Summary

Program goals

The aim of the initiative has been to reduce maternal and neonatal mortality by improving women’s access to good-quality emergency obstetric care, particularly in rural and isolated areas. Tanzania has the fifth highest number of maternal deaths in Sub-Saharan Africa and the eighth highest in the world. Although progress has been made in reducing maternal mortality, the country is still not on track to achieve MDG 5 by 2015. The Bloomberg Philanthropies Maternal Health Initiative has shown results in the decline of maternal deaths in areas where they operate and an increase in utilization of delivery care.

Key program components

**Upgrading Infrastructure:** Almost every community in Tanzania has access to a health care center that can provide basic health care services. The program has upgraded these health centers by constructing operating rooms and other critical infrastructure needed for comprehensive emergency obstetric care. **Training healthcare workers:** Most remote communities of Tanzania do not have a medical doctor, and obstetricians are almost non-existent in rural areas. Tanzania was an early adopter of a practical solution known as “task-shifting” which allows non-physician clinicians to provide health care services. Non-physician clinicians are much more likely to work in isolated communities than doctors. Recognizing this, the program trains non-physician clinicians – called Assistant Medical Officers (AMO) – to manage complicated deliveries, including caesarian sections, and nurse midwives to administer anaesthesia. Having successfully accomplished the goals of Phase One, the project has now moved on to Phase Two: eliminating gaps in service delivery. WLF is working with the government to augment the program with additional trained staff, ideally at least two AMOs and two nurse midwives per center. With four WLF-led trainings planned in Kigoma and Morogoro during 2011, at least 50 additional staff will be enabled to carry out emergency deliveries. While the infrastructure-building aspect of the project has come to a close, WLF continues to work with the Tanzanian government at the central, regional and district levels to ensure that supply needs are met. With a newly opened office in Dar es Salaam, WLF is keen to assist the government as it scales-up this model where needed. **Information Communication Technology:** Further ICT activites are being developed to support training, monitoring and communication for maternal health services. Field tests have been conducted in Rufiji and Kilombero districts to establish a network for e-learning and internet-based training. The project’s focus is now on quality improvement of emergency services and facilities as well as on medical education and support supervision for staff, with a focus on staff retention and quality of care. With the help of e-learning tools, the health professionals working in WLF supported health facilities in very remote areas will soon be able to connect with their colleagues as well as with obstetrician/gynecologist specialists around the country for continuing medical training and clinical discussions which will improve service delivery.