RT Journal Article
SR Electronic
T1 Improving Maternal and Reproductive Health in Kigoma, Tanzania: A 13-Year Initiative
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2100484
DO 10.9745/GHSP-D-21-00484
VO 10
IS 2
A1 Prasad, Neena
A1 Mwakatundu, Nguke
A1 Dominico, Sunday
A1 Masako, Prudence
A1 Mongo, Wilfred
A1 Mwanshemele, Yisambi
A1 Maro, Godson
A1 Subi, Leonard
A1 Chaote, Paul
A1 Rusibamayila, Neema
A1 Ruiz, Alicia
A1 Schmidt, Karen
A1 Kasanga, Mkambu Godfrey
A1 Lobis, Samantha
A1 Serbanescu, Florina
YR 2022
UL http://www.ghspjournal.org/content/10/2/e2100484.abstract
AB Key FindingsThe Program in Kigoma demonstrated that decentralizing high-quality maternal and reproductive health services to lower-level facilities in remote, low-resource settings is both feasible and effective.Between 2013 and 2018, Kigoma achieved significant reductions in maternal and perinatal mortality and increases in contraceptive prevalence by improving the availability of and access to obstetric and family planning services.Key ImplicationsProgram implementing partners who are familiar with the local community and health care system can help foster an environment of collaboration, knowledge sharing, and coordination among stakeholders at all levels.Donors should consider providing flexible support that responds in real time to the needs identified through monitoring and evaluation data to achieve meaningful progress toward reducing maternal mortality.The Program's foundation for successful sustainability included: implementation by Tanzanian teams, as opposed to teams from the Global North, embedding all interventions within existing government health system structures to foster strengthening from within, and working in partnership with all levels of government and in service of government plans and priorities.The Program to Reduce Maternal Deaths in Tanzania was a 13-year (2006–2019) effort in the Kigoma region that evolved over 3 phases to improve and sustain the availability of, access to, and demand for high-quality maternal and reproductive health care services. The Program intended to bring high-quality care closer to more communities. Cutting across the Program was the routine collection of monitoring and evaluation data. The Program achieved significant reductions in maternal and perinatal mortality, a significant increase in the modern contraceptive prevalence rate, and a significant decline in the unmet need for contraception. By 2017, it was apparent that the Program was on track to meet or surpass many of the targets established by the Government of Tanzania. Over the following 2-plus years, efforts to sustain Program interventions intensified. In April 2019, the Program fully transitioned to Government of Tanzania oversight. Four key lessons were learned during implementation that are relevant to governments, donors, and implementing organizations working to reduce maternal mortality: (1) multistakeholder partnerships are critical; (2) demand creation for services, while critical, must rest on a foundation of well-functioning and high-quality clinical services; (3) it is imperative to not only collect robust monitoring and evaluation data, but to be responsive in real time to what the data reveal; and, (4) it is necessary to develop a deliberate sustainability strategy from the start. The Program in Kigoma demonstrates that decentralizing high-quality maternal and reproductive health services in remote, low-resource settings is both feasible and effective and should be considered in places with similar contexts. By embedding the Program in the existing health system, and through efforts to build local capacity, the improvements seen in Kigoma are likely to be sustained. Follow-up evaluations are planned, providing an opportunity to more directly assess sustainability.