Snapshots: Eliza of Tanzania

In Arusha, Tanzania, Eliza talks with a patient at the Ngarenaro Health Clinic. Learn more about EngenderHealth’s work to improve clinical quality.

Photo credit: Mark Tuschman

Spotlight on Tanzania

Kisa and Stanley, a couple in their 30s living in Arusha, Tanzania, are proud parents of five healthy children—and that was enough for them. Before EngenderHealth’s ACQUIRE Tanzania Project (ATP), with support from the American people through the U.S. Agency for International Development (USAID), partnered with their local health clinic to make a range of contraceptive options available, they were resigned to the possibility of Kisa’s becoming pregnant again—a prospect that caused her endless worry. But, according to Stanley, contraception has “helped us plan our life, and take care of our family.”

Read more at EngenderHealth.org.

The Maternal Health Task Force Announces New Grants

Innovative Maternal Health Projects to Inform National Policies

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NEW YORK, July 22--The Maternal Health Task Force at EngenderHealth announced today that it has awarded eight new grants supporting innovative maternal health research across Asia, Africa, and Latin America. The research, which will be carried out by local organizations in developing countries, will lead to national policy recommendations for improving maternal health.

Each research project will evaluate an ongoing effort to advance maternal health in places where too many women still die from preventable complications of pregnancy and childbirth. Examples of such projects include integrating maternal health care with HIV prevention and treatment, organizing support groups for pregnant mothers, and outfitting health workers in rural communities with cellular phones to facilitate emergency care for pregnant women. Following are summaries of the new grants:

In Bangladesh, scientists and nonscientists will collaborate at the International Centre for Diarrhoeal Disease Research in Bangladesh (ICDDR,B) in translating new and existing knowledge about maternal health into proposals to improve government policies and practices. They will seek consensus on identifying key questions raised by three recent research programs, ensure access to the findings, reach out to national policymakers, and build ICDDR,B capacity and visibility for future work in knowledge translation.

In India, the Centre for Development and Population Activities (CEDPA) will combat India's high maternal mortality and morbidity rates by demonstrating the value of integrating maternal health programs into HIV and AIDS programs. Using forums, workshops, and consultations, CEDPA will evaluate existing programs of the government's National Rural Health Mission, the National AIDS Control Programme, and the National Health Policy Administration in the Rajasthan area, to compile best practices and build consensus on a set of recommendations for policymakers.

In Malawi, the MaiMwana project will be a pilot effort to strengthen the current inadequate Maternal Death Review (MDR) system with a village-level program of maternal death audits. Kamuzu Central Hospital and the Mchinji District Hospital will support the formation of three-member MDR teams in each village to conduct a verbal autopsy (a structured interview) among relatives and neighbors within two days of every maternal death. Improved data will allow better analysis and service improvements and will contribute to recommendations to the Ministry of Health for a national audit procedure.

In Mexico, the Centro de Investigaciones y Estudios Superiores en Antropologia Social (CIESAS) is conducting an assessment of the Ministry of Health's Advanced Life Support for Obstetrics Program (ALSO), which manages delivery emergencies in Oaxaca. CIESAS will determine whether ALSO courses improve the technical skills and professional morale of health care providers enough to justify expanding the program nationwide.

In Peru, Future Generations, in partnership with the Peruvian Ministry of Health, will field test promising methods of reducing maternal and newborn mortality by organizing groups of pregnant women to share their pregnancy histories and experiences. In a controlled trial involving 500 pregnant women, health workers will guide the discussions, document benefits, develop a training manual and materials for possible nationwide use, hold workshops on the materials, and advocate for policy change.

In South Africa and Kenya, the mothers2mothers program, which offers education and emotional support to pregnant women and new mothers living with HIV, will field test "active client follow-up" to increase the number of HIV-positive pregnant women who return to a health care facility for care after an initial visit. In much of Africa, the return rate is low, posing a major obstacle to preventing mother-to-child transmission of HIV. Mothers2mothers will use peer "mentor mothers" to send text messages or cell phone calls to previously contacted pregnant women to urge them to make return visits. Best practices will be collected for integration into the mothers2mothers standard model used continent-wide.

In Sri Lanka, the Department of Community Medicine at Rajarata University will work to improve the collection of data on the impact of maternal death and postpartum illness, a process that is now limited to hospital reports. University researchers will develop a survey questionnaire for field testing among a sample of expectant mothers in the resource-poor Anuradhapura District, where maternal mortality rates are high. Researchers will analyze the frequency and prevalence of health events and their direct and indirect economic impacts on families, to contribute to national service delivery planning.

In Tanzania, the Ifakara Health Institute (IHI) will seek to improve emergency care for pregnant women and newborns by providing free cellular phones and business-related services for mid-level health care providers, to allow better communication with distant emergency obstetric specialists. Cooperating with district councils and a local telecommunications company IHI will evaluate the cost, feasibility, and implementation issues that arise if health workers at the district level have better access to long-distance counseling, faster referrals and resupply services, and emergency clinical support.

[See the original press release.]

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EngenderHealth is a leading international reproductive health organization working to improve the quality of health care in the world's poorest communities. EngenderHealth empowers people to make informed choices about contraception, trains health care providers to make motherhood safer, promotes gender equity, enhances the quality of HIV and AIDS services, and advocates for positive policy change. The nonprofit organization works in partnership with governments, institutions, communities, and health care professionals in more than 20 countries around the world. For more information, visit www.engenderhealth.org.

The Maternal Health Task Force at EngenderHealth brings together existing maternal health initiatives and engages new organizations to facilitate global coordination of maternal health evidence, programs, and policies. Supported by the Bill & Melinda Gates Foundation, the Maternal Health Task Force convenes stakeholders and creates an inclusive setting to engage in dialogue, build consensus, foster innovation, and share information. For more information, visit www.maternalhealthtaskforce.org.

Contact:
Tim Thomas, Maternal Health Task Force/EngenderHealth
646-436-6555, tthomas@engenderhealth.org

First Lady of Tanzania Visits EngenderHealth-Supported Clinic

In November 2009, the First Lady of Tanzania, Mama Salma Kikwete, visited Madaba Health Centre, a facility in the Ruvuma Region in southwestern Tanzania that is supported by EngenderHealth and that serves 50,000 people. The First Lady was there as part of a national campaign to reduce maternal and neonatal mortality, and she spoke about the importance of avoiding early pregnancy, improving maternal health care, and openly discussing HIV and preventing its spread.

EngenderHealth, through a U.S. Agency for International Development–supported ACQUIRE Project Associate Award, is helping to equip facilities in the Ruvuma Region with obstetric wards and is improving the quality and use of family planning services by training health care staff, strengthening supervisors’ skills, and raising awareness in communities. Over the past year, more than 400 clients received long-acting or permanent methods of contraception at Madaba, and nearly 9,000 clients received these methods in the region overall. EngenderHealth, through funding from the President’s Emergency Plan for AIDS Relief (PEPFAR), also trains health care professionals to provide counseling and testing for HIV and AIDS, other reproductive health services, and life-skills coaching to youth.

Last year, EngenderHealth assisted 38 facilities throughout Tanzania in improving the quality of their maternal health and family planning services.

Learn more about EngenderHealth’s work in Tanzania.

Live from MenEngage Rio: Overcoming resistance to male involvement in health services

Posted by Eric Ramírez-Ferrero

One of the recurring themes at global symposium is the resistance to male involvement in reproductive and sexual health services that we’ve encountered around the world—resistance among individuals, in communities, and from governments. And it occurred to me yet again that this resistance may be due to simple lack of imagination: When people haven’t “seen” male involvement in practice, it’s hard to fathom what programs for men could look like. What resources are required to get men involved? What expertise is needed to start effective programs? And how would such programs affect current efforts that aim to improve women’s health and lives?

On Wednesday, I attended a training session on “Engaging Men and Boys in Clinic and Social Service Settings” in which we examined the nuts and bolts of programming and started to answer some of these questions.

The training, conducted in part by EngenderHealth’s own Manisha Mehta, started with a great activity where we were each put “in charge” of providing a health service focused on either men, or on couples, and asked to think about what our client, or clients, might need: Would it be counseling, clinical care (such as testing or treatment), health education, or would broader social marketing efforts be best? It got the room thinking about what we can easily offer from means within our reach.

My assignment was: “You are a nurse speaking with a couple in which one person is living with HIV, and the other does not have HIV. They want to know about their options for avoiding pregnancy and transmitting HIV.” (I decided this couple would need both health education and counseling—perhaps slightly more counseling.)

This activity led to enthusiastic conversations and demonstrated a diversity of what male involvement programming can look like, the huge range of services that are possible, that many services can be offered at low or no cost, and—perhaps best of all—that they actually could be integrated alongside existing services for women. In fact, there was a consensus that for reasons of ethics, equity, and sustainability, an integrated approach (rather than offering separate men’s services) really makes the most sense in settings like Tanzania, where there are is already a shortage of health services.

Next, we were divided into groups and given a case study. My group examined why young people in general—those between the ages of 15 and 24—and young men in particular are reluctant to use health services, even when they are designed to be “youth-friendly.”

We also had a larger discussion of why men are reluctant to use services ostensibly designed for them—so-called “male-friendly” services. We cited many reasons, but ultimately it seems like it’s a vicious cycle: Men don’t seek services, so health clinics become geared towards women, which means that they become “women’s” places, and then men won’t go to get care because clinics are “for women.” There’s also the reality that many health clinics aren’t open during hours that men have time to go.

I was lucky that my group included a senior member from Tanzania’s Ministry of Health. We talked very concretely about how CHAMPION and the Ministry could collaborate to provide male- and couple-friendly services. It was so encouraging to see the Ministry representative’s enthusiasm for integrating services—everything from prostrate cancer screenings, to counseling for sexual anxiety and dysfunction, to better vasectomy services, and improved treatment for sexually transmitted infections—as a start!

As importantly, we discussed how we might offer counseling to men—in a site outside of a clinic—that can help them examine and start to change behaviors (like having multiple sexual partners at the same time) that make them more likely to spread HIV.

This conversation cemented a key point of the training workshop: Male-friendly services cannot exist in a vacuum. Instead, they need to be an integral part of a continuum of care for whole families. This is what will make a difference in the lives of men, women and children.

International Women's Day: Photo essay from the CHAMPION Project

Ending violence against women and girls is one of this year’s themes for International Women’s Day—celebrated March 8. This goal is central to EngenderHealth’s own mission, every day and everywhere. View a photo essay of men involved with EngenderHealth’s CHAMPION Project in Tanzania who promote gender equity and better health in their communities.

CHAMPION Project Launches in Tanzania

What can communities do to help men become part of the solution for healthier families? These and other questions were debated at the launch of the EngenderHealth-led CHAMPION Project in Tanzania on February 17. More than 170 guests gathered at the Mövenpick Hotel in Dar es Salaam for the interactive event. The five-year CHAMPION Project, supported by the U.S. Agency for International Development (USAID), inspires men to become partners and leaders in combating some of the most serious reproductive health challenges in Tanzania, including HIV and AIDS.

“Men have long been acknowledged as providers, central players in the community, and on the world stage. But far less attention has been paid to men’s roles in promoting the health of the family.”
–Robert Cunnane, Director of the USAID Mission in Tanzania

Each invitation for the launch had the message “Be part of the solution” and a puzzle piece, which attendees were asked to bring to the event. At the launch, the puzzle was completed and revealed a photo of a male champion, a man who had taken an active, positive role in promoting health in his family and community. The completed puzzle illustrates that it takes a community to create champions. Other such champions were featured in a photo exhibition spread throughout the venue.

Officiating at the event, the Honorable Samwel Sitta, Speaker of Tanzania’s National Assembly, noted that harmful gender stereotypes had greatly affected the country’s health systems and the health of individual citizens, accelerating the HIV epidemic.

Other attendees included Robert Cunnane, USAID Mission Director in Tanzania; Fatma Hadfidh Mrisho, Executive Chairman of the Tanzania Commission on AIDS; other government officials; and representatives of the donor community and religious organizations.