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Increasing access to quality focused ANC: Tanzania experience 2000/07. FLEMAFA Conference, Kisarawe Gaudiosa Tibaijuka Senior Midwifery Advisor 31 Aug 2007. Objectives of FLEMAFA Conference. Raise awareness regarding issues contributing to Maternal and Newborn morbidity and mortality. - PowerPoint PPT Presentation
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JHPIEGO in partnership with Save the Children, Constella Futures, The Academy for Educational Development, The American College of Nurse-Midwives and Interchurch Medical Assistance
Increasing access to quality focused ANC: Tanzania experience 2000/07
FLEMAFA Conference, Kisarawe
Gaudiosa Tibaijuka Senior Midwifery Advisor
31 Aug 2007
Objectives of FLEMAFA Conference
Raise awareness regarding issues contributing to Maternal and Newborn morbidity and mortality.
Share efforts underway to improve maternal-newborn-child health in Tanzania and Kisarawe in particular
Hear from selected RCH partners in Tanzania (WRA, ACCESS/JHPIEGO)
Identify ways to improve efforts done by MOHSW and other reproductive and child health partners
Generate and share plan of action demonstrating the commitment of all participants to continue engagement within the local community and among individuals and organizations participating in the conference) in Kisarawe District
Objectives of Focused ANC presentation
Share ACCESS/JHPIEGO experience in providing technical
assistance to the MOHSW in the implementation of Focused ANC
National Programme including malaria and syphilis in pregnancy
through:
Introducing ACCESS Programme
Describing the rationale for focused ANC
Listing Partners and collaborators in Focused ANC
Listing strategies used in implementing strategies used in implementing FANC programme irogramme in Tanzania
Share program achievements and results
Discuss challenges and opportunities
“I’m going to fetch a baby. It’s a dangerous journey and I may not return.”
~ Traditional African saying
This conference is the beginning of a journey … for us and for her representing women in Kisarawe!!
Are we committed to making her journey/ their journey safe?
Introduction
ACCESS is a five-year global program in its third year of implementation aimed at reducing maternal and newborn deaths and improving the health of mothers and newborns
JHPIEGO in partnership with Save the Children, Constella Futures, The Academy for Educational Development, The American College of Nurse Midwives and Interchurch Medical Assistance.
Focused Antenatal Care
An approach to ANC that emphasizes Evidence-based Goal-directed actions Individualized woman-centered
care Quality versus quantity of visits Care by a skilled provider
Goal of Focused Antenatal Care
To promote maternal and newborn health
and survival through Early detection and provision of treatment for existing
diseases
Promotion and maintenance of the physical, mental and social health of mother and baby through enhanced interpersonal skills on nutrition, PMTCT etc.
Development of individual birth plans and complication readiness plans.
Early detection and management of complications during pregnancy, labour, delivery and post partum through identification of danger signs
Partners
Ministry of Health and Social Welfare at all
levels
National- RCHS, NMCP, NACP, HSIU and HRDD
Zonal- ZRCH teams, ZTCs
Regional- RHM teams
District- DHM teams and others
Other Collaborating Organizations: White Ribbon Alliance IMA CSSC and other Tanzanian FBOs JSI/DELIVER
Routine practices proved not to be significant
Numerous visits
- Burdens women and health care system
- Reduced number does not seem to affect pregnancy outcomes (WHO multi-center study, Villar et al 2001 )
Some measurements and examinations
Care based on risk assessment
Risk Approach
Not an effective ANC strategy because
Complications cannot be predicted hence, all pregnant women are at risk for developing complications
Many “low risk” women develop complications Do not know how to recognize/respond to
problems Have false sense of security
Most “high risk” women give birth without complications Inefficient use of scarce resources
FANC Best practices
• Focused antenatal visits by skilled provider• Detection and management of coexisting
conditions and complications • Birth preparedness and complication readiness
planning• Family planning, breastfeeding, danger signs,
HIV/STIs, and nutrition counseling• Tetanus toxoid• Iron and folate• Mebendazole -Helminth presumptive treatment• SP for IPT of Malaria
IPT GOAL
Presidential Malaria Initiative goal 85% IPTp uptake by 2009
MOHSW targets 60% by 2007
ACCESS is collaborating with other partners
in reaching the PMI targets for IPT coverage in
Tanzania
Birth Preparedness, and Complication Readiness
Preparing for Normal Birth Identifying a skilled attendant and place of
delivery Arranging finance, essential items Nutrition
Readiness for Complications Early detection –danger signs Designated decision maker(s) Emergency funds, communication Transport, blood donors
Tanzania Focused ANC Program Strategies and approaches
ACCESS uses Focused Antenatal Care as a platform for increasing
access to quality maternal and newborn services through:
Influencing policy change, development of guidelines and standards for Focused ANC, Malaria & Syphilis during pregnancy and Infection Prevention
Advocacy and joint planning- working with policy makers at all levels; national, regional, district and facility advocacy meetings
Partnership and collaboration with stakeholders
Tanzania Focused ANC Program Strategies and approaches cont…
Incorporating into pre service midwifery education: Curriculum and learning package development
In-service and pre-service training in public and private (Faith Based Organizations) sectors
Introducing Standards based management approach for Performance Quality Improvement (PQI)
Collaborate with community organisations mainly through White Ribbon Alliance
Program strategies and approaches cont…
Comprehensive coverage with FANC/MIP/SIP
Regional advocacy meetings
Regional TOTs for District trainers including RCH clinic in charges, RCH coordinators
District based clinical training for ANC service providers
ANC & PSE Quality improvement processes
Follow-up of trained facilities and schools using QI tools to monitor service trend
Program achievements
Policy change for Focused ANC; Malaria Intermittent Preventive Treatment, syphilis screening and treatment, infection prevention standard precaution practices
Infection prevention national guidelines, training of national core team
Job aids on FANC, Malaria and syphilis during pregnancy
Provision of integrated ANC services- PMTCT, MIP, SIP, nutrition, STIs, FP etc
RCH trainers, supervisors (zonal, regional and district RCHCos) and providers trained on Focused ANC clinical and teaching skills
Program achievements : training
Focused ANC introduced in Nursing Midwifery Certificate and Diploma national curricula
All 55 Nursing and Midwifery Schools in Tanzania updated in focused ANC clinical and teaching skills- (110 tutors and 110 preceptors)
All 22 cert schools and half of the remaining schools are equipped with training equipment, reference books and anatomical pelvic models
System for rolling out Focused ANC nationwide established
Standards-based management process for performance and quality improvement introduced to 15 regions.
Standards Based Management: A Performance and quality Improvement Model
Desired performance
Actual performance
Gap Cause analysis
Intervention identification & implementation
Indicator for success of program
Intermittent preventive treatment for malaria increased from 0% to 18.4%
50% of Tanzania households own a mosquito net
14% of families own Insecticide Treated Nets
47.1% gave birth at health facility
80% received TT at least once
61.1% received iron supplementation
94.3% received ANC from a health professional at least once.
Source: TDHS 2004/05
Challenges and Opportunities
Limited numbers of skilled providers Shortages especially of Sulfadoxine
Pyrimethamine, RPR kits Poor data management; recording, processing
and use Quality antenatal care platform suited to
introduction of other services e.g. PMTCT of HIV, Intermittent Preventive Treatment of malaria among infants
National system for expanding quality ANC in place
Thank you for active Thank you for active listening!listening!