Neonatal deaths contribute to 47% of the infant mortality rate, driven most significantly by low birth weight babies, defined as weighing less than 2,500 grams at the time of birth – which represent 13% of all Tanzanian newborns. Low birth weight babies face significant risks to survival during the neonatal and infancy periods, such as: breathing and feeding difficulties, infections and temperature moderation. These risks are not being adequately addressed by current neonatal care resources and practices in Tanzania – compounding the issue and contributing to Tanzania’s neonatal, infant and under-five mortality rates. Save the Children’s work in health primarily targets children under the age of five and their mothers, including adolescent mothers. Maternal and newborn children’s health (MNCH) is a key component of our programmatic work and forms part of the EVERYONE campaign.
Kangaroo Mother Care
Funded by USAID through Jhpiego, the Maisha (Mothers and Infants Safe, Healthy and Alive) project aims to influence policy and change for newborn health at the national level while strengthening health care provision for newborns at the regional level. Save the Children has taken the national lead role in establishing and monitoring the delivery of the Kangaroo Mother Care (KMC) standard of care for low birth weight babies. KMC is a simple, low-cost, yet highly effective standard of care where mothers (or other caregivers where necessary) serve as a human incubator for their newborn, providing warmth through continuous skin-to-skin contact on the chest, breast feeding and immediate child bonding. Together with Tanzania Ministry of Health and Social Welfare, Save the Children has established 27 sites across Tanzania training 973 healthcare workers and orienting a further 939 health facility managers. Beyond skills transfer, Save the Children has committed complementary resources to strengthen health delivery systems, equipping sites with: KMC manuals, beds and bedding, room heaters, digital weigh scales, neonatal resuscitation equipment and feeding tubes.
Through practicing facility-based KMC between October 2009 to December 2013, 6,416 newborns were discharged at a healthy weight to continue with home based KMC practices until they graduated from KMC on reaching a weight of 2.5 kg.
Integrated Management of Childhood Illness (IMCI)
Lindi region is one of Tanzania’s poorest areas (poverty rate 40.6%) with one of the highest under-five mortality rates in the country, at 117.9 per 1,000 live births against the national average of 81/1000 live births (TDHS 2010).
The corporate Reckitt and Benckiser (RB) investment in maternal, newborn and child health (MNCH) has contributed to a 17% reduction in child mortality and a 9% reduction in maternal mortality in Lindi Rural, Kilwa and Ruangwa districts in Lindi Region.Conducted over four and a half years (2009-2013) the project has reached 794,200 people, including 287,000 children under the age of five.We have achieved sustainable changesby enabling:
- 16% increase in the coverage of childhood immunization.
- 12% increase in the number of pregnant women delivering at health facilities and 8% increase in postnatal care coverage.
- Increased the availability of skilled providers by training 292 health professionals: improved case management and quality of care with 70% of health professionals demonstrating correct treatment as per the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) protocol, resulting in accurate diagnosis and treatment of childhood illnesses.
- Improved community satisfaction of services: 38 out of 52 (73%) respondents (mothers/caregivers) expressed satisfaction of either one or more of the services provided by the trained health workers.
- Improved family and community practices through support of 1,000 Community
- Owned Resource Persons (CORPs) who were trained to raise the awareness of communities, hence increase the utilisation of maternal, newborn and child health (MNCH) services.
- Increased political commitment through increased budgetary allocation for MNCH services, with an increase of 34.4% for Lindi Rural and 3% for Ruangwa.
RB’s support has strengthened the linkage and work at the community and facility level of the health system, in order to generate demand at the community level while ensuring supply through training health professionals and provision of commodities, to respond to this demand effectively and efficiently.
Other Maternal and Newborn Health (MNH) projects
The social accountability project funded by Transparency and Accountability was implemented in two districts of Lindi region, Kilwa and Ruangwa - each with five wards. In each of these wards, community members were selected, trained and empowered to design a Community Score Card (CSC) system to monitor the quality of health services related to maternal, newborn and child health, and provide input into the health sector budget in the two districts. The aim of this work was to increase the government’s health sector budget allocations, improve delivery of health care, and ensure government transparency and accountability. It also created opportunities for citizens – especially women, children and young people – to participate in and offer feedback on the quality, adequacy, accessibility and efficiency of key health services, and to build capacity within communities to participate in local governance.
The work on CSC was closely linked to a Breakthrough Investment project which ensured that the local communities and various groups including children in the target areas in Lindi and Shinyanga are pro-actively engaged in our work, are made aware of their health rights and entitlements, and provided an opportunity to actively participate in assessing their health needs and developing solutions, including their own actions to ensure adequate child and maternal survival. The activities comprised a set of trainings and meetings on advocacy, budget tracking and participatory budgeting, child participation and a human rights’ perspective in relation to health, aimed at enabling the communities to influence district authorities in setting MNCH priorities in district health budgets, while monitoring their performance in implementation of the One Plan (National Road Map). Breakthrough Funds were linked to the ongoing health, HIV/AIDS and nutrition programmes in Lindi and Shinyanga, presenting a model of good practice to be utilised by similar projects and programmes in other districts, regions, and potentially other countries in the wider Eastern Africa region.
The Breakthrough Investment Fund activities, being implemented in 2 districts of Lindi Region - Lindi Rural and Ruangwa, will support around 14,000 children and 32,000 women in 100 villages. The project will influence practices in 77 health facilities (2 hospitals, 9 health centres and 66 dispensaries) and support training of 88 health workers. The overall strategy of this project comprises health systems strengthening and community mobilisation and empowerment.
The project will contribute to sustained improvements in maternal and newborn survival in Ruangwa and Lindi rural districts through four main interventions, namely:
- Improving equitable access to essential maternal and newborn health and nutrition interventions;
- Improving the quality of maternal and newborn care services;
- Increasing demand for and uptake of essential services and key family practices for maternal and newborn health and nutrition including empowering communities to progressively realize their rights for accessible and quality maternal and newborn care and to hold providers accountable.
- Enhancing the policy environment - specifically policies around financial and human resources allocation - for improved maternal and newborn survival.