Improving Maternal and Reproductive Health in Kigoma, Tanzania: A 13-Year Initiative

Abstract

The Program to Reduce Maternal Deaths in Tanzania was a 13-year (2006-2019) effort in the Kigoma region that evolved over 3 phases to improve and sustain the availability of, access to, and demand for high-quality maternal and reproductive health care services. The Program intended to bring high-quality care closer to more communities. Cutting across the Program was the routine collection of monitoring and evaluation data. The Program achieved significant reductions in maternal and perinatal mortality, a significant increase in the modern contraceptive prevalence rate, and a significant decline in the unmet need for contraception. By 2017, it was apparent that the Program was on track to meet or surpass many of the targets established by the Government of Tanzania. Over the following 2-plus years, efforts to sustain Program interventions intensified. In April 2019, the Program fully transitioned to Government of Tanzania oversight. Four key lessons were learned during implementation that are relevant to governments, donors, and implementing organizations working to reduce maternal mortality: (1) multistakeholder partnerships are critical; (2) demand creation for services, while critical, must rest on a foundation of well-functioning and high-quality clinical services; (3) it is imperative to not only collect robust monitoring and evaluation data, but to be responsive in real time to what the data reveal; and, (4) it is necessary to develop a deliberate sustainability strategy from the start. The Program in Kigoma demonstrates that decentralizing high-quality maternal and reproductive health services in remote, low-resource settings is both feasible and effective and should be considered in places with similar contexts. By embedding the Program in the existing health system, and through efforts to build local capacity, the improvements seen in Kigoma are likely to be sustained. Follow-up evaluations are planned, providing an opportunity to more directly assess sustainability.

A family planning campaign poster shows a supportive partner escorting a pregnant woman at term to a health facility for delivery and states: “For safety and reliability, please deliver in a health care facility.” © 2018 ABC Bros Co Ltd.

FIGURE 1

Program Logic Model Abbreviations: GoT, Government of Tanzania; EmONC, emergency obstetric and newborn care; MRH, maternal and reproductive health; MMR, maternal mortality ratio. ^aPartnership is GoT, communities, health facilities/providers, donors, implementing partners, and evaluator. ^bMRH services is EmONC, skilled birth attendance, newborn care, family planning, and comprehensive postabortion care. ^cQuality in terms of clinical services and women's experience of care.

FIGURE 2

Snapshot of Major Program-Supported Interventions by Level of Health System Abbreviations: CPAC, comprehensive postabortion care; EmONC, emergency obstetric and newborn care; LARC, long-acting reversible contraceptive. ^aIn select catchment areas/facilities. ^bIn a subset of 18 dispensaries.

FIGURE 3

Evaluation Methods Source: CDC evaluation reports^,,–,