“If my mother, gave birth to me through an emergency C-section at Mawenzi Hospital, Northern Tanzania, why can’t we give every mother who may need that service now, half a century later?” asks Rose Mlay, trained midwife renowned maternal and newborn survival advocate. She is also the National Coordinator for the White Ribbon Alliance for Safe Motherhood in Tanzania (WRATZ).She passionately talks about a case from an area she recently visited in Tanzania where emergency help for women in labouris (virtually) non-existent:“A health worker at Wampembe in Rukwa told me ‘What can we do when a woman is dying? There is no operating theatre, no laboratory or blood bank, no running water, no 24 hours communication, the radio call is not on during weekends, and there is no mobile phone network. ’”The nearest hospital to Wampembe is six-hours away through a rough road which means a heavily haemorrhaging woman may not reach help on time. According to the World Health Organisation (WHO) Postpartum Haemorrhage (PPH) is the leading cause of maternal mortality in low-income countries and the primary cause of nearly one quarter of all maternal deaths globally.I was listening to Rose speak at a meeting with over 60 representatives of national parliaments, civil society, ministries of health, media and development agencies from Kenya, Liberia, Sierra Leone, Tanzania, and Uganda this week in Nairobi. At this workshop we were shown how to engage with health budgets and undertake budget advocacy for improved women’s and children’s health.Rose’s question is partly answered by the fact that the health sector has not been able to keep up with the population increase over the years - despite a few success stories here and there - as found by evidence expert Dr. Moke Magoma in his assessment of Demographic and Health Surveys from 1985-2010.The Nairobi workshop came at an ideal time for Rose and me. We were both involved in the planning process for budget advocacy campaign titled ‘Wajibika Mama Aishi,’ or ‘Be Accountable so Mama Can Live’ only last month. Our first activity took place on August 12 when we met the Parliamentary Committee for Safe Motherhood in Dar es Salaam.The campaign is asking for a specific budget line with enough funds to facilitate access to Comprehensive Emergency Obstetric and Newborn Care (CEmONC) services in Tanzania, so that the process of establishing CEmONC at health centres can start in 2014.A CEmONC centre must have both the manpower and the infrastructure required to care for the mother and her baby round the clock. Ideally the centre should have a fully functional maternity block, including a labour ward, operation theatre, blood bank/storage unit to so that a mothers in need can deliver through c-section and receive blood transfusions.Rose presented the WRATZ campaign at the workshop and lots of people spoke up and made positive and constructive comments.While as a country we have strategies/plans such as the The National Roadmap Strategic Plan (One Plan), Human Resources for Health (HRH), Health Sector Strategic Plan (HSSP3) and the Primary Health Development Programme, the situation is still dire in relation to meeting the Millennium Development Challenge Goals 4 and 5, especially number 5 which aims to maternal mortality rates by 75% by 2015.Rose and the WRATZ call for everyone to act through this country-wide campaign. As much as Wajibika Mama Aishi focuses on Rukwa, the call is to all Tanzanians in their respective communities to call on to the government to honour its promises to save mothers and babies. The evidence to support our campaign has already been collected, and includes:on an average day, 24 women and 144 newborn babies die in Tanzaniaskilled birth attendance is a proven way to reduce pregnancy-related deaths. Skilled birth attendant is someone trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period. In Tanzania, this is only available at health facilitiesOnly 51% of Tanzanian pregnant women give birth at health facilities. Rukwa is the region with lowest access to skilled birth attendance ,with only 29.3% giving birth at health facilities75% of maternal deaths are due to direct causes including severe bleeding, obstructive labor, eclampsia, infection and abortion. All these can be managed and treated in a facility where CEmONC services are offered.In Rukwa, the average distance from a health center to a regional hospital which offers CEmONC is 94.5kmThe Government’s commitment is for 50% of all health centres to provide CEmONC, BUT there is no budget line for CEmONC in the Comprehensive District Health PlansAll the ten Government health centres in Rukwa Region do not offer CEmONC although one - Kirando - can perform caesarean section with difficulty as it has no reliable electricity, no oxygen machine or resuscitation kitsWhite Ribbon Alliance Tanzania is therefore campaigning for a budget line for CEmONC at health centres so that we can follow whether the money is going where it needs to go.The workshop confirmed that we were on the right track in the planning and timing the campaign, but also highlighted areas for improvement so that we can make the most impact. For example, sitting next to the Assistant Director of Policy at the Ministry of Health and Social Welfare enlightened us as to the importance of identifying all necessary items needed – skilled workers, equipment and medicines - cost them and ask for their total budget as a CEmONC budget line.Other participants from Tanzania also played a key role in enriching the focus of the campaign, while pledging their support for the campaign. Tanzanian delegates included Hon. Dr. Fausitine Ndugulile (MP) and a member of the Parliamentary Group for Safe Motherhood, Dr. Ahmad Makuwani from the Ministry of Health, Rose Mlay, White Ribbon Alliance Coordinator, and Kenneth Simbaya, President of the Union of Tanzania Press Clubs.My colleague Craig Ferla and myself attended from Mama Ye. We are a member of WRA, along with over 100 others working on maternal, newborn and child health sector in Tanzania. Together we will ensure Wajibika Mama Aishi campaign involves not just politicians, but also communities throughout the country to add their voices. We will politely, but firmly, request the Members of Parliament to approve the Budget of the Ministry of Health and Social Welfare ONLY IF it includes a specific budget-line for CEmONCs. We look forward to watching our efforts stimulate Government to move ever closer to honouring its promises:a dispensary in every villageand a health centre in every ward50% of health centres providing CEmONC services The workshop breathed new energy into the campaign, but initiated a complementary budget advocacy programme that will include even more stakeholders, to be rolled out from September 2013, supported by the WHO through the Partnership for Maternal, Newborn and Child Health.
“If my mother, gave birth to me through an emergency C-section at Mawenzi Hospital, Northern Tanzania, why can’t we give every mother who may need that service now, half a century later?” asks Rose Mlay, trained midwife renowned maternal and newborn survival advocate. She is also the National Coordinator for the White Ribbon Alliance for Safe Motherhood in Tanzania (WRATZ).She passionately talks about a case from an area she recently visited in Tanzania where emergency help for women in labouris (virtually) non-existent:“A health worker at Wampembe in Rukwa told me ‘What can we do when a woman is dying? There is no operating theatre, no laboratory or blood bank, no running water, no 24 hours communication, the radio call is not on during weekends, and there is no mobile phone network. ’”The nearest hospital to Wampembe is six-hours away through a rough road which means a heavily haemorrhaging woman may not reach help on time. According to the World Health Organisation (WHO) Postpartum Haemorrhage (PPH) is the leading cause of maternal mortality in low-income countries and the primary cause of nearly one quarter of all maternal deaths globally.I was listening to Rose speak at a meeting with over 60 representatives of national parliaments, civil society, ministries of health, media and development agencies from Kenya, Liberia, Sierra Leone, Tanzania, and Uganda this week in Nairobi. At this workshop we were shown how to engage with health budgets and undertake budget advocacy for improved women’s and children’s health.Rose’s question is partly answered by the fact that the health sector has not been able to keep up with the population increase over the years - despite a few success stories here and there - as found by evidence expert Dr. Moke Magoma in his assessment of Demographic and Health Surveys from 1985-2010.The Nairobi workshop came at an ideal time for Rose and me. We were both involved in the planning process for budget advocacy campaign titled ‘Wajibika Mama Aishi,’ or ‘Be Accountable so Mama Can Live’ only last month. Our first activity took place on August 12 when we met the Parliamentary Committee for Safe Motherhood in Dar es Salaam.The campaign is asking for a specific budget line with enough funds to facilitate access to Comprehensive Emergency Obstetric and Newborn Care (CEmONC) services in Tanzania, so that the process of establishing CEmONC at health centres can start in 2014.A CEmONC centre must have both the manpower and the infrastructure required to care for the mother and her baby round the clock. Ideally the centre should have a fully functional maternity block, including a labour ward, operation theatre, blood bank/storage unit to so that a mothers in need can deliver through c-section and receive blood transfusions.Rose presented the WRATZ campaign at the workshop and lots of people spoke up and made positive and constructive comments.While as a country we have strategies/plans such as the The National Roadmap Strategic Plan (One Plan), Human Resources for Health (HRH), Health Sector Strategic Plan (HSSP3) and the Primary Health Development Programme, the situation is still dire in relation to meeting the Millennium Development Challenge Goals 4 and 5, especially number 5 which aims to maternal mortality rates by 75% by 2015.Rose and the WRATZ call for everyone to act through this country-wide campaign. As much as Wajibika Mama Aishi focuses on Rukwa, the call is to all Tanzanians in their respective communities to call on to the government to honour its promises to save mothers and babies. The evidence to support our campaign has already been collected, and includes:
- on an average day, 24 women and 144 newborn babies die in Tanzania
- skilled birth attendance is a proven way to reduce pregnancy-related deaths. Skilled birth attendant is someone trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period. In Tanzania, this is only available at health facilities
- Only 51% of Tanzanian pregnant women give birth at health facilities. Rukwa is the region with lowest access to skilled birth attendance ,with only 29.3% giving birth at health facilities
- 75% of maternal deaths are due to direct causes including severe bleeding, obstructive labor, eclampsia, infection and abortion. All these can be managed and treated in a facility where CEmONC services are offered.
- In Rukwa, the average distance from a health center to a regional hospital which offers CEmONC is 94.5km
- The Government’s commitment is for 50% of all health centres to provide CEmONC, BUT there is no budget line for CEmONC in the Comprehensive District Health Plans
- All the ten Government health centres in Rukwa Region do not offer CEmONC although one - Kirando - can perform caesarean section with difficulty as it has no reliable electricity, no oxygen machine or resuscitation kits
- a dispensary in every village
- and a health centre in every ward
- 50% of health centres providing CEmONC services