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Manifesto for Maternal Health: In-Country Perspective From the White Ribbon Alliance Tanzania

By: Rose Mlay, National Coordinator, The White Ribbon Alliance Tanzania

Throughout my career as a midwife, I am all too familiar with the challenge of women arriving too late to the hospital to give birth. Over and over again, I have attended to women who had traveled for days to reach care. It is so heart breaking to know that these women’s lives could be saved if only they could reach quality professional care faster. We, at the White Ribbon Alliance, have advocated strongly over the years to our government in Tanzania to focus on maternal and newborn health, and great promises have been made! Now, we are faced with the challenge of making sure these promises are delivered. And we are working hard on that front!

In recognition of the one-year anniversary of the publication of the Manifesto for Maternal Health, I’d like to take this opportunity to share some of our recent efforts to ensure that promises to women and newborns are kept.

Just last year the White Ribbon Alliance Tanzania brought together national leaders engaged in maternal and newborn health ranging from the media, government, non-governmental organizations, and professional associations to set out a strategy for holding the government of Tanzania accountable for delivering on commitments made to our women and newborns. More specifically, we collectively set out a plan for holding the government accountable on promises to provide comprehensive emergency obstetric care (CEmONC) in at least half of all health centers by 2015. Together, we concluded to focus our efforts on the commitment to CEmONC because we listened to our citizens who have asked for these services to be closer to their homes. In addition, we know that the majority of the 24 women who die every day in childbirth die due to the lack of access to quality emergency care.

In order to make our case, we knew we would need strong evidence to show the government just how off track their promises are, so we carried out a full facility assessment in 10 government-run facilities in Rukwa region. We engaged with community leaders, media and district officials as we moved through the region. Rukwa is beautiful with its rolling hills and great lakes, but it is a treacherous journey through the dirt tracks to get to rural health centers, with many being so remote that they are out of reach of telephone signals.

As we gathered the data, we found that for a population of 1 million people, and over 10 health centers throughout the district, there was not a single health center that was providing the level of care that the government had promised.

According to plan, we shared the evidence with the district government teams, and we pushed the district leadership to budget adequately for emergency obstetric care. In the meantime, we also set up meetings with national leaders and the Parliamentary Safe Motherhood Group to make sure emergency obstetric care is budgeted for adequately in the 2014-2015 budget cycle.

We also made this film about the situation in Rukwa which Dr. Jasper Nduasinde, our White Ribbon Alliance focal person from the region took to the United Nations General Assembly to get global attention on the gap between promises and implementation.

We called on our politicians to act. The Safe Motherhood Group in Parliament is working to get all politicians to sign a petition to the government to prioritize this issue.

We called for a meeting with the Prime Minister. We spoke for an hour and a half on what could be done now to change this critical situation. He promised to take action.

We also made this film about Elvina Makongolo, the midwife in Mtowisa who works tirelessly to save women’s lives.

As we move to make these critical changes happen, we are faced with very sad news that motivates us even more. Shortly after this film was made with Elvina, the teacher of her grandchildren died in childbirth. Leah Mgaya died because Mtowisa health center does not have a blood bank. In the maternity ward of the health center ,a big refrigerator stands tall but the electricity to power it is missing. The closest blood supply is 100 km away at the regional hospital, reached only by a 4×4 vehicle due to the rough terrain.

Leah’s husband, Cloud Kissi, said: ‘My wife has left a big gap in my life and she has left three children without a mother. It has left me with trauma as every time I see a woman carrying a baby I feel that if my wife could have survived, she could have been carrying a baby like the one I am seeing. I am quite sure that if we had a good operating theater, availability of safe blood and a reliable ambulance, we would have surely saved my wife’s life.’

We continue to hear the personal accounts of husbands losing their wives, children losing their mothers, families losing their aunties, sisters and nieces and, in Leah’s case, a community losing their teacher. Citizens want change and they are pushing for it.

In Rukwa alone, over 16 thousand citizens have signed a petition pushing the district officials and their MP to prioritize a budget for CEmONC.

Recently, on White Ribbon Day in Rukwa, the Minister of Health spoke on behalf of the Prime Minister to say that this budget must be prioritized across the country.

We now believe that the Prime Minister has become this campaigns’ greatest ally! And we know that our President Kikwete cares about the women of our nation. He has committed greatly to preventing these tragic deaths. But we cannot let up until women can access emergency life saving care near their homes. It is their right.

As critical decisions are being made on budget allocation for 2014-2015, we are urging our leaders to listen to the citizens of our nation and budget adequately for comprehensive emergency obstetric and newborn care.

If you would like to share your in-country story with us, please email Natalie Ramm or join the conversation on Facebook and Twitter.

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