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Care Group Approach to Improve MCH in Tanzania

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Paul Mosley, MPH, Health Programs Coordinator, Mennonite Central Committee discusses the Care Group approach used by the Mennonite Central Committee to improve maternal and child health through a local Maasai partner in Tanzania at the 2018 CCIH conference.

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Care Group Approach to Improve MCH in Tanzania

  1. 1. IMPROVING HEALTH OF WOMEN AND CHILDREN USING A CARE GROUP APPROACH THROUGH A LOCAL MAASAI PARTNER IN NGOGONGORO DISTRICT OF TANZANIA: Presented by Paul D. Mosley Health Programs Coordinator Mennonite Central Committee July, 2018
  2. 2. Ebiotishu Oondomonok Ongera (EbOO) --is Maasai for Healthy Mother and Child. It is a project of MCC Tanzania implemented through their partner Naiboisho Development Initiative (NDI) and supported by the Luann Martin Legacy Fund. The 3 year project, begun in November 2017 seeks to reduce maternal and child mortality among the Maasai people living in Nainokanoka Ward in the Arusha region of Tanzania. NDI is the implementing partner and MCC provides project oversight and technical support. Introduction
  3. 3. Project Overview EbOO has developed an integrated approach aimed at changing attitudes in the community as well as improving quality of care at health facilities in the ward. The three axes of intervention are: 1. Promoting adoption of MCH practices among pregnant women 2. Building the capacity of midwives serving the local govt. facilities in the ward that provide ante-natal care as well as labor and delivery services 3. Reducing gaps in availability of needed meds and supplements for pregnant women at the 3 local health facilities in the ward.
  4. 4. 1) Promoting adoption of MCH practices among pregnant women • Care group approach facilitated by local partner. • 6 Care groups in the ward. • 75 traditional birth attendants (TBAs) are members of the care groups and meet monthly. (12 to 13 per group) • TBAs meet monthly with 75 neighborhood groups of approximately 10 women per group. (Due to distance between households, many TBAs meet women through home visits.) • There are an average of 250 pregnant women among group participants each month.
  5. 5. CARE GROUP APPROACH There are monthly meetings by each group listed below. This creates a cascading effect to disseminate information, and encourage peer learning. Neigborhood groups run by TBAs Care Groups run by Facilitators Program Oversight 1 Project Manager and 1 Program Director 2 Care Groups in Irkeepusi village with 25 TBAs 25 Neighborhood Groups ( 12-14 women each) run by 25 TBAs 2 Care Groups in Bulati village with 25 TBAs 25 Neighborhood groups ( 12-14 women each) run by 25 TBAs 2 Care Groupsin Nainokanoka village with 25 TBAs 25 Neighborhood Groups ( 12-14 women each) run by 25 TBAs
  6. 6. 1) Promoting adoption of MCH practices among pregnant women, cont. Care group curriculum developed from: Home-based life saving skills curriculum from American College of Nurse Midwives: http://www.midwife.org/Home-Based-Life-Saving-Skills-HBLSS Topics in year 1 include: • Antenatal Care (visiting a facility) • Pregnancy complication warning signs • Nutrition during pregnancy and lactation • Birth plan for facility-assisted delivery (preparations) • Signs of Delivery and Facility-assisted birth • Immediate breastfeeding and colostrum use • Exclusive breastfeeding • Hygiene practices around pregnancy, labor, delivery, new born care • Post-natal and well child visits
  7. 7. 2) Building the capacity of nurse midwives serving the 3 ward health facilities: 6 nurse midwives receive a 2 week practicum (2 at a time) in a tertiary care center where they review delivery BEmOC and delivery procedures and assist at a large number of births.
  8. 8. 3) Reducing gaps in availability of needed meds and supplements for pregnant women at the 3 local health facilities in the ward • Stock out of ANC vitamin supplements is a problem in the ward. EbOO works in collaboration with ward medical officer to identify short falls and procure supplements. Vitamin B Complex tablets Vitamin B Complex 100ml syrup Vitamin B Comples 2mls inj Vitamin A capsules Ascorbic Acid tablets Ferrous Sulphate/Folic Acid Calcium Gluconate 100mg/ml inj Zinc Sulphate tablets Sodium Bicarbonate 20mls inj Magnesium Sulphate 10mls inj Albendazole 200mg tablets
  9. 9. LogicModelforEbOOProject
  10. 10. MONITORING & EVALUATION Impact Indicators: # of maternal deaths (reported by care groups) # of neonatal/infant/under 5 deaths (reported by care groups) Outcome Indicators: # of ANC visits (reported by care groups and clinics) # of women reporting completing 4+ ANC visits (reported by care groups and clinics) # of Facility Assisted deliveries (reported by care groups) # of Home deliveries (reported by care groups) # of women reporting exclusive breastfeeding (reported by care groups) Care groups meet and report monthly. Data is collected from TBAs in care groups and put into a form on KOBO toolbox (an opensource statistical package) to be shared and analyzed with MCC.
  11. 11. RESULTS TO DATE 1: ANC visit increase After 6 months of program implementation, some preliminary results from Irkeepusi dispensary shows increased use of ANC services. 0 10 20 30 40 50 60 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 NumberofANCvisits Number of women per month going to ANC visits in past year (Irkeepusi Dispensary) project start date
  12. 12. RESULTS TO DATE 2: Facility-assisted births: No change observed in increasing facility-assisted births to date. 0 1 2 3 4 5 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 NumberofBirths Facility Assisted Births per month (Irkeepusi Dispensary) project start date
  13. 13. PROJECT OPPORTUNITIES To date the project has yielded both opportunities and challenges. The most significant opportunity has been the ability to collect data directly from care groups which have given a better MCH health profile of the ward than we are able to get from the 3 clinics. 1. Ward medical officer says that maternal and infant deaths are underreported as women or children who die in pregnancy or infancy may not be brought to a clinic prior to burial. So there is no record– Care groups report monthly on all births and deaths of women and children on a monthly basis. 2. The ratio of facility to home births is not known by the clinic and is estimated based on ANC visits. – Care groups report on all pregnant women participating in the ward as well as those who had home births and facility births on a monthly basis.
  14. 14. PROJECT CHALLENGES The project has also created challenges for the partner that have had to be managed 1. Tradition TBAs who are neighborhood group leaders are mainly illiterate, this has made data collection a challenge and limited the project to very basic indicators as listed above. Keeping demographic data on individual women is not possible. 2. Maasai women in Nainokanoka ward have robust preference for home birth even after completing ANC visits and having access to a facility. It has been hard to date for this project to change their behavior. This fall we are conducting qualitative research funded by Child Health Foundation to better understand their preferences and potential barriers to adoption of a safer delivery behavior. (Date indicates 5% have facility births compared to 60% for TZ)
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