Dunstan Bishanga | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: More than 40% of maternal and new-born deaths occur in the first 24 hours after birth, reinforcing the critical need for improved maternal and newborn care on the day of birth. The USAID-funded MAISHA program supported the Ministry of Health to improve a package of high-impact interventions on the day of birth through Basic Emergency Obstetric and Newborn services at a national scale in Tanzania.

Methodology: Following policy revisions, a multi-faceted program to improve a package of minimum services for mothers and newborns was supported in 23 hospitals and 219 lower level facilities Tanzania Mainland. Key program elements included clinical competency-building, commodities procurement, and a continuous quality improvement process. A mixed methods baseline and end-line facility survey (2010 and 2012) assessed program progress to improve prevention, identification and management of major causes of maternal and newborn deaths.

Results: Mean adherence with best practices increased by 27% for danger signs evaluation at initial assessment of women in labour, by 38% for Pre-Eclampsia/Eclampsia screening and by 13% for use of partograph. Explaining care and findings to clients went up but giving clients a chance to ask questions & to have a companion of choice remained low. Availability of oxytocin rose to 99% on average, although some facilities opted to use a uterotonic other than the recommended oxytocin. Both baseline and follow-up had high achievement in cord care, wrapping and drying of the infant. Placing the newborn on the mother’s abdomen immediately after birth to warm the baby had 35% increase overall while helping to initiate breastfeeding increased by 42% overall. Low provider knowledge, unavailability of basic equipment and low levels of client monitoring were observed. Providers more frequently washed hands after client examination in labour (90%) than before initial assessment (70%).

Conclusion: Quality health care is every woman’s right. Use of an observational assessment of labor and delivery, which is rarely done, allowed documentation of major improvements in delivery care. This comprehensive program demonstrated achievements in provision of a day of birth package for mothers and newborn. Future assessments should cover whole package including newborn immunization and MNH/FP before discharge.