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Saving a Generation: Maternal, Newborn and Child Health (MNCH)
Eastern and Southern AfricaAga Khan Health Services
Today’s presentation
• Situation of Maternal, Newborn and Child Health (MNCH) in Sub-Saharan Africa, with a particular focus on Tanzania
• Approaches and impact of community interventions to improve mother and child health outcomes
ESA: maternal mortality amongst the highest in the world
“In 2010, close to 58,000 women [across Eastern and Southern Africa] lost their lives in pregnancy and childbirth, accounting for more than 1/5 of all such deaths in the world.
That’s close to 10 deaths every hour.”
- UNICEF
Tanzania’s maternal mortality rates are amongst the worst in an already bad situation
Rwanda
Burundi
Uganda
Kenya
Tanzania
0 300 600 900
Maternal Mortality Rate
Amongst highest maternal mortality rates in the world, Tanzania ranks 21st globally, tied with Afghanistan.
Child mortality rates are also unconscionably high
Tanzania
Under 5 mortality rate: 81 / 1000 live births
Infant mortality rate:51 / 1000 live births
Neonatal mortality rate:26 / 1000 live births
The neonatal mortality rate is the first 28 days after birth, and in Tanzania accounts for over 30% of all child deaths.
Largely, the problem is no skilled attendant at delivery…
…and most deaths are largely preventable
Haemorrahage
Infections
Eclampsia
Unsafe Abortions
Obstructed Labour
Others
0% 10% 20% 30%
Direct Cause of Maternal Deaths
Asphyxia
Congenital
Preterm
Infection
Diarrhoea
Tetnus
Other
0% 5% 10% 15% 20% 25% 30% 35%
Causes of Neonatal Deaths
But, there is progress in both maternal mortality rate…
1996 2004 20100
150
300
450
600
750
529 578454
Maternal Mortality Rate in Tanzania – 1996-2010
…and in child mortality rate
Newborn Infant Under-50
20
40
60
80
100
120
140
160
40
99
147
32
68
112
29
58
91
51
81
Child mortality in Tanzania (per 1000 live births)
1999200520082010
Still, there are large challenges in Tanzania’s health sector
Within health sector:
.Weak health infrastructure
.Limited human resources
.Poor referral systems
.Inadequate equipment and supplies
Community:
.Inadequate community involvement and participation in health
Other factors:
.Education levels
.Economic, social, & cultural issues.Gender dynamics
Still, there are large challenges in Tanzania’s health sector
Within health sector:
.Weak health infrastructure
.Limited human resources
.Poor referral systems
.Inadequate equipment and supplies
Community:
.Inadequate community involvement and participation in health
Other factors:
.Education levels
.Economic, social, & cultural issues.Gender dynamics
Why do we work in the community?
In Tanzania:• Out of a population of 40
million, 80% live in rural areas
• In rural areas, health infrastructure and services are limited
• Most people live below the poverty line and cannot afford to travel for health services
Outreach aims to: • Develop a relationship
with the communities• Stimulate behavioral
changes that improve health and prevent disease
• Improve maternal, newborn and child health indicators
And what exactly do we do?
Community support
Service delivery in communities Community
Meetings and Interactions
Health promotion activities
Develop links with referral
health facilities
Develop links with referral health facilities
• Links established through comms systems
• Ambulance services • Feedback mechanism• Follow-up
Government referral hospital
Aga Khan Health Services PCM
Public Health Facility
Teleconsultation Linkage
Service delivery in communities
Community meetings and interactions
Mobile health reach:• Regular outreach mobile
health visits to under-served rural areas
• Community training and empowerment
• Support to community health workers
Health promotion activities – education & entertainment
Community health camps:• Create demand• Raise awareness –
prevention, treatment care, social services
• Change attitudes to foster behavioral change
Outpatients at public health centres rose 6.5x last year…
37,971
243,676
30,000
80,000
130,000
180,000
230,000
280,000
2012 2013
Year
Number of Outpatient (Public Health Facilities)
…and deliveries in health facilities rose 11x
1,539
17,351
0
5,000
10,000
15,000
20,000
2012 2013
Year
Number of Deliveries (Public and Private Health Facilities)