This document summarizes two projects - the EACH WOMAN Health project and a proposed synergy project on contraception and provider support. The EACH WOMAN Health project aims to improve access to maternal and newborn healthcare in rural Tanzania through community consultations, mobile health data collection, and three interventions: village education meetings, transport vouchers, and birth kits with misoprostol. Initial results show barriers to facility access are understood but policy buy-in is challenging. The synergy proposal would add a family planning component to also measure and improve contraceptive access and education through community health workers trained to provide services and referrals using mobile health applications. Collaboration is proposed with other groups to share

1. Title of IMCHA Project: EACH WOMAN Health - “Enhancing all
Community Health Workers on Maternal and Newborn Health”
Title of Synergy Proposal: EWH Plus CAPS - “Contraception
and Provider Support”
Names of Implementation Research Team:
Dr. Bwire Chirangi (Tanzanian PI)
Dr. Gail Webber (Canadian co-PI)
DMO-RORYA and RMO-MARA

2. Rorya District

3. EACH WOMAN Health Overview
• Background
• high non-facility birth rate in Mara (about 60%)
• Barriers to accessing care are distances from facility, cost of transport and care, health care provider
attitudes, lack of supplies at facility, cultural and gender barriers
• Research Objectives
• Hold community and policy maker consultations to review barriers and solutions
• Conduct a multiple baseline trial focusing on using m-health applications to collect baseline data then
introducing 3 specific interventions to improve access to care: village meetings to educate about safe
deliveries, transport voucher for local motorcycle (boda boda) to access health facility at delivery, and
birth kits with misoprostol distribution to women to provide supplies for delivery (to be used for birth
in facility, but also outside of facility if women are unable or unwilling to access health care facility).
• Mixed Methods
• participatory action research for initial consultations
• m-health quantitative data on pregnancy registrations and use of interventions
• focus groups with women, CHWs and nurses on experiences

4. IMCHA Project Implementation
Results to Date/Key Lessons Learned
- Multiple barriers to facility access well understood by community members, but less so by policy makers
- Working with policy makers to encourage uptake is slow and requires building trust, very helpful to have DMO
staff in project and support from Regional and National level as well as NIMR
- Training CHWs to use m-health applications on smart phones requires large investment of training and ongoing
support
- Need for Close monitoring of m-health data and timely response to data collection problems
Challenges in Implementation and Mitigation Strategies
- Continue to work hard to involve DMO staff and promote buy-in, especially as DMO staff turns over, prepare for
end of project even as still rolling out project
- Invest more resources in CHW training and support, be selective about CHW chosen to work with project who is
capable of learning to use smart phone
- Regular communication between m-health consultants and research team to ensure quality data collection

5. IMCHA Project Implementation
Implementation Research Team – Focus on Capacity Strengthening
- Currently rolling out our multiple baseline intervention trial.
- Working on building capacity of CHWs to collect data using smart phones
-Preparing for 3 interventions (village meetings, transport vouchers and distribution
of birth kits with misoprostol)
Next Steps (Plan for 2017) and Areas for Collaboration
- Interventions to start in July 2017 in first division, then every 4 months thereafter to
remaining divisions
- Continue to have policy maker meetings every 6 months
- Collaboration with ECSA where possible, include other stakeholders
- Possible collaboration with other IMCHA teams, especially in Tanzania to promote
project findings and discuss means for sustainability

6. Synergy Proposal Overview
• Background
- in the Lake Zone rate of modern contraceptive use is only 15 % and the unmet need for contraception is 33 %, with
more frequent stock-outs of family planning items than elsewhere in Tanzania.
• Research Objectives
•To measure baseline use of family planning in rural Rorya District through m-health applications.
•To improve access to family planning and safe sex education and contraceptive methods.
•To train and support CHWs to provide family planning services using m-health applications for education and basic
methods (condoms and pills), and referral and reminders for advanced methods (injectable, implantable, IUDs and tubal
ligation).
•To train and support nurses to provide advanced methods in family planning to adolescents and women.
•To use m-health applications to monitor performance of CHWs and to help maintain stocks of family planning items in
rural health facilities in order to reduce stock outs.
•To regularly meet with community, District ,Regional and National policy makers for ongoing knowledge translation
activities.
• Mixed Methods
•m-health quantitative data on contraception use, stock monitoring and work flows of CHWs
•focus group data from women, CHWs, nurses and policy makers using PAR tools

7. Focus of Work in Synergy
Areas for Strategic Consideration/Collaboration
- Collaboration with ECSA, particularly for 6 monthly
policy maker meetings
- Presentations at other events in Tanzania (e.g.
national reproductive health task force meetings)
- Presentations at other academic and policy maker
events in Africa to share results

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