ANC in Tanzania: improving high impact measures to reduce maternal and newborn mortality

Scholastica Chibehe Midwifery Advisor Jhpiego, MAISHA

Importance of ANC:
Achieving good outcome for mother and baby: Early detection and provision of treatment for existing diseases supporting clients in developing individual birth plan and complication readiness Nutrition support during pregnancy Preventive measures including TT, IPTp, PMTCT, ITN, de-worming, Iron and Folic acid etc.

Background

QoC Study on Maternal and Neonatal Health Services

Multi-country study First study was conducted in 2010 Second study was conducted in 2012

Study Overview

Objectives:
To capture proportion of women and newborns receiving key maternal health services To assess knowledge on maternity and ANC best practices (including neonatal resuscitation) To assess availability of key drugs and supplies for ANC and maternity services

Tanzania Overview
Survey conducted in 12 regions, 50 health facilities(not nationally representative) 12 regional hospitals , 31 health centers and 7 dispensaries ANC data collected from 48 health facilities Training on data collection tools and methods

Study design
The study used combination of approaches: Observation of deliveries and ANC consultations Inventory of health facilities where drugs and supplies are stored Record review of service statistics Knowledge and skills assessment of providers

A simulated resuscitation of newborn using a model

Key services in ANC

n=385 2010, n=361 2012
100 90 80 70 60 50 40 30 20 10 0

93

82

75

82
60

76

82

70 46

69

66

75

Hospital

HC/Disp

Hospital
2010

HC/Disp
2012

Hospital

HC/Disp

BP taken

Cunselling for FP

Oered TT

Preventative services
n=385 2010, n=361 2012
86 84
73
100 90 80 70 60 50 40 30 20 10 0

63
54

72

72

76 67 59

41

43

Hospital

HC/Disp

Hospital

HC/Disp

Hospital

HC/Disp

SP for IPT

Blood test for syphilis 2010 2012

Counseling and tesIng for HIV

Counseling on IPTp
n=385 2010, n=361 2012
77 51 33 33 11 HC/Disp Hospital HC/Disp Hospital HC/Disp 38 41 41 77 90 80 70 60 50 40 30 20 10 0 74 74

10
Hospital

Explain possible side eects

Explain how to take 2010 2012

Explain the purpose of tratment

Counseling on Fe/Fo
n=385 2010, n=361 2012
80 70 60 50 40 30 20 10 0 Hospital HC/Disp Hospital HC/Disp Hospital HC/Disp Explain possible side eects Explain how to take 2010 2012 Explain the purpose of the treatment

68 59

63

57

62 54

33

35 18
22

19 10

Pre-eclampsia screening
2010 REGIONAL HOSPITALS n=87* 2012 REGIONAL HOSPITALS n=79* 2010 HEALTH CENTRES/ DISPENSARIES n= 298 2012 HEALTH CENTRES/ DISPENSARIES n=361*

COMPONENTS OF SCREENING

Ask about headache or blurred vision Ask about swollen hands or face Take the client's blood pressure

33 25 93

49 45 82

22 21 75

49 45 82

Counseling on Danger Signs

n=385 2010, n=361 2012

Return if swollen hands and face

HIV testing for ANC clients

SERVICE BY HEALTH CARE PROVIDER
REGIONAL HOSPITALS n=88 HEALTH CENTRES/ DISP n=303 ALL HEALTH REGIONAL ALL FACILITIE CENTRE HOSPITALS FACILITIES S S/ DISP n=72 n=351 n=391 n=279

Perform, inquire about or refer for HIV test Provide or refer for counselling related to HIV test

72% 67%

65% 56%

66% 59%

84% 76%

86% 67%

86% 69%

Recommendations
The study shows there is an improvement in Maternal and Neonatal health Services. In collaboration with the MOH together other stakeholders, the following should be addressed Ensure continuous availability of all necessary equipment, supplies and medicines (BP machines, FeFol, SP, etc) Strengthen interpersonal communication skills at inservice and pre-service training for improved counselling.

Recommendations
Increase number of qualified health personnel for ANC and other maternal health services Improve supportive supervision coaching and mentoring to support high quality provision of care Strengthen linkage between health care facilities with community to improve quality of care

Acknowledgements
Other authors: Scholastica Chibehe; Gaudiosa Tibaijuka; Christina Makene; Marya Plotkin; Dunstan Bishanga; Maryjane Lacoste; Sheena Currie
Study teams: Jhpiego staff from MAISHA project and Baltimore, Ministry staff and staff from health facilities Institutions: Reproductive and Child Health Section, Ministry of Health and Social Welfare, Tanzania; Jhpiego Tanzania; Jhpiego Washington DC
This presentation is made possible by the generous support of the American people through the United States Agency for International Development (USAID) Cooperative Agreement No. 621-A-00-08-00023-00. The contents are the responsibility of the Mothers and Infants, Safe Healthy Alive (MAISHA) program and do not necessarily reflect the views of USAID or the United States Government.