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.

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. 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

4. 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.

5. 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.

6. 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

7. 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

8. 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.

9. 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

10. LogicModelforEbOOProject

11. 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.

12. 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

13. 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

14. 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.

15. 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)

16. END