Comprehensive Emergency Obstetric and Newborn Care: The Proven Approach in Tanzania
By Rose Mlay, National Coordinator, WRA for Safe Motherhood in Tanzania.
Comprehensive Emergency Obstetric and Newborn Care services, more commonly known as CEmONC, are the interventions provided to pregnant women and newborns experiencing fatal complications, including severe bleeding, infection, prolonged or obstructed labor, eclampsia, and asphyxia in the newborn. CEmONC interventions include safe blood transfusion, providing oxytocin and antibiotics, performing cesarean sections, manual removal of the placenta, assisted vaginal delivery, abortion and resuscitation of the newborn.
These comprehensive services are the only proven approach to saving the lives of the 75% of women who die while pregnant and giving birth and the 25% who die after birth; providing CEmONC at health centers has been found to encourage Tanzanian women to give birth at health facilities instead of at home, where they run the risk of losing their lives with often unskilled personnel. The availability of CEmONC services also persuades women to give birth safely while being looked after by trained professionals. The best example of CEmONC’s effectiveness comes from the Rukwa Region of Tanzania. Before CEmONC services were available at health centers there, only 30% of pregnant women gave birth at health facilities (DHS, 2010), but after the 3-year WRA Tanzania campaign from 2013 to 2015, 5 out of every 10 health centers now provide CEmONC, and 65% of women now give birth at health facilities DHS, 2015). This is a truly successful intervention.
CEmONC’s other gift showed up as I watched a documentary aired by one of the most popular and reliable television shows in Tanzania earlier this year. The documentary focused on one of the poorest districts in Tanzania called Kakonko, in the Kigoma Region. They filmed in a health center that had been upgraded by one of the WRA Tanzania member organizations to provide CEmONC services and featured interviews with pregnant women and health workers in Kakonko. Unlike before, the pregnant women were now expecting safe deliveries. It touched me to hear the medical officer in charge telling my fellow Tanzanians that before CEmONC was available at that health center, they experienced 4–5 maternal deaths per month. But, after CEmONC was introduced, there had not been any maternal death for more than a year — and neither they do not expect one. He went on to say that the number of women who gave birth at that facility before CEmONC was available was 30 per month. After CEmONC became available, the number raised to 160 per month. This is a 533% increase, meaning 5.3 times as many women were giving birth in their facility, and not one single death had been observed. CEmONC truly has a “wonder working power” and it is helping WRA Tanzania reach its 2016–18 advocacy campaign theme of “Zero Tolerance to Maternal Deaths, Be Accountable.”
The White Ribbon Alliance for Safe Motherhood in Tanzania was so successful in advocating for CEmONC at health centers in Rukwa Region between 2013–2015 that now 50% of all health centers there provide these life-saving services, which is also in line with the government own 2008 commitment promising that by 2015, 50% of its 700 health centers would provide CEmONC. But, this is 2016 and still only 22% — 159 in total — of the nation’s health centers provide CEmONC. While many regions were unable to reach the CEmONC goal, WRA Tanzania’s advocacy strategy ensured that Rukwa was able to achieve the government’s commitment. We therefore do not see any reason why we should not advocate for CEmONC at health centers in all 26 regions of the Tanzanian mainland.
This year, we started with a popular launch of the 2016–2018 advocacy campaign on March 15 — White Ribbon Day — where the Vice President of the United Republic of Tanzania was invited to implement this task. WRA Tanzania engaged citizens to speak for themselves through live TV shows in which 100 citizens demanded the government ensure all women access CEmONC by budgeting for these services adequately. The following day, the Minister of Health called a Press Conference to address some of the issues raised, proving that the demands were heard and seen by decision makers. We went on to train journalists and to urge them to report on maternal deaths, including causes, so that action could be taken. One journalist reported a maternal death and the reason was she had no funds to pay for cesarean section. She and the unborn baby died. Because this was in the newspapers, the District Medical Officer has taken up the case. We did not end there. We convened a meeting with the Parliamentarian Group for Safe Motherhood where the Minister of Health honored us all with a promise that she will build 100 operating theaters at health centers before she leaves office. We noted this commitment and will follow-up.
We have plans to convene a meeting with all 26 regional commissioners of Tanzania for the same purpose. We have found out from the Comprehensive Council Health Plan that local governments are not budgeting and funding CEmONC. We want to influence the Regional Commissioners to ensure their regions allocate enough funds to CEmONC so that all Tanzanian Women access these life-saving services before, during and after childbirth.
WRA Tanzania will not stop until we achieve Zero Tolerance to Maternal Death. We want every decision maker to be accountable for the 24 women dying needlessly in childbirth every day in Tanzania. Availability of CEmONC services works wonders in saving lives and it must be a priority for district, regional and national health plans in order to receive adequate funding. What compares to saving a life? Nothing. Mothers and newborns have the right to live like every other human being. Pregnancy is not a disease meant to kill; rather it should be a healthy process. And so, we demand “Zero Tolerance to Maternal Deaths, Be Accountable” and ensure CEmONC is funded adequately. Life depends on it.