Feature Story

Saving mothers, babies with a result-driven health plan

This opinion-editorial originally appeared in The Citizen newspaper on November 6, 2016

In Summary 
The third annual meeting of the Global Financing Facility (GFF) under the theme,
“For Every Woman, Every Child” aims at creating partnerships that support smart
and sustainable financing to eliminate preventable, maternal, newborn and
child deaths and reach out to adolescents.

Tanzania is hosting two global meetings that will focus on women, their survival, well-being, and their access to life saving maternal and reproductive health services. The third annual meeting of the Global Financing Facility (GFF) under the theme, “For Every Woman, Every Child” aims at creating partnerships that support smart and sustainable financing to eliminate preventable, maternal, newborn and child deaths and reach out to adolescents.

The second meeting is being organised by Family Planning 2020, a global partnership that supports the rights of women and girls to decide freely, whether, when, and how many children they want. Significant progress was made towards achieving the Millennium Development Goals (MDGs) with the number of expectant mothers dying as a result of complications during pregnancy and childbirth decreasing by 43 per cent since 1990.

Globally 300 million women use modern contraception, enabling them to take charge of their own lives and their families. In Eastern and Southern Africa, countries have experienced the fastest increase in the use of modern contraception but it is important to remind ourselves of the scale of the challenges that remain.

Last year at least 550 expectant mothers died daily due to complications of pregnancy and child birth in sub-Saharan Africa and the desired number of children identified by women is consistently higher than the actual number of children.

Furthermore, the risk of a woman in a low-income country dying from a pregnancy-related cause during her lifetime is about 33 times compared to a woman in a high income country, pointing to close links between high fertility and maternal mortality rates.

Progress is being seen in Tanzania. More and more women are surviving the natural act of giving birth and are planning their families. The use of modern contraception increased from 27 per cent to 32 per cent between 2010 and 2015 and as a result an approximately 2,000 maternal deaths were prevented annually over this period.

While Tanzania did not reach the MDG for maternal mortality, it achieved a 40 per cent reduction in maternal mortality over the past decade, the fifth most successful reduction in Africa and well above the average in Sub-Saharan Africa. This is cause for celebration, but more can still be done for – and with – the women of Tanzania.

The biggest challenges facing the lower income earning households in Tanzania is that few women have the opportunity to safely plan their families as less than a fifth of these women use contraceptives. Among these households the demand for contraception was satisfied among only 43 per cent of the women compared to 75 per cent in higher income earning households.

Equally disconcerting is the fact that pregnancy rates among adolescents are increasing from 23 per cent in 2010 to 27 per cent in 2015. Among girls from lower income earning households this number is almost double – 42 per cent of these girls have given birth or are about to give birth.

Furthermore, in poorer households far too few women access basic prenatal care – 39 per cent as opposed to 70 per cent in higher income earning households – and only a third deliver their babies at health facilities against 88 per cent from the higher earning households.

The government’s Star Rating Assessment and the World Bank’s Service Delivery Indicators have shown that basic services are not in place for expectant mothers about to deliver at health facilities.

So what will improve the sexual and reproductive health of women in Tanzania?

Spurred by the scale of the challenge, the Health ministry is calling for “business unusual”, and is committing to a data driven accountability. The ministry is increasing the quality and access to health services by focusing on results and value for money. The ministry is also aligning funding, both domestic and foreign under a strategy that addresses sexual and reproductive health and caters for all age groups including adolescents.

Tanzania is a pioneer of the Global Financing Facility and has led the way in moulding it. The government-led GFF partnership, is scaling up investments in basic emergency obstetric and neonatal care, family planning, antenatal care, skilled deliveries, and infant and young child feeding. Investments by the government, supported by the World Bank and other development partners, are increasingly performance-based. A Programme-for-Results links the release of funds directly to the attainment of set targets.

So how will the women of Tanzania benefit?

With support from development partners, the Government is channelling resources directly to health facilities, starting with the poorest regions. The focus on measuring results has motivated health facilities and Local Government Authorities (LGAs) to improve the quality of care, starting in Shinyanga, Mwanza and Coast regions.

Country-wide performance-based scorecards are being used to boost the delivery of set targets in reproductive, newborn and child health services. In the first year of implementation there are already improved results in the prevention of malaria among expectant mothers, improved diets and better functioning boards at health facilities, much more can be done. Improved transparency and accountability are central to the success of these efforts.

Earlier this year the Star Rating Assessment results were presented to Members of Parliament. The rating will be updated at each parliamentary session so that MPs use the information to hold service providers, LGAs and Regional Authorities accountable.

Last week during the annual meeting of regional and district medical officers, the ministry announced it would release scorecards ranking the best and worst performing districts twice a year. With efforts like these, Tanzania is leading the way in the Sub-Saharan Africa region in improving data driven accountability.

This is a very promising agenda for action and we look forward to celebrating the results for the women of Tanzania, so that they survive and thrive and effectively participate in the economy.

Ummy Mwalimu, Bella Bird and Mariam Claeson

Ummy Mwalimu is the current Minister of Health, Community Development, Gender, Seniors and Children. Between 2000 and 2010. She worked in various governmental and NGO agencies in legal, research and governance roles. She holds a Bachelor of Laws from the University of Dar es Salaam and a Master of Laws degree from the University of Pretoria.

Bella Bird is the Country Director for Tanzania, Burundi, Malawi and Somalia, Africa. Prior to taking up this role, Bella was the World Bank Country Director for Sudan, South Sudan and Somalia, based in Nairobi, Kenya from 2011 to 2015. Before joining the Bank in 2011, Bella served in various leadership positions in the UK Department for International Development (DFID). From 2009 - 2011, she was Head of Governance Policy in DFID. She provided leadership to a number of international policy processes at the OECD, as well as leading policy development on governance and fragile states policy within DFID. Bella also previously served in the roles of Head of DFID Nepal and of DFID Vietnam. Prior to these positions, she spent seven years with DFID as an adviser on poverty and social issues in Kenya, Tanzania and Uganda. She played a leadership role for the UK government and internationally on policies to promote state-building and peace building, championing aid effectiveness and south-south collaboration. 

Mariam Claeson, M.D., M.P.H. has been the Director of the GFF since October 2016. She is a recognized expert on global health issues, with deep experience in addressing the particular challenges faced by women, newborns and children.

She previously served as the Director for Maternal Newborn and Child Health at the Bill & Melinda Gates Foundation, which she joined in July 2012.  Prior to that, she was the Regional Program Coordinator for AIDS in the South Asia Region of the World Bank (2005- 2012) and the Lead Public Health Specialist in the Health, Nutrition and Population, Human Development Network of the World Bank (1996- 2004).  

Before joining the World Bank, Dr. Claeson worked with the Global Program for the Control of Diarrheal Diseases, World Health Organization (1987-1995). She has worked in clinical practice at the rural district level (Tanzania, Bangladesh and Bhutan); in national immunization and diarrheal disease control (Ethiopia 1984-1986); and, for the World Bank in health sector development programs in middle- and low-income countries, including in Egypt, Jordan, Uzbekistan, China and the Philippines and in national HIV/AIDS programs, including in Afghanistan and India.