1. Improving Access to Health Services and Quality of Care for Mothers and Children in Tanzania (IMCHA.)

Recent studies in Tanzania have shown that when healthcare systems are addressed (including barriers to health services and improving the quality of care), maternal and newborn deaths can be substantially reduced.

The Government of Tanzania has placed a high priority on this issue. Healthcare service coverage has increased in recent years, but there are still significant geographic, financial, and socio-cultural barriers to services being accessed.

This project consists of select interventions targeting users and providers of healthcare in four districts in Tanzania's Iringa Region. Researchers are looking at how poverty, gender relations, and living in rural areas act as barriers to accessing quality care. The project's interventions are addressing delays caused by:

• Decisions to seek care
• Transportation needs
• Availability of adequate and timely care at the facility

The project team is evaluating the impacts and conduct a cost analysis of the interventions. It is further working on interventions that will increase the demand and use of maternal and newborn health services at the community level.

PROJECT LEADERS
Stephen Maluka
Khadija Begum

INSTITUTIONS
University of Dar es Salaam. Institute of Development Studies
HealthBridge Foundation of Canada

INSTITUTIONS WEBSITES
http://www.ids.udsm.ac.tz
http://www.healthbridge.ca

TOTAL FUNDING
CA$ 995,940

2. Replicating the MamaToto Program in Rural Tanzania

The rural regions of Geita and Mwanza have some of the worst maternal and child health indicators in Tanzania. Local health facilities are under-resourced and possess limited management capacity. While the national policy calls for a community health worker program, the reality is that there are gaps in coordinating and implementing community health services at local levels.
Community health workers have limited training and supervision. The Government of Tanzania's new commitment to improving mothers and children's well-being needs evidence that will support the creation of stronger health systems through community-based interventions.

This project is addressing high maternal and newborn mortality in Tanzania by adapting and implementing an intervention approach that follows the MamaToto (mother-baby) process in Geita and Mwanza regions. It is drawing on the low-cost MamaToto (mother-baby) process implemented in Uganda, where substantial gains in maternal and child health were achieved. These gains took place through an approach that strengthened services at health facilities and within communities.

This project is implementing and evaluating a modified version of MamaToto in rural Tanzania, aligned with the country's current policy guidance for community health services. The project team is engaging district leaders, strengthening facility services, and developing the role of community health workers. Based on these interventions, the project team will develop an implementation package that includes lessons learned, tools, and other materials to allow for scale up.
The researchers intend to demonstrate if and how community-based interventions can reduce maternal and child mortality by effectively bringing low-cost program efforts to scale under government leadership.

PROJECT LEADERS
Dismas Matovelo
Jenn Brenner

INSTITUTIONS
Catholic University of Health and Allied Sciences
The Governors of the University of Calgary

INSTITUTIONS WEBSITES
http://www.bugando.ac.tz
http://www.ucalgary.ca

TOTAL FUNDING
CA$ 987,800

3. Quality Improvement for Maternal and Newborn Health in Mtwara Region, Tanzania (IMCHA)

Maternal and newborn health outcomes in southern Tanzania's Mtwara region are poor despite 70% of births occurring at health facilities. Recent research in the region found that maternal and newborn mortality rates were similar when comparing home births with health facility births. This suggests a clear need for improved quality of skilled care in health facilities.

Another issue is poor health-seeking behaviors among women. Combined with weaknesses in the health system, these factors limit the use of high quality interventions that have been proven to reduce maternal and neonatal morbidity and mortality.

The Ifakara Health Institute, Tanzania's Ministry of Health, and Canada's SickKids Centre for Global Health are testing and applying quality improvement strategies for mothers and newborns across six districts in southern Tanzania. This project is exploring if these strategies can be scaled up and integrated into district-level health systems. It will also examine whether these strategies for higher quality maternal and newborn health care services, better care-seeking, and improved health outcomes can be sustained at the regional level.

This project aims to provide evidence on how systems-wide quality improvements can enhance maternal and newborn health outcomes at the district, health facility, and community levels in Tanzania.

PROJECT LEADERS
Fatuma Manzi
Zulfiqar Bhutta

INSTITUTIONS
The Registered Trustees of Ifakara Health Institute
Hospital for Sick Children

INSTITUTIONS WEBSITES
http://www.ihi.or.tz
http://www.sickkids.ca

4. Building an Enhanced Cadre of Community Health Workers to Improve Maternal and Newborn Health in Rural Tanzania (IMCHA)

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.

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 healthcare. 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

The project team is training community healthcare workers to improve how they assess and treat women and infants, and extend healthcare to rural areas. They are evaluating 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 aims to generate evidence on sustainable interventions for delivering community-based primary health care in Tanzania that improves access to antenatal care and skilled delivery. 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 LEADERS
Bwire Chirangi
Gail Webber

INSTITUTIONS
Shirati KMT Council Designated Hospital
Bruyere Research Institute/Institute de Recherche Bruyere

INSTITUTION WEBSITE
http://www.bruyere.org/en/vision-and-mission

TOTAL FUNDING
CA$ 944,450

5. Accessing Safe Deliveries in Tanzania (IMCHA)

Tanzania has placed a priority on improving access to obstetrical and neonatal care in health facilities. This is currently a major barrier to reducing deaths. Few healthcare workers are trained to offer emergency obstetrical care, so timely access to safe delivery services is a challenge. There is also insufficient support and mentorship from senior staff, lack of motivation to participate in training courses, and limited equipment to support obstetrical interventions.

To reduce some of these gaps, associate clinicians, midwives, and nurses need training and skills upgrading. This will help meet the demand for life-saving emergency obstetrical procedures for mothers and their newborns. This promising training approach is often referred to as task shifting and forms part of Tanzania’s Ministry of Health's comprehensive emergency obstetric and newborn care strategy.

This project is ranking barriers and highlighting factors that support a national scale-up process. With better access to skilled care and emergency services, the project aims to improve maternal and newborn health outcomes throughout Tanzania. The project team is also identifying and improving activities that increase community members' access to comprehensive care.

This project aims to address Tanzania's critical need for reducing maternal and newborn deaths by building on the country's comprehensive emergency obstetric and newborn care strategy by implementing proven intervention strategies: training on emergency obstetrical care and post-training mentorship and support.

PROJECT LEADERS
Angelo Nyamtema
John C. LeBlanc

INSTITUTIONS
Tanzania Training Centre for International Health
Dalhousie University

INSTITUTIONS WEBSITES
http://www.healthtrainingifakara.org
http://www.dal.caort.

6. An mHealth strategy to reduce eclampsia and maternal and infant death in Tanzania

This project aims to address Tanzania's critical need for reducing maternal and newborn deaths. It will build on the country's comprehensive emergency obstetrical and newborn care strategy by implementing proven intervention strategies: training on emergency obstetrical care and post-training mentorship and support.

In Tanzania, the maternal mortality rate of 578 deaths per 100,000 live births means that every hour, a woman dies in childbirth. Many of these deaths are avoidable if symptoms such as high blood pressure, known as eclampsia, and associated challenges arising during pregnancy, are recognized and treated. This requires trained birth attendants and appropriate equipment for early and accurate detection.

This project is testing interventions that improve monitoring of pregnant women for pre-eclampsia and eclampsia - conditions that, if left untreated, can result in maternal and neonatal deaths. With the support of an existing mobile phone-based system, this project is providing education and practical skills to health workers for improved detection and management of these conditions. Mobile phones and other tools are being used to capture and use real-time data related to maternal and child health.

The evidence generated from this project will provide a scientific basis for integrating a targeted mobile health (mHealth) strategy to improve education, detection and management of eclampsia and pre-eclampsia. Findings from the study are also expected to support sustainable strategies to scale up the intervention from the eight districts included in the study.

PROJECT LEADERS
Godfrey Mbaruku
Karen Yeates
Jessica Sleeth

INSTITUTIONS
The Registered Trustees of Ifakara Health Institute
Queen's University at Kingston
Pamoja Tunaweza Womens' Centre Company Limited

INSTITUTIONS WEBSITES
http://www.ihi.or.tz
http://www.queensu.ca/ors
http://www.pamojatunaweza.com

TOTAL FUNDING
CA$ 999,350