Note: World Lung Foundation united with The Union North America. From January 2016, the combined organization is known as “Vital Strategies.”
(Dar es Salaam, Tanzania and New York, USA) – The Government of Kigoma and World Lung Foundation (WLF) today reported promising initial results of Thamini Uhai (Value Life), a radio and community outreach campaign launched in October, aimed at increasing the number of women delivering their babies in health facilities. Delivering at a health facility is the best way of ensuring the health of mothers and babies. This is true not only for women with high-risk pregnancies but for all women, because unanticipated complications can occur at any stage during the delivery process. Fewer than 50% of women in Kigoma deliver their baby in a health facility and this low utilization of health facilities is an underlying reason for the high number of maternal deaths in Kigoma, higher even than Tanzania’s maternal mortality ratio of 410 per 100,000 live births.
The Thamini Uhai campaign has been credited with helping to increase the number of deliveries at health facilities in the Kigoma region. In addition, the risk of complications is being reduced because women are coming early to health facilities. One month after the launch of the campaign, reports from WLF-supported facilities in Kigoma indicate that there is a slight overall increase in the number of deliveries in Kigoma (approximately 1%). By contrast, the number of deliveries utilizing health centers increased by 21%, while hospital deliveries decreased by 11%. The number of maternal deaths fell from six to one, while stillbirths nearly halved from 12 to seven.
Nguruka Health Centre, located 50 kilometers from its new District offices of Uvinza, reported 180 deliveries in October compared with 137 deliveries in September 2014; four of these deliveries were Caesarean Section. Dr Chamgeni, who is in charge of the facility, believes that the figures show that women are coming early to the health facilities and therefore are reducing the chance of complications. Other facilities seeing an increase in deliveries are Ujiji, which reported 172 deliveries in October compared with 150 in September and Kakonko Health Centre, which reported 173 deliveries in October compared with 132 deliveries in September.
The main factor in this increase in deliveries is believed to be better awareness. Women and couples have reported hearing about the campaign through various channels, particularly via health education provided by Community Health Workers, radio spots, posters and billboards. Women and couples who have been exposed to the campaign report that they have gained new knowledge and are more likely to plan to go early to their local health facility. One couple based in a village called Muhama Kalonga, 15km from the Nguruka Health Centre, said: “We received information from the health facility and so we are preparing the mother to go to to Nguruka to wait for her labor.”
People have reported seeing Thamini Uhai in a wide variety of places in Kigoma via channels including posters, stickers and billboards. For example, a motorbike with a Thamini Uhai Sticker was seen at Ilagala Ward near Buhingu; a remote town that typically is reached only by boat.
“We are very pleased to have worked closely with the Kigoma regional authority and our partners to launch the Thamini Uhai campaign. One of the best ways to save a mother from needlessly dying in childbirth is to make sure she plans for the birth, and this plan includes planning to deliver in a health facility such as those in the Kigoma region that have been upgraded by WLF and that are staffed with experienced health workers,” said Dr. Nguke, Director of the WLF Maternal Health Project Tanzania. “We know that many women in Kigoma attend ante-natal care appointments but that far fewer go to health facilities to give birth and it is our hope that this campaign, combined with community mobilization efforts on the ground, is helping to close this gap.”
The Thamini Uhai campaign
The Thamini Uhai campaign is designed to address the socio-cultural and attitudinal factors that lead to low health facility utilization. These include misconceptions about the safety of delivering at home, lack of planning to address the long distances and transportation issues that many women face in reaching health facilities, and, in some instances, concerns about poor capacity and care at health facilities. The campaign is intended to reduce deaths due to complications during childbirth by:
– Increasing the likelihood that women will form an intention to deliver at a health facility;
– Increasing the likelihood that women will make a birth plan with their partners and families, including planning for costs, transport and supplies; and
– Increasing the likelihood that women will seek skilled care immediately in response to pregnancy danger signs.
The campaign was pre-tested among its target audience of women and men in the Kigoma region to confirm the effectiveness of the campaign’s messages. The campaign highlights three main messages across five radio spots: one message is focused on the need for birth planning; another on the importance of delivering in a health facility; and the third on the warning signs of complications during pregnancy. Pre-testing found that the most effective radio ads increased risk perception, generated conversation, and modeled positive male behavior, among other variables. The Thamini Uhai campaign also includes wall paintings, posters, and an extensive effort to engage community leaders as message ambassadors.
WLF’s Maternal Health Program
The Thamini Uhai campaign is part of WLF’s Maternal Health Program, which seeks to address several major challenges impeding efforts to reduce maternal mortality in Tanzania. These challenges are exacerbated in the rural region of Kigoma, where there is a higher incidence of staff shortages (Assistant Medical Officers, skilled nurses), inadequate resources, and women coming late to the facilities that are available. Kigoma has been a major focus of WLF’s Maternal Health Program’s efforts for the past five years and a priority for support from Bloomberg Philanthropies.
WLF has supported the upgrade and building of 15 health facilities in the Kigoma, Morogoro and Pwani regions and has trained 106 Non-Physician Clinicians, nurse-midwives and clinical officers in Comprehensive Emergency Obstetric and Newborn Care (CEmONC) and anesthesia across Tanzania. Working across five districts in Kigoma, WLF has helped to upgrade nine facilities, including six health centers, to become CEmONC service delivery facilities. These facilities include health centers in Ujiji, Nguruka, Kakonko, Mabamba, Nyenge, Buhingu and three hospitals: Maweni, Kibondo and Kasulu.
The campaign is made possible by support from The Swedish International Development Cooperation Foundation (SIDA), with programmatic support for the Maternal Health Project in Tanzania from Bloomberg Philanthropies and the H & B Agerup Foundation, the project’s principal donors.