“…can you imagine that for a whole year I haven't had a single maternal death!" That’s what one health worker has to say about the change since working with TAMANI—fewer complications and fewer deaths.
Another worker describes the difference like this: "[people] have confidence in me, they believe in the education I provide, they don't doubt me. So even today if I say that I am calling for a meeting, a lot of people will be coming, and I'm so proud of that."
It’s not just health workers who notice the difference. A teenage girl says, “[Health workers] are good indeed, they educate nicely and in case you haven’t understood something you can tell them and they will explain again. They are charming." A boy says, “When you see a nurse on the street you just feel you want to greet her/him just because s/he is the person who you live well with"
That trust and confidence makes all the difference. It helps women and children survive childbirth. It helps teenagers access health care. And it’s helping push for gender equality. "In the past we were not sharing. When a man says that a woman has no voice, she wouldn’t speak, but right now I am grateful that we are sharing."
The Tabora Maternal and Newborn Health Initiative (TAMANI) ran from 2017-2021 with $5.6 million in funding from Global Affairs Canada. The project reached 300,000 people directly (99% women) and 3.6 million people indirectly (78% women).
TAMANI worked closely with Ifakara Health Institute (IHI), a leading health research organization in Tanzania, and the White Ribbon Alliance of Tanzania (WRATZ). Other partners included the Canadian Society for International Health (CSIH), McGill University, the Society for Obstetricians and Gynecologists of Canada (SOGC), and the Association of Obstetricians and Gynecologists of Tanzania (AGOTA).
What changed?
- More women and children survived. The National Newborn Mortality Ratio dropped 9 percentage points, and maternal mortality dropped 6 percentage points.
- Women got better health care. Women were 21% more likely to get at least four pre-natal consultations, up to 68%. They also got health care earlier. Women were 50% more likely to be getting health care in their first trimester at the end of the project. There was a 12 percentage point increase in the number of women who gave birth with a Skilled Birth Attendant.
- Women were “completely confident.” The number of women who felt completely confident that they could make health care decisions and visit a health facility alone went from 35% to 58%.
- Men are more likely to support women’s rights and access to health care. Men who agree that women have a right to seek health care rose from 34% to 46%. "There is cooperation and communication, the mothers are happy. They have told TAMANI that this issue has really helped us, we can sit and talk and our husbands will understand us.”
- Women got more choices during childbirth. Women were more than twice as likely to be able to chose their preferred birthing position after the project, and 44% more likely to have a choice about who accompanied them during labor. The number of women who rep reported not being treated with respect, or coerced into something they did not want to do during labor decreased by almost 50% between the beginning and the end of the project, from 13% at baseline to 7% at endline.
- There is better follow up for pregnant women. The number of women who had someone check up on their status before they left the hospital went up 68%. "In the past, mothers were not staying long. If you give birth at 9 o'clock you are given permission to return almost immediately, but now someone can stay until tomorrow at 9 o'clock before being discharged."
- Women feel more confident and satisfied with the quality of care. The number of women who felt sure health workers would keep information confidential jumped from 58% to 80%. 77% of women and girls were satisfied with the health facilities and emergency transportation—up from 53%.
- Family planning more than doubled, and quadrupled for adolescent girls. Over the life of the project, the number of family planning visits is 2 times the number of visits reported in December 2017 for women over the age of 25, 3 times the number of visits for women between the ages of 20-24, and almost 4 times for adolescents between 15-19.
How did it happen?
- Work with government services. TAMANI was implemented in close collaboration with the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), The Prime Minister's Office for Regional and Local Governance (PO-RALG), and Regional Health Management Teams (RHMT).
- Help health workers build skills. The project trained 997 community health workers (including 538 women), 160 formal health workers (105 women), and 76 (38 girls) youth trainers. Anacret Sindabha, a health worker said “...The mentoring visits have changed my practices generally because I was not technical and skillful enough to deal with emergency obstetrics as well as neonatal resuscitation before and I can confidently say we have no maternal deaths or neonate deaths that have happened since we got knowledge from your mentoring visit.”
- Build confidence for workers. The project included mentoring visits for health workers, which helped them trust their skills. “...the partnership helped me build some confidence... what I am doing is probably right, is acceptable internationally... in terms of improvement... because if you are psychologically satisfied that what you are doing is right... and somebody from another country can vouch for that, then you feel so.”
- Focus on gender norms. Using Social Analysis and Action, the project tackled issues like sharing the workload at home, and women’s rights to make decisions about their own bodies. As one woman says, “We have changed at home. For example when I went for a test I went with my husband to the clinic, and when we were given that education my husband left there, understanding. So I found that I’m no longer doing most of the works. I remain with household chores and he helps me to fetch water, so those are the activities I do now.”
- Improve infrastructure: “After the meetings, there have been better attitudes towards patients and infrastructure improvement. Now we have six-hole toilets, we have an ambulance, we have an increased number of service providers and there is enough space between the kitchen and the bathroom.”
Want to learn more? Check out the evaluation.