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ANC in Tanzania: improvinghigh impact measures to
reduce maternal andnewborn mortality
Scholastica Chibehe
Midwifery AdvisorJhpiego, MAISHA
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Background
Achieving good outcome formother and baby:
Early detection and provision oftreatment for existing diseases
supporting clients in developingindividual birth plan andcomplication readiness
Nutrition support duringpregnancy
Preventive measures includingTT, IPTp, PMTCT, ITN, de-worming,Iron and Folic acid etc.
Importance of ANC:
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3
QoC Study on Maternal and Neonatal Health Services
Multi-country study First study was conducted in 2010
Second study was conducted in 2012
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Study Overview
To capture proportion of womenand newborns receiving keymaternal health services
To assess knowledge on maternityand ANC best practices
(including neonatal resuscitation)
To assess availability of key drugsand supplies for ANC andmaternity services
Objectives:
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Tanzania Overview
Survey conducted in 12 regions, 50 healthfacilities(not nationally representative) 12 regional hospitals , 31 health centers and 7
dispensaries
ANC data collected from 48 health facilities
Training on data collection tools andmethods
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Study design
The study used combination of approaches:
Observation of deliveries and ANCconsultations
Inventory of health facilities where drugsand supplies are stored
Record review of service statistics Knowledge and skills assessment of providers
A simulated resuscitation of newborn using amodel
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Key services in ANCn=385 2010, n=361 2012
93
75
60
46
69
66
82 8276
70
8275
0
10
20
30
40
50
60
70
80
90
100
Hospital HC/Disp Hospital HC/Disp Hospital HC/Disp
BPtaken CunsellingforFP OfferedTT
2010 2012
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Preventative servicesn=385 2010, n=361 2012
41 43
86
54
72
59
73
63
84
7276
67
0
10
20
30
40
50
60
70
80
90
100
Hospital HC/Disp Hospital HC/Disp Hospital HC/Disp
SPforIPT Bloodtestforsyphilis CounselingandtesngforHIV
2010 2012
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Counseling on IPTpn=385 2010, n=361 2012
10 11
38
51
41 41
33 33
77 77 74 74
0
10
20
3040
50
60
70
80
90
Hospital HC/Disp Hospital HC/Disp Hospital HC/Disp
Explainpossiblesideeffects Explainhowtotake Explainthepurposeof
tratment
2010 2012
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Counseling on Fe/Fon=385 2010, n=361 2012
33
22
68
59 5754
18
35
19
63
10
62
0
10
20
30
40
50
60
70
80
Hospital HC/Disp Hospital HC/Disp Hospital HC/Disp
Explainpossiblesideeffects Explainhowtotake Explainthepurposeofthetreatment
2010 2012
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Pre-eclampsia screening
2010 2012 2010 2012
COMPONENTSOF
SCREENINGREGIONAL
HOSPITALS
n=87*REGIONAL
HOSPITALS
n=79*
HEALTH
CENTRES/
DISPENSARIES
n=298
HEALTH
CENTRES/
DISPENSARIES
n=361*% % % %
Askaboutheadache
orblurredvision 33 49 22 49Askaboutswollen
handsorface 25 45 21 45Taketheclient's
bloodpressure 93 82 75 82
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Counseling on Danger Signsn=385 2010, n=361 2012
Returnifswollenhands
andface
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HIV testing for ANC clients
Perform,inquireaboutorreferfor
HIVtest72% 65% 66% 84% 86% 86%
Provideorreferfor
counsellingrelatedtoHIVtest 67% 56% 59% 76% 67% 69%
SERVICEBYHEALTH
CAREPROVIDERREGIONAL
HOSPITALS
n=88HEALTH
CENTRES/
DISP
n=303
ALL
FACILITIE
S
n=391REGIONAL
HOSPITALS
n=72HEALTH
CENTRE
S/DISP
n=279ALL
FACILITIES
n=351
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Recommendations
The study shows there is animprovement inMaternal and Neonatal health Services. In
collaboration with the MOH together otherstakeholders, the following should be addressed
Ensure continuous availability of all necessaryequipment, supplies and medicines (BP machines,
FeFol, SP, etc)
Strengthen interpersonal communication skills at in-service and pre-service training forimprovedcounselling.
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Recommendations
Increase number of qualified healthpersonnel for ANC and other maternal
health services
Improve supportive supervision coachingand mentoring to support high qualityprovision of care
Strengthen linkage between health carefacilities with community to improve qualityof care
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Acknowledgements
This presentation is made possible by the generous support of the American peoplethrough the United States Agency for International Development (USAID)
Cooperative Agreement No. 621-A-00-08-00023-00. The contents are the
responsibility of the Mothers and Infants, Safe Healthy Alive (MAISHA) program and
do not necessarily reflect the views of USAID or the United States Government.
Other authors: Scholastica Chibehe; GaudiosaTibaijuka; Christina Makene; Marya Plotkin; Dunstan
Bishanga; Maryjane Lacoste; Sheena Currie
Institutions: Reproductive and Child Health Section, Ministry of
Health and Social Welfare, Tanzania; Jhpiego Tanzania; Jhpiego
Washington DC
Study teams: Jhpiego staff from MAISHA project and Baltimore,
Ministry staff and staff from health facilities