Replicating the MamaToto Program in Rural Tanzania (IMCHA)
Programs and partnerships
Lead institution(s)
Summary
This project will address high maternal and newborn mortality in Tanzania by adapting and implementing a maternal and newborn health intervention approach that follows the MamaToto process.
Health care in rural TanzaniaRead more
This project will address high maternal and newborn mortality in Tanzania by adapting and implementing a maternal and newborn health intervention approach that follows the MamaToto process.
Health care in rural Tanzania
The rural regions of Geita and Mwanza have some of the worst maternal and child health indicators in the country. Local health facilities are under-resourced and possess limited management capacity. While the national policy calls for a community health-worker program, the reality is that there are gaps in coordinating and implementing community health services at local levels.
Community health-workers have limited training and supervision. The Government of Tanzania's new commitment to improving mothers and children's well-being needs evidence that will support the creation of stronger health systems through community-based interventions.
The MamaToto approach
This project draws on the low-cost MamaToto (mother-baby) process implemented in Uganda, where substantial gains in maternal and child health were achieved. These gains took place through an approach that strengthened services at health facilities and within communities.
This project will implement and evaluate a modified version of MamaToto in rural Tanzania, aligned with the country's current policy guidance for community health services. The project team will engage district leaders, strengthen facility services, and develop the role of community health workers. They will demonstrate if and how community-based interventions can reduce maternal and child mortality by effectively bringing low-cost program efforts to scale under government leadership.
This project aims to scale up national maternal and child health programs that will improve survival rates for mothers and children. Based on these interventions, the project team will develop an implementation package that includes lessons learned, tools, and other materials to allow other jurisdictions to undertake similar initiatives.
Project partners
This project is part of the Innovating for Maternal and Child Health in Africa program. The program is a seven-year $36 million initiative funded by Foreign Affairs, Trade and Development Canada (DFATD), Canada's International Development Research Centre (IDRC), and the Canadian Institutes of Health Research (CIHR).
Research outputs
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In this study, six healthcare providers assessed and scored 42 training scenarios. Raters identified average test proficiency 50% of the time. Experts in the field of clinician-based training for frontline staff recommend that all examiners undergo rater training prior to becoming an Objective Structured Clinical Examination (OSCE) assessor. Helping Babies Breathe, Essential Care for Every Baby and Bleeding after Birth are standardised training programmes in maternal and child health care. Studies examining the reliability of assessments are rare. This study shows that rater training is critical to ensure that the potential of training programmes translates to improved outcomes for mothers and babies.
Mama na Mtoto activities in Tanzania included meetings, equipment provision, facility upgrades, training, mentorship, and technical assistance to improve maternal, child and newborn health (MNCH). Health workers refreshed their basic emergency obstetric and newborn care skills, and received training and mentorship on data use and management. District health managers and facility supervisors participated in leadership training, oversaw facility-based improvements, and action planning initiatives. Carefully selected and integrated district, facility and community-level MNCH activities strengthen capacity and can significantly improve service quality and care-seeking over a short period of time.
The Mama na Mtoto initiative aims to improve maternal, newborn, and child health (MNCH) in Misungwi and Kwimba Districts (Tanzania) through a variety of activities, including development of clinical capacity at health facilities. Using simulation, teams can practice managing emergency cases in a safe and controlled environment with supportive coaching. Simulation events were used to refresh MNCH clinical care skills through 5-day workshops for 200 health workers.
Project activities supported improvements to district health systems, provided training for health workers in clinical and management skills, and deployed a network of maternal, newborn, and child health (MNCH) community health workers (CHWs) to support mothers, babies, and their families. This brief outlines and reviews research and monitoring conducted throughout the implementation phases of the project.
System readiness approaches move towards better understanding and managing challenges that governments and development partners face in advance of programme delivery. The Maximizing Engagement for Readiness and Impact (MERI) Approach is the focus of this brief. The term “system readiness” is used in implementation science, rather than “system strengthening.” Readiness theory suggests that motivation factors are critical in implementation. For example, if there are gaps identified in leadership capacity, one would incorporate and emphasize strategies to build leadership skills within implementation activities and to encourage leader buy-in. Because general capacity and motivation are improved, beneficiaries are more ‘ready’ to take on other interventions.