This South-South study visit with His Excellency Jakaya Mrisho Kikwete, the 4th President of Tanzania and Maternal & Newborn Health Advocate has allowed countries with similar challenges and low resource settings to share innovative approaches to maternal health solutions and learn from each other.
While Tanzania made significant gains and achieved its targets for child survival (MDG 4) during H.E. Kikwete’s Presidency, maternal and newborn health outcomes were lagging behind. On retiring from Presidency, Dr. Jakaya Kikwete established a Foundation and announced his ongoing commitment, “It is unfinished business. Pregnancy is not a disease, a woman should not die simply for giving a life to another being. It should be a cause for celebration not grief. In Tanzania, maternal and newborn survival is off track.”
Looking for successful interventions in low resource settings to bring back to Tanzania and the continent of Africa at large, President Kikwete learned about an initiative in India that was increasing the number of pregnant women giving birth in health facilities, increasing staff moral and applying simple solutions to achieve quality healthcare services. All of which are matters of concern back home in Tanzania that are resulting in high maternal and newborn mortalities.
The introduction of a simple check list in Rajasthan’s health facilities has succeeded in empowering health workers, creating an enabling environment for them to perform their duties; it has also prioritized and standardized approaches for life-saving practices at the point of use. Perhaps equally impressive was the government’s commitment in providing a financial incentive that each pregnant woman received when delivering their newborn in the health facility under the eye of a qualified birth attendant.
We visited peri urban centres, villages and schools where community outreach workers monitor pregnant women and their children. An ASHA that stands for ‘Accredited Social Health Activist’ has received training at the community level to share information and encourage pregnant women to seek regular hospital check ups and plan to give birth in a health facility under the supervision of qualified nurse-midwife.
Rajasthan has demonstrated a pragmatic approach to solving what was an overwhelming challenge from within rather than aspiring to western solutions that are not always appropriate or achievable. The staff have figured out a way of stripping the problem down and piecing it back together bit by bit to build an infrastructure that ensures quality of care for the pregnant woman. There was a strong interplay between the government and health partners. They have a collective goal with clearly defined roles and responsibilities.
Rebecca Young stated, “The takeaway if you will, from our study visit was that all the interventions we witnessed were simple, were locally owned and financially sustainable. While there are not enough midwives, Rajasthan has demonstrated how they have compensated for this staffing gap by ensuring that the healthcare workers that are in the health facilities are equipped to fullfil the continuum of care a pregnant woman needs and empower more agents of change and community workers to disseminate life saving messages at the household level. These simple solutions are driving down deaths and improving the quality and service a pregnant women can expect in government hospitals. Poorly equipped staff are a thing of the past here in Rajasthan as are maternal deaths in the health facilities.
Our thanks extend to The Children’s Investment Fund Foundation, The Minister of Women and Child Development, Maneka Ghandi, The Hon’ble Minister of Health in the Government of Rajasthan, Shree Kali Charan Saraf, Country Director for Jhipego and every single health practitioner who is putting a stop to unnecessary maternal and newborn deaths.