Every two minutes a woman dies due to complications from pregnancy and childbirth - more than 300,000 a year. 99% of these deaths occur in low-resource, rural settings, and nearly all of them could have been prevented if the necessary medical care were available.
Vital Strategies brings life-saving emergency obstetric care to underserved rural locations through task-sharing. An almost decade-long program has proven this model works, decreasing maternal deaths by half while increasing by 50% the number of women who used supported maternal health facilities.
Vital Strategies believes that comprehensive emergency obstetric and neonatal care (CEmONC), which includes Caesarian Section surgery and blood transfusions, can and must be available locally to all delivering women. This can only be achieved in countries experiencing acute doctor shortages by task-sharing with non-doctor health providers, who can be specially trained in CEmONC. Then, once CEmONC capacity becomes consistently available, far fewer women will die in childbirth, far more women will choose to deliver their children in health facilities, and the health facilities will become more trusted hubs for healthcare service delivery in general.
To implement our vision, Vital Strategies recognizes that our most important partner is the government of the country where we work, both at the national and at the local levels. We secure government engagement and commitment in advance and then work with them every step of the way to build and sustain CEmONC capacity. We work in government operated health facilities and train providers selected by the government for the task-sharing roles. Our integrated model has proven that CEmONC service delivery at the local level through task-sharing can decrease the proportion of women dying in childbirth by half, while at the same time increasing the number of women delivering in our supported facilities by 50% or more.
Our approach incorporates four central elements:
Task-sharing to fill the provider gap: Vital Strategies trains mid-level healthcare workers in CEmONC to ensure women delivering even in the most remote regions have access to this and other lifesaving procedures. Once the province of only doctors, evidence has shown that using intensive training to allow “task-sharing” of some critical procedures – including C-Section – to non-doctors is safe and effective.
Supportive supervision and mentoring: Building skills and capacity depends on ongoing support and management across facilities, connecting the newly trained providers with doctors who can mentor them as they put their skills into practice. In addition to frequent on-site supervision, we provide opportunities for continuing medical education, a 24-7 emergency call system manned by obstetricians if a provider needs extra support, remote e-learning courses, weekly clinical conference calls and periodic clinical audits. All of this supervision and mentoring creates a sense of a supportive, reliable community that helps the providers hone their skills, feel connected, and develop confidence.
Integration with host government systems: Vital Strategies partners with the health system of the host country and engages local commitment and support before implementation. We seek to build capacity and train officials such that we will be able to hand over management of the capacity in its entirety once the CEmONC system has taken root. Local officials select all of the providers who are trained by the program, and they participate actively in on-site supervision visits throughout the life of the project. In this way, they are fully aware of the project’s accomplishments and trained in how to supervise and maintain the capacity once donor funding ends.
Driving demand for facility delivery: Using strategic communication including mass media such as radio ads, community-level media and social media, we target expecting women and families to encourage use of a facility for birth. We use innovative messaging – with strategies drawn from successful campaigns in other health areas – that raise risk perceptions of home delivery and encourage expectant mothers and their families to make a plan for how to reach a clinic for delivery.
Vital Strategies has been running a demonstration program in Tanzania for 9 years. The program operates in 3 remote regions of Tanzania and has proven that our approach can work.
babies have been born in facilities upgraded by our program.
50% decline in the proportion of maternal deaths
52% increase in the number of women using supported facilities overall
45 Assistant Medical Officers trained to do CEmONC
65 nurse-midwives and clinical officers to provide anesthesia
Over 100,000 deliveries assisted
Over 10,000 C-Sections performed
1464 Vacuum Extractions performed
When a woman experiences a childbirth complication, timely treatment is critical.
In Kigoma, Tanzania, bad roads, limited transport, long distances to health facilities and transport costs put mothers and their babies at unnecessary risk when childbirth complications occur. Since 2008, Vital Strategies has improved the availability of quality emergency obstetric care in rural health centers through our Thamini Uhai program, with great success. Unfortunately, some women still don’t reach care in time.
A doctor meets with a mother and her newborn baby at Kibondo Hospital, in Tanzania.
In 2015, after meetings with communities, health providers and district officials, we worked together to create guidelines to strengthen the referral system in Kigoma. By mid-2016, 11 villages had partnered with health facilities and project staff to build local systems to get women with obstetric complications to care quickly.
The system is based on three pillars: preparedness, communication and transport. Community health workers were trained to mobilize the community, and met with thousands of women and families through group meetings, home visits, and during antenatal care. Health providers at the lowest level facilities, dispensaries, were trained in basic emergency obstetric care to better identify and manage complications, and the Thamini Uhai expert clinical team followed up with support visits.
A mother holds her newborn baby at Kakonko Health Center.
The project provided mobile phones to community leaders, transporters and to the dispensaries to ensure free communication among themselves and with the Nguruka Health Center. Wireless landline phones were installed in the labor wards at Nguruka Health Center and at Maweni Regional Hospital in Kigoma town. By October 2016, nearly 400 calls had been made on the system – 250 from CHWs to health facilities, alerting them about obstetric emergencies.
Cost of transportation remains a major barrier to timely obstetric care. In 2016, Thamini Uhai staff worked with the district social welfare officer and community leaders to help each village set establish and manage emergency fund schemes. By October, emergency fund accounts had between 45,000 and 118,500 TZS, allowing families to rapidly access money for transportation. To improve transportation, the health center’s ambulance was repaired, and the District Council agreed to provide funds for fuel and maintenance. Since the ambulance serves a large area and may not always be available, community leaders met with local drivers and negotiated standard prices for transport to facilities, and now each village has a list of at least five private drivers that can provide transportation at an agreed-upon price.
Though still in its early stages, the referral system is already making a tremendous impact. And we hope that our community-based approach to referral can become a model for other parts of Tanzania and the world, to help save mothers and babies from preventable deaths.
A nurse at Kakonko Health Center