Rose Mlay reflects the challenges still faced by women giving birth in Tanzania – and the inspiring commitment of global colleagues to win justice for women and newborns via accountability.
Recently, a woman told me about her birth. While in labour, she and three others had to share one hospital bed, just in order to have a place to sit down. At one point she went to the bathroom, and when she came back she found that another labouring woman had taken her space on the bed. So she had to go through her labour on the floor, along with several other women.
Currently only 50 per cent of Tanzanian women give birth at health facilities, and yet these are appallingly overcrowded. This gives us a dilemma; we want women to give birth safely in health facilities, but if ALL women started coming to the same facilities, the overcrowding – bad as it is - could be twice as bad.
This is why I believe that our government should focus on ensuring functional health facilities.
This will address the inequality there is in accessing MNH services in urban and rural areas in line with the 2015-2025 Tanzania Global Financing Facility (GFF) Health Strategy. This clearly states that we must have “results based funding with a strong focus (on how) to include the poorest in terms of access to quality health services”. If this focus is sustained, the problem of inequality and injustice in MNCAH services will be reduced or eliminated.
White Ribbon Alliance in Tanzania has recently proved that this is perfectly possible. Our recent campaign revealed at the outset that not one health centre in the rural region of Rukwa provided the comprehensive Emergency Obstetric and Newborn Care (CEmONC) that our government has promised. Yet as a result of our campaign, within three years half of all health centres were providing CEmONC and saving many lives.
However, I recently attended a meeting in Dodoma, Tanzania, with Ministry of Health Leaders, Regional Medical Officers, Regional Reproductive Maternal and Child Health Coordinators, and Civil Society Organizations (CSOs). The thread of the meeting was accountability and how our government must lead this, by being accountable to citizens.
To me accountability at individual levels is key to the bigger picture. Individuals in authority must employ skilled health workers, and must ensure that infrastructure in health facilities is conducive to saving lives. Practising transparency to all - including citizens - on budget planning, allocation of funds, expenditure and performance outcomes, is also part of accountability. Citizens and CSOs should also be accountable, asking questions on plans and allocated funds from the planning stage onwards.
One strand of the Tanzania Maternal Newborn Children and Adolescent Health (RMNCAH) Strategy that evolved during the Dodoma meeting was about ensuring ‘healthy well informed Tanzanians (have) access to quality RMNCAH services which are affordable, equitable and sustainable, so that by 2020 the maternal mortality ratio is reduced from 454/100000 to 292/100000 and newborn deaths from 26/1000 to 16/100000.’ Part of this was to ensure contraception acceptance increases from 36%-60% and youth friendly services from 30%-60%.
However, I was shocked to discover that one of the outcomes of the Big Results Now (a MNCH program intended to show quick results) was to increase the number of trained community health workers (CHC) countrywide. One of their tasks is to inspire women to give birth at health facilities – yet the reality is that our health facilities are currently extremely overcrowded – as the woman who had to labour on the maternity ward floor testified.
To me the best approach would be to first invest in ensuring that half of health centres are upgraded to provide CEmONC – as the government has promised. This is because these are nearer to the majority of poor village women than our hospitals which are in towns. It will only be detrimental if CHWs push women into the facilities which are already overcrowded and functioning with few or no skilled health workers.
After the Dodoma meeting, I participated in the Global Maternal Newborn Health Conference (GMNHC) in Mexico on October 18-21, 2015. This really inspired me. With over a thousand men and women attending from all over the world, I was impressed by the determination to hold each other accountable so together we can end preventable maternal and newborn deaths.
The enthusiasm and compassion of colleagues during panel sessions, in presenting posters, in the opening and closing ceremonies, energised me to never stop what I am doing until all preventable maternal and newborn deaths are no more.
For it’s my conviction that maternal death is not a ‘tragedy’, it is an injustice based on inequality. The solution is to budget according to MNH services gaps, taking maternal death auditing very seriously – involving the family, community, health facility and government – in order to prevent any more deaths.
So let us practice zero tolerance of maternal deaths. Let us be accountable so that mothers and newborns can survive childbirth.
Rose Mlay is National Coordinator, White Ribbon Alliance for Safe Motherhood Tanzania