Integrated facility and community approach in improving MNCH in Tanzania

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Integ rated fac ility andcommunity approach inimproving MNCH inTanzania

Global Maternal Hea lth Conferenc e,

Arusha , Tanzania

15th -17th January,2013

Authors: C. Lipingu; E. Charurat;M. Kom be; E. Mtete ; G. Besana ;D. Bishanga; K. Winani


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Outline

Program goa l

Rationale

Program Model Program Strateg ies and Progress

Lessons Learned from the p roc ess

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Rationale

Improve maternal health: 60% of materna l dea ths oc c urduring first postp a rtum week, yet only 31% of women whodeliver a t home a re seen within the first week after

delivery Improve neonatal and infant hea lth: 75% of neona ta l

dea ths oc c ur during first week

Prevent unintended pregnanc ies: Tota l fertility ra te : 5.4;

CPR for a ll methods: 34% (27% modern) Ensure ongoing c are of HIV+ mother and her exposed

infant: Currently a PMTCT p rogrammatic gap


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Bac kground and Program model

Facility: Ca pac ity build ing a t selec ted d istric t hosp ita ls

hea lth c enters and d ispensaries Pre-d isc harge c ounseling, extended postpartum c are

inc lud ing PPFP, fo llow up of HIV + mothers and exposedinfant

Community: development o f CHWs to p rovide hea ltheducation

FANC, ma la ria p revention, infa nt feed ing , PMTCT, PPCPPFP and c ervic a l c anc er p revention

Mobile phone tec hnolog y (fac ility and c ommunity)

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Program model

Facility: To have two hea lth c entres ( HC) perd istric t having a t least two p roviders tra ined inPost Partum Care (PPC ) in eac h fa c ility

Community: In eac h of the HC c overed to be

assoc ia ted with five d ispensaries ( to ta l of 6fac ilities), with one CHW supervisor in eac hfacility

Eac h fac ility to c over two villages with 2 CHW inea c h village


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Community approach

Development of standa rd ized CHW p rogram to p romo tec MNCH inc lud ing PMTCT and FP in the community b y homevisits

Foc uses on 4 thematic a reas:

1) Women during preg nancy and a fter delivery2) Newborns and under 5 c hild ren

3) Follow-up of HIV+ mo thers and exposed infants

4) Postp artum family p lanning** Other c ross-cutting issues a lso a ddressed (suc h a s M&E, IEC/ BCC)

CHWs conduct health education, mobilization, and referralsra ther tha n d irec t servic e provision


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Iringa

Morogoro

Lindi

Mtwara

In 2009,began workingwith MoHSW/RCHS ondevelopment of

integrated facility -community MNCHcomponents

Coverage: 49 facilities

and 210 villages inMorogoro, Iringa, Lindiand Mtwara Regions

Regional coverage


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Program Progress (1)

Program Materials developed with the Ministry:1). PPC p ac kage inc lud ing;

Nationa l PPC Guidelines

PPC Fac ilita to rs guide for tra iners

Learning resourc es: PowerPoint slides, pre and midc ourse knowledge assessments

Performanc e Sta nd ards for PPC

All are approved by the ministry and in use

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2). Community program package inc luding;English version

Nationa l Guidelines onInteg ra ted Comm unityMNCH

Printed and signed

Swahili version

Integra ted c ommunity MNCHTra ining guide

CHW Referenc e Guide Sup ervisor Guide

Job Aids ( 26)

Printed and signed


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Training:Fac ility postpa rtum c are

25 tra iners in Morogoroand Iringa

Morogoro: 86 providers

Iringa : 18 providers

Mtwara : 38 providers

Lind i: 49 p roviders

Community MNCH

25 tra iners in Morogoro

44 supervisors of CHWs in5 d istric ts of Morogoro

72 CHWs in Morogoro DCand Munic ipa l


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201220112010

12 facilities

14 facilities

25 facilities

37 facilities49 facilities

Started in

Morogoro

IRINGA

LINDIMTWARA

COVERAGE OF 20 DISTRICTS


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Number of first postpartum visits in relation to hea lthfac ility deliveries

0

2000

4000

6000

8000

10000

12000

Nov-Dec

2010

Jan-March

2011

April-June

2011

July-Sept

2011

Oct-Dec

2011

Jan-March

2012

April-June

2012

July-Sept

2012

HF deliveries

1st PNC Visit

(Within 48hrs)


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Proportion of a ll post pa rtum care visits, by healthfac ility, for the period Nov 2010-Sept 2012

80%

54%

8%

19%

8% 16%

5%

10%

0%

10%

20%

30%

40%

50%60%

70%

80%

90%

Hospitals Health Centers

Within 48hrs

3-7 days

28 days

42 days


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Post Partum c are c lients rec eiving c ounselling onFamily Planning

0

500

1000

1500

2000

2500

3000

3500

July 2012 Aug 2012 Sept 2012

Clients

reving PPC

Clients

counselled on

FP

93% 95%

94%


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Conc lusion for service delivery

Inc reasing number of hea lth fac ility deliveriesrec eiving a postpartum c are visit w ithin 48 hoursof delivery

Gradua l inc rease in 2nd

, 3rd

, and 4th

Post partumc are visit over time

Very high ra te of Postp artum Family Planningc ounseling for PNC c lients.


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Partnering with D Tree to introduc e mobilephone application;

Mobile phone Aiming to assist hea lth

workers in d eliveringhigh qua lity care toea c h c lient both atfac ility and c ommunitylevels

Introd uced and

func tiona l in twofac ilities in Morogoro

13 HCWs tra ined


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Program eva luation; The eva lua tion of the Integra ted Program is

being led by the collabora tion between theInstitute for Interna tiona l Programs (IIP) a t the

Johns Hopkins Bloomberg Sc hool of Pub licHea lth and the Muhimb ili University o f Hea lthand Allied Sc ienc es (MUHAS).


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Lessons Learned:

Working with the Ministry to esta b lish na tiona ldoc uments was a c ritic a l stage

Integra tion o f servic es is importa nt for p rovisionof c ontinuum o f c are

Following training, service p roviders still requiresup portive sup ervision to master skills

Use of mob ile phone app lic a tion ensures

c omprehensive c a re CHWs apprec ia te the c omprehensiveness of

the tra ining c ontent


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Contact: c [email protected]

THANK YOU
mailto:[email protected]:[email protected]

Documents

Integrated facility and community approach in improving MNCH in Tanzania