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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.

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Increasing access to quality focused anc tanzania experience 2000 07

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
Objectives of FLEMAFA Conference experience 2000/07

  • 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
Objectives of Focused ANC presentation experience 2000/07

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

  • Listingstrategies used in implementing FANC programme in Tanzania

  • Share program achievements and results

  • Discuss challenges and opportunities


Increasing access to quality focused anc tanzania experience 2000 07

“I’m going to fetch a baby. It’s a dangerous journey and I may not return.”

~ Traditional African saying


Increasing access to quality focused anc tanzania experience 2000 07

This conference is the beginning of a journey … for us and for her representing women in Kisarawe!!


Increasing access to quality focused anc tanzania experience 2000 07

Are we committed to making her journey/ their journey safe? for her representing women in Kisarawe!!


Introduction
Introduction for her representing women in Kisarawe!!

  • 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
Focused Antenatal Care for her representing women in Kisarawe!!

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
Goal of Focused Antenatal Care for her representing women in Kisarawe!!

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
Partners for her representing women in Kisarawe!!

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
Routine practices proved not to be significant for her representing women in Kisarawe!!

  • 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
Risk Approach for her representing women in Kisarawe!!

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
FANC Best practices for her representing women in Kisarawe!!

  • 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
IPT GOAL for her representing women in Kisarawe!!

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
Birth Preparedness, and Complication Readiness for her representing women in Kisarawe!!

  • 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
    Tanzania Focused ANC Program Strategies and approaches for her representing women in Kisarawe!!

    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
    Tanzania Focused ANC Program Strategies and approaches for her representing women in Kisarawe!!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
    Program strategies and approaches for her representing women in Kisarawe!!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
    Program achievements for her representing women in Kisarawe!!

    • 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
    Program achievements : training for her representing women in Kisarawe!!

    • 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 for her representing women in Kisarawe!!

    Cause analysis

    Gap

    Actual performance

    Intervention identification & implementation

    Standards Based Management: A Performance and quality Improvement Model


    Indicator for success of program
    Indicator for success of program for her representing women in Kisarawe!!

    • 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
    Challenges and Opportunities for her representing women in Kisarawe!!

    • 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 listening
    Thank you for active listening! for her representing women in Kisarawe!!