WRA Tanzania Efforts Result in 50% Budget Increase for Maternal & Newborn Health
Pregnant with her sixth child, Judith Akili had no option but to leave her 15-year-old daughter in charge of her three siblings, aged 12, 10 and seven. At 40-years-old, Judith was at risk of a ruptured uterus and post-partum hemorrhage and chose to stay at Chikande Maternity Waiting Home, where they could handle any emergency needs. But she was worried about staying away from her young children and taking her oldest out of school to care for them. Judith has been at the facility for three weeks.
“I spend every night staring at the ceiling and sometimes I cry when I think of my little girl performing all those adult responsibilities. She has to cook and take care of her siblings. The problem comes when she is in school and cannot cook. Her sisters and brother go back home for lunch and there is nothing to eat so they go back to school hungry. None of them will perform well in their school work. This is killing me,” Judith grieved. “I wish the services we are seeking here at the regional hospital could be near our home.”
Judith’s story echoes that of many Tanzanian women who lack access to basic and comprehensive emergency obstetric services at health centers near their homes. With 30 women dying every day from pregnancy and childbirth-related complications in Tanzania, many do not feel confident about surviving childbirth and must often make what feels like the difficult choice between dying or staying at distant maternity waiting homes for long periods of time.
Out of the 700 health centers in Tanzania, only 117 — roughly 16% — provide emergency maternity services. On a mission to improve maternal and child health in Tanzania, White Ribbon Alliance Tanzania (WRA Tanzania), together with its partners and champions, launched a campaign to bolster the budget for maternal health with the slogans, “Zero Tolerance to Maternal Death: BE ACCOUNTABLE,” and “Social Accountability for Reproductive, Maternal, Newborn, Child and Adolescent Health.”
The goals included the allocation of more financial resources for Comprehensive Emergency Obstetric and Newborn Care (CEmONC) and to put in places measures to protect the budget once allocated, also called ring fencing. Additionally, the idea of social accountability for maternal, newborn, child and adolescent health was embedded in all the discussions around the campaign. Fifteen months later, WRA Tanzania and partners had cause to celebrate.
With the campaign formally launched in March of 2016, WRA Tanzania and partners were overjoyed when the FY2017/2018 budget was released in June 2017 with a 52.6% increase in the budget for maternal and newborn health from the previous year. This historic increase specifically targeted areas vital to the survival of women and their newborns during pregnancy and childbirth, including the availability of oxytocin, magnesium sulphate, and safe blood services including blood banks and satellite locations for blood donation. Additionally, the Minster of Health, Hon. Ummy Mwalimu, says there are plans to combine government and World Bank resources to upgrade 150 health centers so that they have the capacity to provide emergency services. If the Minister’s plan is implemented this year, the percentage of health centers providing these services will increase from 16.7% to 38%. The goal is to make that number 50% by 2020.
Multi-Pronged Strategy Employed
To arrive at this historic budget increase, WRA Tanzania used various strategies to influence different decision makers crucial to the budget allocation process. One strategy was to put a human face on the issue by arranging to have 12 pregnant women attend a parliamentary session as special visitors just as the Ministers presented their budgets. Because these budgets were about resources for women’s, children’s and adolescents’ health, the presence of women conveyed the stark message that while they were alive and present that day with parliament, without resources they could die, just like the thousands of women and their newborns who die every year in Tanzania.
WRA Tanzania’s campaign included several other meetings and activities which were meant to recognize White Ribbon Day, a national Remembrance Day which commemorates those who have lost their life in childbirth. One activity was a high-profile climb to the top of Mt. Kilimanjaro, where advocates left a sign about the WRA Tanzania campaign at UHURU Peak, something they were granted special permission to do.
Advocacy Meeting on CEmONC Budget with Regional and District Authorities
They also organized budget advocacy meetings with regional and district authorities and specifically with the Minister of Finance and Planning. Through these efforts, they secured commitments to improve maternal health from various officials.
The meetings reached all regional administrative secretaries, planning officers, medical officers and some district medical and planning officers from the 28 provinces of Tanzania, with support from the President’s office and regional and local governments.
The regional and district authorities committed to increase the CEmONC budget and number of health workers, while also improving infrastructure, supplies, medicines and equipment. They even convinced some of the donors to build surgical theaters and labor wards.
The regional administrative secretary from Rukwa got everyone’s attention when he said, “Let’s not approve district budgets which do not address mothers’ and newborns’ issues, let us not wait for Members of Parliaments to disapprove our budgets, let us not be ashamed to cut down allowances and refreshments and start the business of saving mothers and newborns’ lives.”
Advocacy Meeting on CEmONC Budget with Parliament Standing Committees of Budget, Community Development and Local Government and Councils
WRA Tanzania was privileged to hold a brief conference with three Parliament standing committees, including the Budget Committee where they promised to carefully examine the budgets and ensure that the full spectrum of maternal health — and specifically emergency maternity services — were prioritized in each of the council and central government plans. The committee members agreed, and the Honorable Sevelina Mwijage (MP-Special Seats Kagera) said, “WRA Tanzania has opened our eyes today. It is a sad oversight, how women are dying when giving birth and yet the budget to solve the calamity is not prioritized.”
The legislature acknowledged that emergency maternal health services had not been prioritized, and that they have a responsibility to ensure that no other woman loses life when giving birth, and called for adequate funding in the 2017/2018 budget. WRA Tanzania also directly reached out to the Minister of Finance, requesting that he do three specific things:
- Protect the CEmONC budget as it goes from Treasury to the Councils so it is not used for other competitive needs.
- Ensure that 5% of VAT and 5% of Other Charges be allocated for emergency maternity services.
- Consider disbursement of the approved CEmONC budget to councils on time for every quarter.
International Day of the Midwife with Hon. Sameer Suluhu, Vice President of Tanzania
WRA Tanzania also tied in activities from International Day of the Midwife, which falls every year on May 5th, to their campaign, as midwives are vital to ensuring quality care for pregnant women and their newborns.
“Midwives are the first people who meet us as we come to the earth,” said Vice President of Tanzania, Hon. Sameer Suluhu, during an International Day of the Midwife event. “God creates us; midwives help us come to live on the earth. Not only that; midwives took commendable care of me and my children. I respect you midwives,” she said.
Hon. Sameer went on to endorse a standalone course for midwifery, something which WRA Tanzania and other maternal health advocates in Tanzania have been pushing for. “I direct the Ministry of Health to work on a curriculum to ensure midwives study to become midwives and nurses to become nurses. The integrated nurse/midwifery course may not suffice to have competent midwives to ensure women and newborns survive childbirth,” she implored.
Throughout this campaign, WRA Tanzania realized that every speech made, activity organized and relationship built was equally important, and that without funding from the WRA Global Secretariat and UNICEF, and support from Parliamentarian Group for Safe Motherhood, the Directorate of Parliament Coordination, the Ministries of Health and Local Government, WRA Tanzania member organizations and many others, the campaign would not have been as successful. This historic budget increase is an important step in achieving WRA Tanzania’s goal of Tanzania becoming a country where the right of women to be safe during pregnancy, childbirth and post childbirth is upheld.