Co-authored by John Engels, Director of Advocacy, Communications and Knowledge Management, Saving Newborn Lives, Save the Children US
In Tanzania, 30 women and 49 newborns die or are stillborn every day due to birth-related complications. Many of these deaths could be prevented if mothers had access to basic and comprehensive emergency obstetric services. However, a lack of funds, equipment, supplies, and qualified staff means that only 117 of the country’s 700 primary care health centres currently offer these essential services.
What are we doing to improve funding for mothers and children in Tanzania?
Save the Children is an active member of the White Ribbon Alliance in Tanzania – a coalition of civil society organizations with a mission to improve maternal and child health – and has been advocating with the government to increase its budget for maternal and newborn health.
To everyone’s joy, when Tanzania released its 2017/2018 figures, it had increased the budget for maternal and newborn health by 52.6 percent over the previous year. This increase means improved survival for women and newborns, as the funds will ensure that oxytocin, magnesium sulphate, and safe blood services will be available when women need them before, during and after delivery.
It will improve the equitable distribution of supplies and services, especially in rural areas. It will also improve the training and deployment of more skilled birth attendants to the country’s rural areas. In addition, it will accelerate the reduction of maternal and newborn mortality and reduce stillbirths.
How did this success come about?
The White Ribbon Alliance (WRA) in Tanzania’s slogans, “zero tolerance to maternal death: be accountable” and “social accountability for reproductive, maternal, newborn, child and adolescent health”, were designed to ensure that any budget increases were protected and then allocated to reach those in need. The WRA applied learning from its experience conducting citizens’ hearings and organized advocacy from the grassroots and district levels to the World Health Assembly in Geneva, with the idea of social accountability for maternal, newborn, child and adolescent health strongly featuring in the campaign.
In addition to holding citizens’ hearings, the WRA heavily engaged the media, put young women at the forefront of the campaign as change champions, and maintained continuous dialogue with members of parliament. The trust and joint decision-making among the partners – always in the name of young mothers and pregnant women and their newborns – was also key.
As an active member of the WRA Tanzania, including serving as a Core Committee member and on the Board of Directors, Save the Children helped lead this advocacy effort as part of its strategy to ensure that Tanzania’s investments in maternal and newborn health will be adequate to deliver on its commitments. During the WRA’s strategic planning process, Save the Children identified health budget advocacy as a priority work area and helped finalize and implement the strategic plan and roadmap to guide the organization’s advocacy.
This budget increase is just one – but very important – win. Another goal is to end child marriages, which contribute to the country’s high rate of adolescents giving birth. About one in four girls give birth in Tanzania, with the consequent increased risks of childbirth-related complications, including deaths.
Save the Children will continue its strong advocacy for women, newborns, children, and adolescents through its membership in the WRA Tanzania, and will continue working toward the following strategic plan objectives:
- Increased budget allocation, disbursement and expenditure for maternal and newborn health
- Adequate number of equitably distributed skilled healthcare providers for maternal and newborn health
- Adequate number of strategically located health facilities providing quality basic and comprehensive emergency obstetric and newborn care services.
While the 2015 maternal mortality ratio of 398 deaths per 100,000 live births is a significant decline from 842 per 100,000 in 2000, there is still a long way to go to meet the SDG goal of reducing maternal deaths to 70 per 100,000 by 2030. Similarly, neonatal mortality, currently at 19 deaths per 1,000 live births in 2015 must be reduced to 12 or below by 2030 to meet the SDG target.
Comprehensive Emergency Obstetric and Newborn Care services (CEmONC) are the interventions provided to pregnant women and newborns experiencing serious complications, such as severe bleeding, infection, prolonged or obstructed labor, eclampsia, and asphyxia in the newborns. CEmONC also 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. CEmONC is the only proven approach to saving the lives of 75% of women who die while pregnant and giving birth and the 25% who die after birth and one of the reasons why Tanzanian women more and more decide to give birth at health facilities instead of at home.
 WHO. 2015. Levels and Trends for Maternal Mortality: 1990 to 2015. Geneva: World Health Organization.
 Blencowe H et al. 2016. Group National, regional, and worldwide estimates of stillbirth rates in 2015 with trends from 2000. The Lancet Global Health www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)00275-2/references.
 WHO. 2015. Levels and Trends for Maternal Mortality: 1990 to 2015.
 UN Interagency Group for Child Mortality Estimation (IGME) in 2015.