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ANC in Tanzania: improvinghigh impact measures to

reduce maternal andnewborn mortality

Scholastica Chibehe

Midwifery AdvisorJhpiego, MAISHA

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Background

Achieving good outcome formother and baby:

Early detection and provision oftreatment for existing diseases

supporting clients in developingindividual birth plan andcomplication readiness

Nutrition support duringpregnancy

Preventive measures includingTT, IPTp, PMTCT, ITN, de-worming,Iron and Folic acid etc.

Importance of ANC:

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3

QoC Study on Maternal and Neonatal Health Services

Multi-country study First study was conducted in 2010

Second study was conducted in 2012

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Study Overview

To capture proportion of womenand newborns receiving keymaternal health services

To assess knowledge on maternityand ANC best practices

(including neonatal resuscitation)

To assess availability of key drugsand supplies for ANC andmaternity services

Objectives:

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Tanzania Overview

Survey conducted in 12 regions, 50 healthfacilities(not nationally representative) 12 regional hospitals , 31 health centers and 7

dispensaries

ANC data collected from 48 health facilities

Training on data collection tools andmethods

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Study design

The study used combination of approaches:

Observation of deliveries and ANCconsultations

Inventory of health facilities where drugsand supplies are stored

Record review of service statistics Knowledge and skills assessment of providers

A simulated resuscitation of newborn using amodel

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Key services in ANCn=385 2010, n=361 2012

93

75

60

46

69

66

82 8276

70

8275

0

10

20

30

40

50

60

70

80

90

100

Hospital HC/Disp Hospital HC/Disp Hospital HC/Disp

BPtaken CunsellingforFP OfferedTT

2010 2012

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Preventative servicesn=385 2010, n=361 2012

41 43

86

54

72

59

73

63

84

7276

67

0

10

20

30

40

50

60

70

80

90

100

Hospital HC/Disp Hospital HC/Disp Hospital HC/Disp

SPforIPT Bloodtestforsyphilis CounselingandtesngforHIV

2010 2012

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Counseling on IPTpn=385 2010, n=361 2012

10 11

38

51

41 41

33 33

77 77 74 74

0

10

20

3040

50

60

70

80

90

Hospital HC/Disp Hospital HC/Disp Hospital HC/Disp

Explainpossiblesideeffects Explainhowtotake Explainthepurposeof

tratment

2010 2012

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Counseling on Fe/Fon=385 2010, n=361 2012

33

22

68

59 5754

18

35

19

63

10

62

0

10

20

30

40

50

60

70

80

Hospital HC/Disp Hospital HC/Disp Hospital HC/Disp

Explainpossiblesideeffects Explainhowtotake Explainthepurposeofthetreatment

2010 2012

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Pre-eclampsia screening

2010 2012 2010 2012

COMPONENTSOF

SCREENINGREGIONAL

HOSPITALS

n=87*REGIONAL

HOSPITALS

n=79*

HEALTH

CENTRES/

DISPENSARIES

n=298

HEALTH

CENTRES/

DISPENSARIES

n=361*% % % %

Askaboutheadache

orblurredvision 33 49 22 49Askaboutswollen

handsorface 25 45 21 45Taketheclient's

bloodpressure 93 82 75 82

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Counseling on Danger Signsn=385 2010, n=361 2012

Returnifswollenhands

andface

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HIV testing for ANC clients

Perform,inquireaboutorreferfor

HIVtest72% 65% 66% 84% 86% 86%

Provideorreferfor

counsellingrelatedtoHIVtest 67% 56% 59% 76% 67% 69%

SERVICEBYHEALTH

CAREPROVIDERREGIONAL

HOSPITALS

n=88HEALTH

CENTRES/

DISP

n=303

ALL

FACILITIE

S

n=391REGIONAL

HOSPITALS

n=72HEALTH

CENTRE

S/DISP

n=279ALL

FACILITIES

n=351

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Recommendations

The study shows there is animprovement inMaternal and Neonatal health Services. In

collaboration with the MOH together otherstakeholders, the following should be addressed

Ensure continuous availability of all necessaryequipment, supplies and medicines (BP machines,

FeFol, SP, etc)

Strengthen interpersonal communication skills at in-service and pre-service training forimprovedcounselling.

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Recommendations

Increase number of qualified healthpersonnel for ANC and other maternal

health services

Improve supportive supervision coachingand mentoring to support high qualityprovision of care

Strengthen linkage between health carefacilities with community to improve qualityof care

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Acknowledgements

This presentation is made possible by the generous support of the American peoplethrough the United States Agency for International Development (USAID)

Cooperative Agreement No. 621-A-00-08-00023-00. The contents are the

responsibility of the Mothers and Infants, Safe Healthy Alive (MAISHA) program and

do not necessarily reflect the views of USAID or the United States Government.

Other authors: Scholastica Chibehe; GaudiosaTibaijuka; Christina Makene; Marya Plotkin; Dunstan

Bishanga; Maryjane Lacoste; Sheena Currie

Institutions: Reproductive and Child Health Section, Ministry of

Health and Social Welfare, Tanzania; Jhpiego Tanzania; Jhpiego

Washington DC

Study teams: Jhpiego staff from MAISHA project and Baltimore,

Ministry staff and staff from health facilities