JHPIEGO in partnership with Save the Children, Constella Futures, The Academy for Educational Development, The American College of Nurse-Midwives and Interchurch Medical Assistance

Increasing access to quality focused ANC: Tanzania experience 2000/07

FLEMAFA Conference, Kisarawe

Gaudiosa Tibaijuka Senior Midwifery Advisor

31 Aug 2007

Objectives of FLEMAFA Conference

Raise awareness regarding issues contributing to Maternal and Newborn morbidity and mortality.

Share efforts underway to improve maternal-newborn-child health in Tanzania and Kisarawe in particular

Hear from selected RCH partners in Tanzania (WRA, ACCESS/JHPIEGO)

Identify ways to improve efforts done by MOHSW and other reproductive and child health partners

Generate and share plan of action demonstrating the commitment of all participants to continue engagement within the local community and among individuals and organizations participating in the conference) in Kisarawe District

Objectives of Focused ANC presentation

Share ACCESS/JHPIEGO experience in providing technical

assistance to the MOHSW in the implementation of Focused ANC

National Programme including malaria and syphilis in pregnancy

through:

Introducing ACCESS Programme

Describing the rationale for focused ANC

Listing Partners and collaborators in Focused ANC

Listing strategies used in implementing strategies used in implementing FANC programme irogramme in Tanzania

Share program achievements and results

Discuss challenges and opportunities

“I’m going to fetch a baby. It’s a dangerous journey and I may not return.”

~ Traditional African saying

This conference is the beginning of a journey … for us and for her representing women in Kisarawe!!

Are we committed to making her journey/ their journey safe?

Introduction

ACCESS is a five-year global program in its third year of implementation aimed at reducing maternal and newborn deaths and improving the health of mothers and newborns

JHPIEGO in partnership with Save the Children, Constella Futures, The Academy for Educational Development, The American College of Nurse Midwives and Interchurch Medical Assistance.

Focused Antenatal Care

An approach to ANC that emphasizes Evidence-based Goal-directed actions Individualized woman-centered

care Quality versus quantity of visits Care by a skilled provider

Goal of Focused Antenatal Care

To promote maternal and newborn health

and survival through Early detection and provision of treatment for existing

diseases

Promotion and maintenance of the physical, mental and social health of mother and baby through enhanced interpersonal skills on nutrition, PMTCT etc.

Development of individual birth plans and complication readiness plans.

Early detection and management of complications during pregnancy, labour, delivery and post partum through identification of danger signs

Partners

Ministry of Health and Social Welfare at all

levels

National- RCHS, NMCP, NACP, HSIU and HRDD

Zonal- ZRCH teams, ZTCs

Regional- RHM teams

District- DHM teams and others

Other Collaborating Organizations: White Ribbon Alliance IMA CSSC and other Tanzanian FBOs JSI/DELIVER

Routine practices proved not to be significant

Numerous visits

- Burdens women and health care system

- Reduced number does not seem to affect pregnancy outcomes (WHO multi-center study, Villar et al 2001 )

Some measurements and examinations

Care based on risk assessment

Risk Approach

Not an effective ANC strategy because

Complications cannot be predicted hence, all pregnant women are at risk for developing complications

Many “low risk” women develop complications Do not know how to recognize/respond to

problems Have false sense of security

Most “high risk” women give birth without complications Inefficient use of scarce resources

FANC Best practices

• Focused antenatal visits by skilled provider• Detection and management of coexisting

conditions and complications • Birth preparedness and complication readiness

planning• Family planning, breastfeeding, danger signs,

HIV/STIs, and nutrition counseling• Tetanus toxoid• Iron and folate• Mebendazole -Helminth presumptive treatment• SP for IPT of Malaria

IPT GOAL

Presidential Malaria Initiative goal 85% IPTp uptake by 2009

MOHSW targets 60% by 2007

ACCESS is collaborating with other partners

in reaching the PMI targets for IPT coverage in

Tanzania

Birth Preparedness, and Complication Readiness

Preparing for Normal Birth Identifying a skilled attendant and place of

delivery Arranging finance, essential items Nutrition

Readiness for Complications Early detection –danger signs Designated decision maker(s) Emergency funds, communication Transport, blood donors

Tanzania Focused ANC Program Strategies and approaches

ACCESS uses Focused Antenatal Care as a platform for increasing

access to quality maternal and newborn services through:

Influencing policy change, development of guidelines and standards for Focused ANC, Malaria & Syphilis during pregnancy and Infection Prevention

Advocacy and joint planning- working with policy makers at all levels; national, regional, district and facility advocacy meetings

Partnership and collaboration with stakeholders

Tanzania Focused ANC Program Strategies and approaches cont…

Incorporating into pre service midwifery education: Curriculum and learning package development

In-service and pre-service training in public and private (Faith Based Organizations) sectors

Introducing Standards based management approach for Performance Quality Improvement (PQI)

Collaborate with community organisations mainly through White Ribbon Alliance

Program strategies and approaches cont…

Comprehensive coverage with FANC/MIP/SIP

Regional advocacy meetings

Regional TOTs for District trainers including RCH clinic in charges, RCH coordinators

District based clinical training for ANC service providers

ANC & PSE Quality improvement processes

Follow-up of trained facilities and schools using QI tools to monitor service trend

Program achievements

Policy change for Focused ANC; Malaria Intermittent Preventive Treatment, syphilis screening and treatment, infection prevention standard precaution practices

Infection prevention national guidelines, training of national core team

Job aids on FANC, Malaria and syphilis during pregnancy

Provision of integrated ANC services- PMTCT, MIP, SIP, nutrition, STIs, FP etc

RCH trainers, supervisors (zonal, regional and district RCHCos) and providers trained on Focused ANC clinical and teaching skills

Program achievements : training

Focused ANC introduced in Nursing Midwifery Certificate and Diploma national curricula

All 55 Nursing and Midwifery Schools in Tanzania updated in focused ANC clinical and teaching skills- (110 tutors and 110 preceptors)

All 22 cert schools and half of the remaining schools are equipped with training equipment, reference books and anatomical pelvic models

System for rolling out Focused ANC nationwide established

Standards-based management process for performance and quality improvement introduced to 15 regions.

Standards Based Management: A Performance and quality Improvement Model

Desired performance

Actual performance

Gap Cause analysis

Intervention identification & implementation

Indicator for success of program

Intermittent preventive treatment for malaria increased from 0% to 18.4%

50% of Tanzania households own a mosquito net

14% of families own Insecticide Treated Nets

47.1% gave birth at health facility

80% received TT at least once

61.1% received iron supplementation

94.3% received ANC from a health professional at least once.

Source: TDHS 2004/05

Challenges and Opportunities

Limited numbers of skilled providers Shortages especially of Sulfadoxine

Pyrimethamine, RPR kits Poor data management; recording, processing

and use Quality antenatal care platform suited to

introduction of other services e.g. PMTCT of HIV, Intermittent Preventive Treatment of malaria among infants

National system for expanding quality ANC in place

Thank you for active Thank you for active listening!listening!