“The maternal mortality rate in Tanzania is still unacceptably high, 454 per 100,000 live births and we wanted to do something about it”, says Sebalda Leshabari, Project Advisor and Secretary General at the Tanzanian Midwives Association (TAMA). TAMA has participated in ICM’s Twinning Project, executing ICM’s mission to strengthen midwives associations. The project twinned several associations, one of them the Tanzanian Association of Midwives (TAMA) and the Canadian Association of Midwives (CAM). The two of them took the twinning to a whole different level. They embarked on a joint bid to implement a revolutionary training programme in Tanzania. TAMA and CAM’s ambitious attempt to improve the lives of women and children was rewarded when they won one of the six “Life Awards” promoted via the Connecting Midwives platform. The Life Award, funded by Sanofi Espoir Foundation enables CAM and TAMA to make their dreams come true and implement the project called “Improving Service Delivery for Safe Motherhood” (ISDSM). The major aim of the project is to train midwives in live saving skills, especially emergency skills. CAM and TAMA have developed an emergency skill manual that aligns with the ICM Essential Competencies and will train 300 midwives in six rural districts across all of the six zones of Tanzania. “We want to reach the most rural districts, where infrastructure is poor and there is a lack of skilled health care providers”, explains Sebalda. It is in these hard to reach areas, where most women die of pregnancy and childbirth related complications because there are no midwives and the roads are often impassable to get the women in need to the health clinics and hospitals.
The project will also recruit and re-engage 12 retired midwives, who have returned to their communities and are well respected there. “They are retired, but they are not tired”, says Sebalda. Quite on the contrary, they are eager to employ the many experiences they gained, for the benefit of their community members. 50% of women still deliver at home without any skilled care, one of the reasons for the high maternal and neonatal mortality rates. The retired midwives, as well respected community members, can help women, their husbands and the people in the community understand how important it is, to deliver with a skilled birth attendant. Another advantage to engage retired midwives is that they can also work with the village development committees to support pregnant women to access health care. In one of the villages the collaboration has already been very fruitful. The village chairman realized, how vitally important the work of midwives is and decided to turn the village office into a “maternity ward”. The district council followed suit and provided the essential equipment for deliveries, such as a delivery bed for free. The facility and the midwife have much popularity with the villagers and the midwife was proud to report that she did five deliveries within her first week of appointment. In another village the Roman-Catholic church donated a building to be used for deliveries and the district council equipped the room with three delivery beds and other necessary equipment. TAMA and CAM in collaboration with District Councils will recruit 4 Community Health Workers (CHWs) in each district to work with retired midwives. The major roles of CHWs will be to register all pregnancy women in their catchment areas and ensure that they access health services regularly.
TAMA and CAM have also just finished with the training of the first 50 midwives in emergency skills. For each of the trainings the 50 participants are split into smaller groups of 17 participants. “This way, the participants can get the most out of the practical exercises”, explains Project Coordinator Martha Rimoy. The training lasts four full days for each group with two trainers from TAMA, one trainer from CAM and the Project Coordinator Martha. Participants improve their emergency skills such as identifying pre-eclampsia, or managing a breech birth. “If a midwife is properly educated these emergency skills are easy to do and truly life-saving”, says Martha. But if this education is lacking, the midwife has to refer the pregnant woman to a hospital, which is risky ,time consuming and costly. The training only takes four days but is highly effective in minimizing complications and reducing maternal mortality. “A week after the first training we received a call from one of the participants, reporting that she had successfully managed a breech delivery”, says Martha.
With the countdown to the Millenum Development Goals (MDGs) in full swing and less than 500 days to go to achieve the MDGs, these results are not only tangible and highly effective, but also evidence based and tailored to the needs of the regions, where maternal mortality is highest.
The project will run for a total of three years with trainings taking place approximately every three months in one of the six districts running three times four days each time for 17 participants, training 50 midwives in each district with a total of 300 trained midwives in all of Tanzania. In the third year of the project a proper evaluation is planned to measure the full impact and potentially scale it up to cover one whole zone of Tanzania.