The need for maternal care, particularly in the rural areas of Tanzania, is desperate the completion of the maternity ward at Kwiro will address many of the problems associated with the very high maternal death rate.
Women in this area face a three-to-six-hour car ride if the transport is available and the roads are passable to obtain competent medical care at a facility able to provide the emergency care needed in the event of complications during the pregnancy or during the birthing process.
Approximately 300,000 maternal deaths occurred globally in 2015. Ninety-nine percent of those deaths occurred in low- and middle-income countries, with sub-Saharan Africa accounting for 66%, indicating that severe global socioeconomic disparities are a significant driver of maternal mortality.
The causes of most maternal deaths are rarely documented in low-income countries. However, available epidemiological studies indicate direct causes (e.g., haemorrhage, hypertension, sepsis, and abortion) account for 73% of cases, while indirect causes (e.g., HIV/AIDS) account for the remaining 27%. Socioeconomic and health system-related factors can exacerbate these causes, contributing to further increased risk of maternal death or disability. Such factors can include the young age of the mother, home birth, unmet need for family planning, absence of a skilled birth attendant, and long travel time to health facilities.
Life-saving maternal health interventions historically strengthen health systems as a whole by addressing the continuum of care and covering various aspects of health service delivery. Given that the greatest proportion of maternal lives stand to be saved by providing care during labour and around childbirth [UNICEF & WHO, 2014], it is especially crucial to prioritize interventions that can reduce delays in reaching and receiving quality care for immediate impact.
According to the World Health Organization (WHO), Tanzania ranks among the 30 countries with the highest maternal mortality ratios (MMR) worldwide, with an estimated 8,200 maternal deaths in 2015 [Trends in Maternal Mortality, 2015]. The country’s progress toward achieving the Millennium Development Goals (MDGs) related to reproductive and maternal health was slower than planned during the period from 2000 to 2015. The maternal mortality ratio significantly missed the MDG target of 193 deaths per 100,000 live births, with a reduction to 398 estimated by 2015.
Unfortunately, statistics reported by the Government of Tanzania indicate a regression: according to the National Demographic and Health Survey released in early 2017, maternal mortality increased from 454 in 2010 to 556 in 2015.
Given this reality, the Tanzanian government and international donors have redoubled their commitment to mothers during the Sustainable Development Goals (SDGs) era. Moving forward, Tanzania’s aim is to reduce the maternal mortality ratio to 292 deaths per 100,000 live births by 2020, and to 140 by 2030 (the SDG target).
It has been recognized that there are three major delay factors that contribute to this high rate.
DELAY 1—Recognition and decision to seek care.
• Educate communities on pregnancy, childbirth and newborn care (i.e., awareness campaigns, community health workers)
• Facilitate income generation schemes to empower women to make decisions about their reproductive health
• Strengthen links between the traditional and formal health sector.
DELAY 2— Transport to care
• Improve access to health services in rural and remote areas
• Build maternity waiting homes next to health facilities for expectant mothers to reside before their due date
• Encourage individual and community-based saving schemes to cover the cost of transport
• Provide transportation support in cases of emergency using alternative forms of transport (i.e., motorcycle ambulances for mountainous terrain, ambulance taxis)
DELAY 3—Receiving quality care
• Train healthcare workers in quality care, especially those in rural areas
• Equip health facilities with required equipment and supplies
• Provide training in maternity care to all healthcare workers
Provision’s approach to addressing Tanzania’s healthcare crisis is coupled with a philosophy that international development should not foster dependency, but rather work to effect long-lasting, positive change. Rather than the traditional approach, a transformational approach is maintained to ensure the longevity of our impact, which will endure as we transition improved infrastructure and programs to our local partners. As such, long-term sustainability, including a focus on solutions that enable the full transition of ownership to the Government of Tanzania with the limited financial burden.
By working with local government and health representatives the transition of operations to the Government authorities has been addressed from the start of the project and the local authorities are fully supportive of this project.
The details of the project are:
The maternity ward is located in southern Tanzania at Kwiro and is located on the site of the local Catholic Church and schools. There is presently a dental clinic and a dispensary also at this location.
The plan is to complete the maternity ward and then upgrade the dispensary to a health centre which would mean that the government would supply operating supplies and the required doctors and nurses for the complete facility
The health system in Tanzania is based on a three-tier system, hospital, health centre, and dispensary is the most basic so an upgrade to a health centre would provide significant advantages
The actual maternity ward is very close to completion. The laundry and related outbuildings are yet to be finished.
The need at this point is to obtain the financial support to purchase the necessary equipment, operating room equipment, beds and all related supplies. There will also be the need to purchase ancillary equipment such as a standby generator etc. There will also be the need to provide additional water delivery and storage capacity to the maternity ward. (Provision has already upgraded the water distribution system at Kwiro so there is adequate water supply available year-round).
The upgrade to the dental clinic and the dispensary will also require funding for equipment etc.
The costs of the upgrade to obtain Health Centre status are being calculated.