Mara determines to take the lead in saving mothers and babies lives

“MARA” – “IMARA”!!  The rallying call of Mara’s Regional Commissioner was heartily responded to by the excited crowd of Musoma Town residents who had gathered in large numbers to participate in the entertaining official launch of Mara’s regional strategy for maternal and newborn survival. Translated loosely as ‘a Resolute Mara’, it is a fitting identity for Mara region, whose leadership and wider community have demonstrated their resolve over the past few weeks in taking action for the survival of Mara’s mothers and babies.Just last month, Mara achieved unprecedented levels of voluntary blood donation to mark the national celebrations of World Blood Donor Day held in Musoma. During four weeks of community mobilisation and mobile bleeding teams traversing across all Mara’s districts, an incredible 5,700 units of blood were collected! As well as meeting blood demand across the six regions of the Lake Zone in June, some of these blood supplies were also transported to Tanzania’s Western Zone. Mara’s residents had taken impressive action, motivated by the messaging of community mobilisers to give the ‘gift of life’, especially to increase the survival of mothers and children.Now in early July, Mara was officially launching its 3-Yr regional strategy for maternal and newborn survival from 2013-16. Significantly, there is an enormous level of buy-in, ownership and ‘Mara resolve’ of the strategy demonstrated across the regional and district leaderships. This determination to save the lives of mothers and babies is palpable.Already we know that Tanzania is unlikely to achieve its targets for MDGs. Our goal is to reduce our maternal mortality ratio to 193 deaths for every 100,000 live births by 2015, but the latest figure is 454. The 2013 State of the World’s Mothers Report recently set out that two-thirds of all babies’ deaths globally occur in ten countries, Tanzania being one of them. We will have to wait until next year for disaggregated estimates of maternal mortality at regional and district levels in Tanzania, drawn from an analysis of data gathered during the 2012 population census.However, while currently there is no robust data on maternal and newborn mortality in Mara region, an analysis of key indicators of maternal and newborn health from the TDHS 2010 reveals the risks faced by Mara’s mothers and babies during pregnancy and childbirth:

•   Mara is one of the regions in Tanzania where mothers are least likely to be informed of pregnancy complications during ante-natal care;
•   Mara is among the three worse performing regions for skilled birth attendance during delivery, with only one in three births taking place in a health facility;
•   Nearly one in eight of these deliveries takes place with the mother alone and absolutely no-one attendant, neither traditional birth attendants, nor even relatives or friends;
•   Mara is the least performing region in Tanzania in proportion of births delivered by operation (0.6%), which means beyond any doubt that mothers and babies are dying during childbirth due to lack of access to emergency care at the time they develop complications;
•   One in ten babies are born critically underweight (<2.5kg), and yet the majority (81%) of Mara’s mothers and babies receive no care in the critical period after birth;
•   Additionally, Mara region has the lowest contraceptive prevalence rate on mainland Tanzania, with only one in ten women of reproductive age in Mara using any modern method of contraception.

It is against this alarming reality facing Mara’s mothers and babies that the region’s leadership and health stakeholders have rallied together determined to take action. While the regional strategy itself reflects the priorities and activities of many similar safe motherhood strategies, there are two particular aspects that set it up with the best start for its implementation:

1. Firstly, the process behind developing the strategy that has generated a deep sense of ownership and responsibility across the respective regional and district leaderships and health management teams. An independent reproductive health expert reviewed the previous regional strategy, and her findings were coupled with additional analyses of key datasets to set the evidence foundation for the strategy. The health management teams at regional level and across the six district councils then came together at a technical meeting to draft the regional strategy. The regional commissioner then chaired a leadership meeting bringing together the regional administration and district leaderships to discuss in depth and contribute to the finalisation of their draft strategy. Culminating in the regional commissioner then officially launching the regional strategy.
2. Secondly, the priority and emphasis that has been placed on supervision and follow-up. The regional administration has committed to 6-monthly reviews during which district commissioners will present progress reports of implementation in their districts. A similar process will be conducted across the regional and district health management teams. Particular importance has been attached to effective implementation of maternal death reviews. Celebrating success, and holding to account anything less, has become a regional mantra for saving mothers and babies’ lives.

 It is only right to also recognise at this stage the contribution in particular of two of Mara’s leaders. Dr. Samson Winani, the Mara Regional Medical Officer, has demonstrated remarkable commitment and leadership throughout the rigorous process to develop the regional strategy, and is clearly dedicated to its successful implementation, seeing this as a fitting legacy when he retires shortly after the end of this strategy. Similarly, Hon. Mr. John Gabriel Tuppa, the Mara Regional Commissioner, has been unequivocal in his support of the whole process, role-modelling and instilling the responsibility and accountability across the regional and district leadership to prioritising maternal and newborn survival in Mara. His articulate and passionate free-flowing speech during the official launch of the strategy further demonstrated his keen understanding and commitment to making a difference for Mara’s mothers and babies.Such leadership, coupled with the engaged administrations and health management teams across the region, and crucially evidence that the wider community can respond resolutely, bodes particularly well for the successful implementation of the strategy. Mara deserves credit for the steps taken so far. However, the real work of saving mothers and babies lives starts now, and all eyes will be on the spirit of ‘Mara Imara’ in taking a lead and ensuring that our mothers and babies survive during the most incredible stage of bringing new life.