The document discusses White Ribbon Alliance for Safe Motherhood in Tanzania (WRATZ), a grassroots movement to save women, newborns, and children's lives. It notes that skilled birth attendance is proven to avoid maternal deaths but that only 46% of pregnant women in Tanzania access such services. Major contributing factors to maternal and newborn mortality in Tanzania include inadequate knowledge, lack of skilled workers, long distances to facilities, and shortage of supplies and equipment at facilities. The document outlines advocacy efforts of WRATZ to address human resource shortages and mobilize communities, and positive outcomes of these efforts in various districts. It calls for more political will, funds, and expanding advocacy and community mobilization nationwide.

1. 1
White Ribbon Alliance for
safe motherhood (WRA) in
Action
Rose Mlay, RN, RM,
BScn, MN
(WRATZ) Coordinator
P. O. box 9170 DSM
Mob: 255 754 316 369
Email: wra_tz@yahoo.com

2. Why White Ribbon Alliance for SafeWhy White Ribbon Alliance for Safe
Motherhood in Tanzania (WRATZ)?Motherhood in Tanzania (WRATZ)?
 WRATZ is a grassroots movement forWRATZ is a grassroots movement for
safe mother hood that inspires action tosafe mother hood that inspires action to
save women, newborn and children'ssave women, newborn and children's
lives in Tanzanialives in Tanzania
 WRATZ vision is, all women andWRATZ vision is, all women and
newborns in Tanzania enjoy essential,newborns in Tanzania enjoy essential,
quality and life saving safe motherhoodquality and life saving safe motherhood
services in a supportive environmentservices in a supportive environment

3. Skilled Birth Attendance is proven toSkilled Birth Attendance is proven to
Avoid Needless Maternal Deaths. Eg. SriAvoid Needless Maternal Deaths. Eg. Sri
LankaLanka
•In Tanzania only 46% of pregnantIn Tanzania only 46% of pregnant
women access skilled birthwomen access skilled birth
attendance.attendance.
• 24 women die needlessly every day24 women die needlessly every day

4.  Inadequate knowledge by womenInadequate knowledge by women
and families in makingand families in making
appropriate decisions duringappropriate decisions during
obstetric emergenciesobstetric emergencies
 Lack of skilled health workersLack of skilled health workers
coupled with inadequatecoupled with inadequate
supplies/equipmentsupplies/equipment
 Long distance, poor roads, lack ofLong distance, poor roads, lack of
transport and money leading totransport and money leading to
delay in reaching Hospitalsdelay in reaching Hospitals
Major Contributing Factors to MMR/NMR in Tanzania

5. Major shortage of skilled workersMajor shortage of skilled workers
 Dispensaries in ruralDispensaries in rural
Tanzania, requiringTanzania, requiring
2 clinical officers, 22 clinical officers, 2
nurse-midwives, andnurse-midwives, and
1 medical attendant,1 medical attendant,
29 of 284 were29 of 284 were
manned by onemanned by one
medical attendant, amedical attendant, a
worker with noworker with no
midwifery, nursing ormidwifery, nursing or
medical coursesmedical courses
(WRATZ 2005)(WRATZ 2005)
RequireRequire
dd
AvailableAvailable
DistrictDistrict
HospitalsHospitals
21602160 12431243
HealthHealth
centerscenters
11191119 557557
DispensariDispensari
eses
10,00010,000 332332
MOH/SW/WHO 2005:

6. Story from Kokomay VillageStory from Kokomay Village
related to shortage of HR andrelated to shortage of HR and
long distancelong distance
 ““Mariana gave birth at home withMariana gave birth at home with
relatives, she bled excessively. Werelatives, she bled excessively. We
had no money to hire a taxihad no money to hire a taxi (income(income
per capital in this village is tsh 200 =per capital in this village is tsh 200 =
US$0.15),US$0.15), which are very far anywaywhich are very far anyway
We took her on a bicycle to the districtWe took her on a bicycle to the district
hospital 45 km away, she and herhospital 45 km away, she and her
baby died before reaching thebaby died before reaching the
hospital”hospital” (Village chairman, Babati)(Village chairman, Babati)

7. Launching of Advocacy andLaunching of Advocacy and
mobilization Campaign to Addressmobilization Campaign to Address
the HR shortagethe HR shortage
 Advocacy package developed targeting theAdvocacy package developed targeting the
President, Parliamentarians, Ministries of Health,President, Parliamentarians, Ministries of Health,
Finance, etc, donors, communities, families, andFinance, etc, donors, communities, families, and
womenwomen
 Calls for:Calls for:
--15% of budget allocated to health (in--15% of budget allocated to health (in
accordance with Abuja Declaration)accordance with Abuja Declaration)
--Incentives for rural postings--Incentives for rural postings
--donors support for human resource training,--donors support for human resource training,
employment and deploymentemployment and deployment

8. Advocacy package officially endorsed byAdvocacy package officially endorsed by::
 JHPIEGOJHPIEGO
 Elizabeth Glaser Pediatric AIDS FoundationElizabeth Glaser Pediatric AIDS Foundation
 ACCESS ProgramACCESS Program
 UNICEFUNICEF
 Ministry of HealthMinistry of Health
 Save the ChildrenSave the Children
 WHO TanzaniaWHO Tanzania
 Women’s Dignity ProjectWomen’s Dignity Project
 Youth Action VolunteersYouth Action Volunteers
 Tanzanian Network of Women Living with HIV/AIDSTanzanian Network of Women Living with HIV/AIDS
 PlanPlan
 Tanzanian Midwives AssociationTanzanian Midwives Association
 USAIDUSAID
 Association of Gynecologists and Obstetricians in TanzaniaAssociation of Gynecologists and Obstetricians in Tanzania
 Medical Women Association of TanzaniaMedical Women Association of Tanzania
 CARECARE
 Ministry of JusticeMinistry of Justice
 Aga Khan FoundationAga Khan Foundation
 POLICY ProjectPOLICY Project

9. March 25, 2007, 25,000 peopleMarch 25, 2007, 25,000 people
matched, The Call was: STOPmatched, The Call was: STOP
NEEDLESS DEATHS!NEEDLESS DEATHS!

10. Outcome of Advocacy andOutcome of Advocacy and
Mobilization CampaignMobilization Campaign
 President speaking against MMR in hisPresident speaking against MMR in his
speeches in and outside Tanzaniaspeeches in and outside Tanzania
 Government employing graduates fromGovernment employing graduates from
health institutions with immediate effects, inhealth institutions with immediate effects, in
Dec 2006/07, 3900 employed, plans forDec 2006/07, 3900 employed, plans for
07/08 is 6000+07/08 is 6000+
 Rukwa is a remote region. This 07 the govtRukwa is a remote region. This 07 the govt
posted 20 skilled workers, 3 reported, only 1posted 20 skilled workers, 3 reported, only 1
remained. The region started its ownremained. The region started its own
nursing-midwifery schoolnursing-midwifery school

11. Outcomes of Advocacy and CommunityOutcomes of Advocacy and Community
Mobilization in Mkuranga District after aMobilization in Mkuranga District after a
yearyear

12. OutcomeOutcome of advocacy and mobilizationof advocacy and mobilization
in 24 dispensaries 7 in Monduli and 17in 24 dispensaries 7 in Monduli and 17
in Sumbawanga districts after 6 monthsin Sumbawanga districts after 6 months
Number of Skilled and Unskilled Staff Before and After Advocacy
0
5
10
15
20
25
30
35
B4 Feb2007 After Feb2007 B4 Feb2007 After Feb2007 B4 Feb2007 After Feb2007
# Cos # NMPs # MA/MCHAs

13. OutcomeOutcome of advocacy and mobilizationof advocacy and mobilization
in 24 dispensaries, 7 in Monduli and 17in 24 dispensaries, 7 in Monduli and 17
in Sumbawanga districts after 6 monthsin Sumbawanga districts after 6 months
Number of Deliveries Before and After Advocacy
0
100
200
300
400
500
600
700
800
900
1000
B4 Feb2007 After Feb2007
# Deliveries

14. What Can Decision Makers DoWhat Can Decision Makers Do
DifferentlyDifferently
 More Political will and Commitment toMore Political will and Commitment to
Maternal Newborn and Child HealthMaternal Newborn and Child Health
 Place Maternal Newborn Child HealthPlace Maternal Newborn Child Health
Top AgendaTop Agenda
 Govt. and Development Partners toGovt. and Development Partners to
allocate more funds to ensure allallocate more funds to ensure all
women in the world receive skilledwomen in the world receive skilled
birth attendancebirth attendance

15. What Can All of us Do Different?What Can All of us Do Different?
 Expand Advocacy campaign to all districts andExpand Advocacy campaign to all districts and
village leadersvillage leaders
 Mobilize communities and inform women onMobilize communities and inform women on
their role in reducing maternal newborn andtheir role in reducing maternal newborn and
child deaths e.g HBLSSchild deaths e.g HBLSS
 Conduct media campaign on MNCH so theConduct media campaign on MNCH so the
message reaches grassroots levelmessage reaches grassroots level
 Avoid mixed/confusing messages to theAvoid mixed/confusing messages to the
community e.g. home vs. facility birthscommunity e.g. home vs. facility births

16. Miriam’s story is a result ofMiriam’s story is a result of
mixed/confusing message tomixed/confusing message to
communities in remote areascommunities in remote areas
““I am 18 years. I passed toI am 18 years. I passed to
continue with secondarycontinue with secondary
education, but was pregnant.education, but was pregnant.
When in labor I went to theWhen in labor I went to the
dispensary. The ‘nurse’ referreddispensary. The ‘nurse’ referred
me to Sumbawanga Hospital.me to Sumbawanga Hospital.
She put me in a car. My ‘aunt’She put me in a car. My ‘aunt’
took me off the car saying Itook me off the car saying I
would die at the Hosp. She tookwould die at the Hosp. She took
me to an old woman’s home. Ime to an old woman’s home. I
delivered a dead fetus thedelivered a dead fetus the
following day. I suffered and Ifollowing day. I suffered and I
am leaking urine. My aunt died 2am leaking urine. My aunt died 2
weeks after this …”weeks after this …” The VVF is nowThe VVF is now
repaired and individuals helped her to startrepaired and individuals helped her to start
school. She is a complete orphan since age 5school. She is a complete orphan since age 5

17. What can we do different contWhat can we do different cont
•Take husbands /fathers on board in
the efforts to avoid needless maternal
and newborn deaths.
•They should take full responsibility in
ensuring their pregnant wives receive
life saving services