Lessons learnt and best practices in scaling up an emergency transportation system to tackle maternal and neonatal mortality: a qualitative study of key stakeholders in Shinyanga, Tanzania.

OBJECTIVE: This study aimed to document lessons learnt and best practices for scaling up an innovative emergency transportation system, drawing insights from the m-mama programme implemented in Shinyanga, Tanzania. The m-mama pilot programme was implemented in phases from 2014 to 2016 in two districts and later scaled up to include all districts in Shinyanga region in 2017. The programme employed an emergency transportation system and technical and operational support of the health system to address the three delays leading to maternal and neonatal mortality. DESIGN: Cross-sectional, qualitative research with key healthcare system stakeholders from the national, regional and district levels. SETTING: The study was conducted in Kahama and Kishapu districts in Shinyanga, Tanzania. The two districts were selected purposefully to represent the programme implementation districts' rural and urban or semiurban settings. PARTICIPANTS: District, regional and national stakeholders involved in implementing the m-mama pilot programme in Shinyanga were interviewed between February and March 2022. RESULTS: Lessons learnt from implementing the m-mama programme were grouped into four key themes: community engagement, emergency transportation system, government engagement, and challenges and constraints in technical implementation. Stakeholder engagement and collaboration at all levels, community involvement in implementation, adherence to local contexts and effective government partnerships were identified as key drivers for programme success. Coordination, supervision and infrastructure enhancement were crucial in implementing the emergency transportation system. CONCLUSIONS: Facilitating community involvement, understanding the local context and adapting to existing structures can enhance programme ownership and utilisation. The government serves as the central coordinator, overseeing resource mobilisation and distribution. A well-executed and coordinated emergency transportation system holds promise in addressing delays and curbing maternal and neonatal mortality. Collaborative knowledge-sharing among implementers is essential for identifying best practices and gaining insights into practical strategies for addressing anticipated challenges.

Community-based transport system in Shinyanga, Tanzania: A local innovation averting delays to access health care for maternal emergencies.

In achieving the sustainable development goal 3.1, Tanzania needs substantial investment to address the three delays which responsible for most of maternal deaths. To this end, the government of Tanzania piloted a community-based emergency transport intervention to address the second delay through m-mama program. This study examined secondary data to determine the cost-effectiveness of this intervention in comparison to the standard ambulance system alone. The m-mama program was implemented in six councils of Shinyanga region. The m-mama program data analyzed included costs of referral services using the Emergency Transportation System (EmTS) compared with the standard ambulance system. Analysis was conducted using Microsoft Excel, whose data was fed into a TreeAge Pro Healthcare 2022 model. The cost and effectiveness data were discounted at 5% to make a fair comparison between the two systems. During m-mama program implementation a total of 989 referrals were completed. Of them, 30.1% used the standard referral system using ambulance, while 69.9% used the EmTS. The Emergency transport system costed USD 170.4 per a completed referral compared to USD 472 per one complete referral using ambulance system alone. The introduction of m-mama emergency transportation system is more cost effective compared to standard ambulance system alone in the context of Shinyanga region. Scaling up of similar intervention to other regions with similar context and burden of maternal mortality may save cost of otherwise normal emergency ambulance system. Through lessons learned while scaling up, the intervention may be improved and tailored to local challenges and further improve its effectiveness.

Towards sustainable emergence transportation system for maternal and new born: Lessons from the m-mama innovative pilot program in Shinyanga, Tanzania.

Maternal mortality comprises about 10% of all deaths among women of reproductive age (15-49 years). More than 90% of such deaths occur in low- and middle-income countries (LMIC). In this study, we aimed to document lessons learnt and best practices toward sustainability of the m-mama program for reducing maternal and newborn mortality in Tanzania. We conducted a qualitative study from February to March 2022 in Kahama and Kishapu district councils of Shinyanga region. A total of 20 Key Informant Interviews (KII) and four Focused Group Discussions (FGDs) were conducted among key stakeholders. The participants included implementing partners and beneficiaries, Community Care groups (CCGs) facilitators, health facility staff, drivers and dispatchers. We gathered data on their experience with the program, services offered, and recommendations to improve program sustainability. We based the discussion of our findings on the integrated sustainability framework (ISF). Thematic analysis was conducted to summarize the results. To ensure the sustainability of the program, these were recommended. First, active involvement of the government to complement community efforts, through the provision and maintenance of resources including a timely and inclusive budget, dedicated staff, infrastructure development and maintenance. Secondly, support from different stakeholders through a well-coordinated partnership with the government and local facilities. Third, continued capacity building for implementers, health care workers (HCWs) and community health workers (CHWs) and community awareness to increase program trust and services utilization. Dissemination and sharing of evidence and lesson learnt from successful program activities and close monitoring of implemented activities is necessary to ensure smooth, well-coordinated delivery of proposed strategies. Considering the temporality of the external funding, for successful implementation of the program, we propose a package of three key actions; first, strengthening government ownership and engagement at an earlier stage, secondly, promoting community awareness and commitment and lastly, maintaining a well-coordinated multi-stakeholder' involvement during program implementation.

Receiving antenatal care components and associated factors in Northwestern Tanzania.

INTRODUCTION: Tanzania had an estimated 5.400 maternal deaths in 2020. Suboptimal quality of antenatal care (ANC) presents a major challenge. It is not known what precisely the uptake of the various ANC components is, such as counseling on birth preparedness and complication readiness, preventive measures and screening tests. We assessed the level of receiving the various ANC components and associated factors in order to identify opportunities to improve ANC. METHODS: A cross-sectional household survey using a structured questionnaire through face-to-face interviews, was conducted in April 2016 in Mara and Kagera regions, Tanzania, applying a two-stage, stratified-cluster sampling design. The analysis included 1,162 women aged 15-49 years who attended ANC during their last pregnancy and had given birth not longer than two years prior to the survey. To account for inter- and intra-cluster variations, we used mixed-effect logistic regression to examine factors associated with receiving essential ANC components: counseling around birth preparedness and complication readiness (with presumed effects on knowledge about danger signs) and preventive measures. RESULTS: About In 878 (76.1%) women preparedness for birth and its complications was observed to exist. Overall counseling was low where 902 (77.6%) women received adequate counseling. Overall knowledge of danger signs was low in 467 women (40.2%). Uptake of preventive measures was low, with presumptive malaria treatment in 828 (71.3%) and treatment of intestinal worms in 519 (44.7%) women. Screening test levels varied for HIV in 1,057 (91.2%), any blood pressure measurement in 803 (70.4%), syphilis in 367 (32.2%) and tuberculosis in 186 (16.3%) women. After adjusting for age, wealth and parity, the likelihood of receiving adequate counseling on essential topics was less in women without education versus primary education (aOR 0.64; 95% CI 0.42-0.96) and in women who had <4 ANC visits versus ≥4 visits (aOR 0.57; 95% CI 0.40-0.81). Receiving care in privacy or not (aOR 2.01; 95% CI 1.30-3.12) and having secondary education as compared to primary education (aOR 1.92; 95% CI 1.10-3.70) were associated with receiving adequate counseling. Odds of receiving adequate care in at least one ANC visit were lower in women with joint decision making on major purchases versus decision making by male partner or other family members alone (aOR 0.44; 95% CI 0.24-0.78), similar to being less knowledgeable on danger signs (aOR 0.70; 95% CI 0.51-0.96). CONCLUSION: Overall uptake of various essential ANC components was low. Frequent ANC visits and ensuring privacy are all essential to improve the uptake of ANC.