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March 16, 2015

Community Health Workers in Tanzania: On the Frontlines of Improving Maternal Health (Part I)

People reading brochures after receiving education at Mabamba- Kibondo District.

This series is a first-person anecdotes from Vital Strategies Community Health Workers (CHWs) working on the ground to improve maternal health in Tanzania. Women in Tanzania face a 1 in 38 risk of dying from complications during pregnancy and childbirth; these advocates work every day to improve much-needed maternal care for Tanzanians, disseminating important health information and encouraging expectant mothers to access services at rural health centers.

CHW Name: Dafroza Bernad

Reporting from: Ujiji Health Centre

Challenges you’ve recently faced: I went to visit traditional mid-wife nurses. I found pregnant women there. I noted that they pay the midwife 10,000 in fees for [the birth of] a male child, and 8000 for a female child. I asked the women why they don’t go to the hospital to give birth [instead]. I explained to them the benefits of giving birth in the hospital, rather than in traditional mid-wife homes. I explained to them that in the hospital a pregnant woman would get safe delivery services. There are skilled nurses, [and] appropriate delivery environments with equipment. The woman delivering can be properly handled… if complications arise, like over-bleeding.

Traditional birth attendants don’t always have patients’ health history information like clinics… which record a pregnancy’s health progress. [Midwives] attend pregnancies in labour stages; they have minimum ability to handle birthing complications. Patients [also] don’t know the health [status] of a traditional midwife. It is free of charge to deliver in the hospital.

As I further spoke with that traditional mid-wife, she told me that she is curing diseases and she offers women delivery services at her home. Her home is 3 km from [the] Health Center. Her name is Nyasa; she lives in Kitongoni Village in Ujiji Ward. I found four women in her home: two had already delivered, another two were not yet delivered.

Successes you’ve encountered:
As I talked to pregnant women regarding quality of services in the hospital; they told me that the quality of labour service has improved… they are no longer disturbed by acts of corruption. Nurses are not asking them for bribes. For me, being a community health attendant, I feel good [about] the way I cooperate with my clients, ward attendants and my immediate supervisors. I am still educating clients not to pay for anything in the labor ward. If [they miss] anything [it’s better] they go to buy it outside hospital premises. Whatever they buy in the hospital ward belongs to them; they deserve to be offered services free of charge.

I told ward attendants that my supervisor has instructed me to tell them that no client is supposed to buy any equipment in the ward; if that happen they must be issued with a receipt.

CHW Name: Annamaria Thomas

Reporting from: Mabamba Health Centre

Challenges you’ve recently faced: Every day I visit and talk to pregnant women and to those who have given birth. I manage to do this since I am living near the health center. I found that some women are travelling long distances from Mabamba’s bus stand to the Kumsenga location. They travel by motorcycle and pay an average [fee] of 40,000 to go and return.

I volunteer to give them breakfast and sometimes lunch whenever I am in a position to do so. I give [meals] to those who don’t have relatives in Mabamba to take care of them during the delivery period. Most of [these women] say that radio advertisement campaigns (Thamini Uhai okoa Maisha ya mama Mjamzito na mtoto) have motivated them to come to give birth at the health center.

There are some areas I can’t reach [to advise women] because of distance, since I don’t have reliable transportation; thanks to Radio Kwizera, which covers those areas, many people hear the advertisements [instead].

Successes you’ve encountered:  I met a pregnant woman named Savera Martin who lives in Mabamba. Her home is only half an hour walking distance from [the] health centre. She was seven months pregnant; she told me that [normally] she never goes to the clinic until her pregnancy is eight months or beyond. I found her suffering from fever; I advised her to start attending clinic immediately and explained the benefits to her.

Clinical services will monitor the mother and child’s health progress. They will get timely treatment, diagnosis, medical consultation, and a cure for any diseases that are found. [Ms. Martin] agreed with me and [started] attending the clinic. Her pregnancy is now nine months along; she will deliver anytime!

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