Abstract
Introduction Rapid urbanisation in Dar es Salaam, the main commercial hub in Tanzania, has resulted in congested health facilities, poor quality care, and unacceptably high facility-based maternal and perinatal mortality. Using a participatory approach, the Dar es Salaam regional government in partnership with a non-governmental organisation, Comprehensive Community Based Rehabilitation in Tanzania, implemented a complex, dynamic intervention to improve the quality of care and survival during pregnancy and childbirth. The intervention was rolled out in 22 public health facilities, accounting for 60% of the city's facility births. Methods Multiple intervention components addressed gaps across the maternal and perinatal continuum of care (training, infrastructure, routine data quality strengthening and utilisation). Quality of care was measured with the Standards-Based Management and Recognition tool. Temporal trends from 2011 to 2019 in routinely collected, high-quality data on facility utilisation and facility-based maternal and perinatal mortality were analysed. Results Significant improvements were observed in the 22 health facilities: 41% decongestion in the three most overcrowded hospitals and comparable increase in use of lower level facilities, sixfold increase in quality of care, and overall reductions in facility-based maternal mortality ratio (47%) and stillbirth rate (19%). Conclusions This collaborative, multipartner, multilevel real-world implementation, led by the local government, leveraged structures in place to strengthen the urban health system and was sustained through a decade. As depicted in the theory of change, it is highly plausible that this complex intervention with the mediators and confounders contributed to improved distribution of workload, quality of maternity care and survival at birth.
Original language | English |
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Article number | e004022 |
Pages (from-to) | 1-10 |
Number of pages | 10 |
Journal | BMJ global health |
Volume | 6 |
DOIs | |
Publication status | Published - 21 Jan 2021 |
Funding
Extensive investments were made to create a conducive environment for care through improved infrastructure: building operating theatres, improving flows and privacy, as well as gap filling of essential equipment and supplies. Access to safe provision of blood, anaesthesia and surgery was improved. Initial support was through donor-funded NGOs; however, from 2016 it was supported by the Ministry of Health and Social Welfare through the local government (online supplemental file 4). Acknowledgements We would like to recognise the leadership of DSM regional and municipal health offices, the health facility management teams of the 22 CCBRT partner health facilities, the management of CCBRT, the CCBRT maternal and newborn healthcare team, and the healthcare providers in the 22 HFs for accepting the interventions and their care for mothers and newborns in DSM. Special appreciation to Joel Missangu, who worked with BSD to develop figures 2 and 3, and Elizabeth Mrema for compiling the data on training (online supplemental file 3) and Sidney Mboya for support in developing online supplemental file 2B and figure 2B. The multiple interventions (online supplemental file 2) were funded through CCBRT and made possible by the generous support of the European Union/ CBM (2010–2014), Australia CBM (2011–2015), Global Affairs Canada (2014– 2019) and USAID/Vodafone (2015–2019). The authors acknowledge all partners and the implementations’ funders listed in online supplemental file 1. Funding This article is based on work done by the CCBRT maternal and newborn healthcare programme through the donors acknowledged and those listed in online supplemental file 1. The retrospective analysis is part of the PartoMa Project, which is funded by the Danida Fellowship Centre, Ministry of Foreign Affairs of Denmark (Danida project 18-08-KU).
Funders | Funder number |
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Australia CBM | |
USAID/Vodafone | |
European Commission | |
Danida Fellowship Centre | |
Udenrigsministeriet | 18-08-KU |
Udenrigsministeriet | |
Global Affairs Canada |
Keywords
- health services research
- intervention study
- maternal health
- public health