Day 2 panel 4 replicating mama toto tz 108024

1. IMCHA: Replicating Mama-Toto in Rural Misungwi & Kwimba
Districts-Mwanza region, Tanzania
SYNERGY: Mama na Mtoto: Barriers and Enablers to Gender,
Equity and Scale-Up
IRT: Dismas Matovelo, Jenn Brenner, Denise Buchner, Leonard Subi,
Zabron Masatu et al.

2. IMCHA Overview
Background: To address persisting MNC survival challenges, this study aims to adapt, implement and
evaluate a district-led, policy aligned MNH intervention package which integrates ‘Mama-Toto(MT)
processes’ (from Uganda) in two rural Tanzania districts.
Objectives:
• Adapt and implement the MT package using a knowledge user-informed engagement strategy.
• Evaluate the effectiveness and conduct a process evaluation of the implementation strategy
Research questions:
“Can implementation of MNH facility and community-based interventions using the ‘MT Process’
improve specific maternal & NB indicators?”
“Can the ‘MT Process’, proven successful in Uganda, be adapted to support successful implementation
in rural Tanzania?”
Methods:
• Pre/post intervention study using embedded mixed methods design on a 54-month
Effectiveness-Implementation Hybrid Design

3. IMCHA Implementation
Results to Date/Key Lessons Learned:
• Gaps in delivery care: 60% achievement of BEmONC signal functions, 1/3 non-
SBA
• ANC Gaps: 4+ANC <50% pregnancies; rare ANC prior to 12 weeks of pregnancy
• Breastfeeding: Limited early initiation (16%); EBF <5m=50%; inappropriate
weaning
• Malnutrition: 16% underweight, 6% wasting; 39% stunting (2x nat’l)
• Limited activity of governance and QI committees
Challenges in Implementation and Mitigation Strategies:
• Most vulnerable populations: gender/equity issues should be incorporated in
every Clinical skills/Health systems/community Package

4. IMCHA Implementation
IRT – Focus on Capacity Strengthening:
• Gender & Equity workshop provided for core and TT members
• M&E workshop for core and TT members
Next Steps (2017) and Collaboration:
• Conduct Exit (quality of care) survey in 2nd district
• Transition of HFS tool into CAPI (paper to tablet-based) then conduct in 2nd
district

5. Synergy Proposal Overview
Background:
• We have identified further potential implementation gaps for the intervention (Mama na Mtoto package) related to
understanding how to best reach most vulnerable women (including adolescents) and their influencers for care-seeking
decisions.
Research questions/objectives:
• Who are influencers for decisions about ANC, delivery, and PNC and how can they be better engaged?
• For all women in target areas
• For adolescents, specifically
• For most vulnerable/marginalized groups?
• What was experience of MT in Uganda of reaching and impacting (or not) these populations and their influencers? What
lessons can be learned?
• What were experiences of MT in Uganda related to scale up DURING or AFTER intervention? What lessons can be
learned?
Methods:
• Five multidisciplinary research teams (3 CUHAS, 2 MUST) work in parallel on the five research questions above using
qualitative methodology
• Capacity building in qualitative research provided at each stage through structured mentorship and coaching.
• Emphasis on achievement of publication for each of the five questions.

6. Focus of Work in Synergy
• Areas for Strategic Consideration/Collaboration:
• HPRO assistance once results available for KT into action/policy
• HPRO link the team with various forums for results sharing