improvements in the capacity to provide all elements of maternal health care. The largest improvements were in the capacity to provide normal and complicated delivery care, and the most noticeable changes were at dispensaries and health centers, which handle the largest proportion of deliveries in Igunga and were the primary focus of the intervention.
There were significant improvements in the content of women’s antenatal visits, as well as use of antenatal care during pregnancy, including an increase in the number of visits by pregnant women. On average, women were coming in at earlier stages of gestation for their first visit as well.
There was an increase in the proportion of women who delivered at a health facility. The majority of the increased delivery caseload was handled by health centers.
At the final evaluation, women who experienced complications were significantly more likely to go to a facility to get treatment than they were at the baseline evaluation.
In addition to evaluating the effectiveness of the intervention package on both the availability and utilization of skilled maternity care, FCI and Abt Associates completed a costing analysis to determine the cost of the interventions, including health systems components and community-focused components.
The analysis found that the most cost-intensive elements of the intervention package were activities aimed at strengthening provider skills and competencies and strengthening the communication and referral system (e.g. purchasing an ambulance and communication equipment).
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