Building an Enhanced Cadre of Community Health Workers to Improve Maternal and Newborn Health in Rural Tanzania (IMCHA)
Programs and partnerships
Lead institution(s)
Summary
One woman dies in childbirth in Tanzania every hour.Read more
One woman dies in childbirth in Tanzania every hour. With such high rates of maternal and newborn mortality, this project will address the problem by giving community health workers greater skills to assess and treat women, while extending the healthcare system's reach to rural women and newborns.
Rural obstacles to better health
In the Mara region of Tanzania, nearly 60% of births occur outside of health facilities. A high proportion of these births result in poor outcomes for the mother, newborn, or both. Reducing maternal and newborn deaths in Tanzania involves overcoming barriers to accessing rural healthcare facilities and improving access to quality community health care. These barriers include:
-lack of qualified human resources
-long distances to health facilities
-high cost and poor availability of transportation
-lack of knowledge of the risks related to non-facility births
-cultural beliefs about avoiding professional care
Extending health care's reach
The project team will train community healthcare workers to improve how they assess and treat women and infants, and extend health care to rural areas. They will evaluate interventions to improve antenatal care and delivery, such as prenatal vitamins and travel vouchers to get women to health facilities for screening of hypertensive disorders, HIV, and other conditions. Community health workers will use mobile phones to improve routine processes such as birth registration and monitoring stocks and workflows.
The research team will generate evidence on sustainable interventions for delivering community-based primary health care in Tanzania that improves access to antenatal care and skilled delivery. They will focus on ways to enhance the knowledge and role of community health workers and to increase their use of mobile health (mhealth).
The project will help guide policymakers at all levels of government to explore scaling up interventions that can improve outcomes for mothers and newborns.
Project partners
This project is part of the Innovating for Maternal and Child Health in Africa program. The program is a seven-year $36 million initiative funded by Foreign Affairs, Trade and Development Canada (DFATD), Canada's International Development Research Centre (IDRC), and the Canadian Institutes of Health Research (CIHR).
Research outputs
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The poster depicts the “Each Woman” project which serves to enhance the role of community health workers (CHWs) in Tanzania. CHWs can provide multiple interventions towards better maternal health, as well as promoting improved access to health care facilities. Because there are severe limitations in access to family planning services especially in rural Tanzania, a second project, “Contraception and Provider Support” (CAPS) promotes research that will improve access to family planning methods in order to reduce unwanted pregnancies and unsafe abortions.
This pilot study trained reproductive health care nurses to be more sensitive to women’s needs based on the “Health Workers for Change” curriculum. Health care provider attitudes are a key issue to address in order to improve access to care. In consultations, women described health care providers using “bad language,” while male partners sometimes resorted to offering bribes to ensure better care for their partners. Health care providers participating in the workshops had several suggestions for improving women’s experiences. They emphasized continuation of health education, the importance of family planning, and safe deliveries as key to improving maternal care.
Multiple intervention strategies help women access maternity care services in rural locations and need to be designed within the local context. The interventions in this study comprised workshops with nurses to encourage respectful care of women, and transportation subsidies in order for women to reach health facilities. Community health workers (CHW) were trained to educate couples about safe birthing options using m-health applications, to collaborate with nurses to distribute clean birth kits with misoprostol (for postpartum haemorrhage prevention) and to hold village meetings to shift community norms. This article reports on the experiences of women, community health workers and nurses during the study.
Key to maintaining community health are relationships between community health workers with local families. This is particularly true for reproductive health care services such as family planning and antenatal care. The paper emphasizes community care strengthening during the COVID-19 pandemic, when women are less likely to leave their communities for health care. As well, it advocates for increased support for health workers at this time - both through phone supervision and through provision of clean supplies which they can distribute to pregnant women, including misoprostol tablets to help prevent postpartum hemorrhage and sepsis.
The pilot study established feasibility of distributing oral medications (such as misoprostol in pill form) to women in rural Tanzania to self-administer after delivery. Two of the largest causes of maternal mortality are bleeding and infection. Of the 642 women provided with medications, 90% took them appropriately, while the remaining 10% did not require them. Mara Region has one of the highest non-facility birth rates in Tanzania, with more than 60% of women delivering in their villages. Hundreds of thousands of women could be saved through access to this inexpensive medication. In Tanzania the maternal mortality ratio is 454 per 100,000 (2011).
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