Photo Essay: Citizens demand quality care for reproductive maternal and child health in Tanzania
Photos and Story by Anna Sawaki
Following an increase in maternal deaths in Tanzania, citizens are demanding improvement in the quality of care provided at health facilities to save the lives of mothers and newborns. According to Tanzania Demographic Health Survey 2015-16, 556 women out of 100,000 die due to childbirth-related complications. This number has increased from 458 per 100,000 live births between 2010-15. White Ribbon Alliance Tanzania (WRATZ) provides important opportunities for people to identify challenges and solutions directly with government officials.
WRATZ PROVIDES SOCIAL ACCOUNTABILITY PLATFORM: With support from White Ribbon Alliance for Safe Motherhood Tanzania (WRATZ), citizens from Kihinga Village in Ngara District, Kagera Region, met with district and regional leaders to discuss what needs to be done to provide quality health care in their area. In 2017, there were 73 maternal deaths in Kagera Region and seven of them were from Ngara District. In photo, Hon. Adronizi Emmanuel, Kibogora Ward Executive Officer talks to citizens. He requested them to be responsive when they are referred to Bukiriro Health Center or Rulenga Hospital since the current dispensary (Kihanga Dispensary) is small and has only two service providers.
THERE IS NEED FOR MORE SKILLED HEALTH WORKERS: A woman demands for more skilled health workers at their dispensary. There is only one dispensary (Kihinga Dispensary) with one nurse and one medical attendant who serve more than 7,000 people from three different villages.
LACK OF TRANSPORT IS BARRIER TO QUALITY CARE: Mr. Badogeza Dominic speaks about how distance to a health centre can cause maternal death during an emergency. He narrated his experience in helping a pregnant woman get to a health facility. Badogeza owns a car and was called in the middle of the night to help transport a woman experiencing severe bleeding after delivery, that Kihinga dispensary could not manage. The new mother was referred to Bukirilo Health Centre about 7 km away. When they arrived at Bukirilo Health Centre, the mother could not be helped due to lack of blood transfusion services. Badogeza had to take the new mother to Rulenge Hospital, another 15 km away. Unfortunately, the woman died on arrival at Rulenge Hospital. He felt sad on losing the new mother after all the effort different people had put in to save the mother’s life. Badogeza called on government to make sure there are ambulances ready to transport women and other patients in case of emergencies, especially in rural areas.
ADDRESS DISRESPECT AND ABUSE: Zainabu Damian requested nurses to stop being cruel and treat patients with dignity and respect. Lack of respectful maternity care was highlighted as one of the issues that affect provision of quality care. Damian narrated how she came for Antenatal Care (ANC) but had no ANC card. She was told to pay a fine of TShs5,000 (USD 2.2) for not having an ANC card. Despite paying the fine, she did not receive the services and was rudely told by the nurses to go to another health center.
BIRTH PREPAREDNESS IS STILL LACKING. Simon Omary requests for quality services at the near-by health facility so that pregnant women receive quality and dignified services despite their financial constraints. Due to geographical location of Kihinga Village, transport to Bukirilo Health Centre is TShs10,000 (USD 4.4). With the poverty in the region, many citizens cannot afford this amount of money. In case of an emergency, it is very difficult for women to access quality services from Bukirilo Health Centre because most of them are not prepared.
LABORATORY SERVICES NEEDED: Kihinga Dispensary does not currently have a laboratory. Rajabu Simon requests for availability of laboratory services and asks that pregnant women be educated on importance of testing for malaria during their first ANC visit and be given SP malaria tablets and prevent malaria. It was revealed that most pregnant women come late for ANC visits, often at six or more months. When such women get malaria, they end up becoming anaemic.
IMPROVE REFERRAL SYSTEM: Veronica Salim raised concern about the long distance to the health centre. She also complained about the poor referral system from the dispensary to Bukiriri Health Center. When they get to Bukirilo, health workers complain that they just come to finish their medicine and are sent back to their dispensary without much help.
BIRTH PREPAREDNESS IS KEY: Machtilda Byambwene, Ngara District Reproductive and Child Health Coordinator (DRCHco) emphasized birth preparedness, which includes setting aside some money for emergencies, male involvement from the beginning and knowing where the woman will deliver among others.
CITIZENS COMMIT: At the fore front of ensuring quality care are the citizens themselves. Kihinga citizens pledged to work with the government to make sure that they build a functional health centre close to them. Methodius Bwampamia said Kihinga citizens are more than ready to provide manpower and make sure they build a health centre close to them.
GOVERNMENT COMMITS: Hon. Luten Canal Michael Mtenjele, Ngara District Commissioner agreed to act to make sure the mentioned demands are taken care of by the government. He said they will start by upgrading two health centres to provide CEmONC services, which will ensure availability of quality care.