VSI recently completed its comprehensive assessment of misoprostol availability in Tanzania. This simple, life-saving medicine holds the potential to save the lives of thousands of women, especially those living in rural and remote communities – if only the medicine is available to them. During this assessment, VSI identified the current challenges to ensuring everyday availability of misoprostol, with the goal of supporting opportunities to improve access to the medicine over time.
The VSI Availability Case Study, attached below, is a brief introduction to this assessment – the framework, methodology and program recommendations. To date, several important milestones have already been achieved in Tanzania, and ongoing government and partner activities are actively contributing to availability. In 2007, Tanzania became the second country in Africa to register misoprostol to address excessive bleeding after childbirth and in 2011, its approved use was expanded to include another leading killer of women, incomplete abortion and miscarriage. However, VSI’s findings indicate that despite some gains, misoprostol tablets are currently in short supply, suffer from low demand, and are underutilized. Our research shows that nationally only 6% of providers in Tanzania have been trained on the use of misoprostol. Thanks to contributions from advocates like you, there are communities with a higher proportion of providers trained, but because so few providers know about the life-saving use of misoprostol across the country, there is low demand for the medicine, and in turn it is not widely available in health facilities.
The case study indicates more work remains – especially as it relates to creating awareness amongst women and healthcare providers. The findings of this assessment will assist VSI and partners with practical solutions to improve women’s access to this essential medicine. The solutions span simple fixes like ensuring misoprostol is listed on pharmacy order forms that are used to stock facilities to more resource intensive efforts like expanding trainings to midwives and nurses. VSI is sharing these results with partners in the field to help galvanize collective action to improve women’s access to this life-saving medicine.
Eustela is the head nurse of St. Francis hospital in rural Kilombero, Tanzania. She stands proudly against the blue clinic walls and sends a wide smile into the camera as she delivers the following message to VSI and our supporters:
“On behalf of the mothers of this village and all parts of Kilombero, we very much thank you for thinking and remembering us here at the periphery to get such a good thing with miso. The mothers are happy and their families are happy. And also the hospital is happy now. If you continue, I think PPH (postpartum hemorrhage) will no longer be the top killer of mothers. Asante sana.”
We spoke with Eustela in March 2011 at the closing of the misoprostol pilot program in Tanzania. Misoprostol, a simple and inexpensive medicine that prevents some of the leading causes of maternal death, had begun to make a memorable and positive impact on several small communities throughout the country. It was also during this time that the Tanzanian Ministry of Health and Social Welfare voiced support for our village-level program and advocated scaling up the distribution of misoprostol throughout the country to significantly reduce maternal deaths. In a country where an estimated 3,000 mothers die each year due to excessive bleeding after childbirth, scalable and profound action is needed to save lives.
A year later, our work in Tanzania continues as we embark on a new project that aims to assure the everyday availability of misoprostol for women countrywide. Having spent the past 16 months conducting qualitative and quantitative assessments to identify the conditions for everyday availability, we are now ready to let our findings inform practice. Over the next year we will be working with local partners and the Tanzanian government to implement targeted activities to improve women’s access to misoprostol, building upon all that we have achieved together so far. And all with a goal of keeping mothers and families, like those Eustela cares for, happy and healthy. The support from advocates like you pushes our programs forward and ensures that more women receive essential care and maternal health supplies. We hope you will continue to stand with us as we begin this new leg of our journey, because together we are stronger and can do more.
In Tanzania, we are working diligently to improve women’s access to misoprostol for a healthier pregnancy and childbirth. As reported last time, we are in the midst of an in-depth series of assessments that are evaluating access to the essential medicine, misoprostol. Our latest results focus on the women themselves. We traveled to three districts (Kilombero, Ulanga and Morogoro Rural) to conduct a survey with over 1,300 women and mothers to get a sense of their knowledge, attitudes and practices related to the prevention of excessive bleeding after childbirth, or postpartum hemorrhage (PPH), and misoprostol to prevent this life-threatening bleeding. We were also keen to assess the role of community awareness activities in increasing their awareness about PPH and misoprostol.
The women we spoke with had varied experiences: some were first-time mothers, others a mother to multiple children, and a few had no children at all. It was important to understand the perceptions of all women on the dangers of childbirth. While some mothers had delivered at home, most had delivered their babies in a facility, signaling that mothers are getting the message that the facility is the safest place to give birth. Nearly half of the mothers surveyed had given birth in the past three years, since the VSI PPH prevention program had been initiated in two of the districts. Overall, a quarter of all women interviewed had heard of misoprostol; this figure increased in previous VSI program districts to nearly half of women having heard of misoprostol through one of our community awareness campaigns. For instance, one in five women reported seeing one of our program posters. Perhaps most encouragingly, women remembered information they had received nearly three years earlier on how to prepare for a safer childbirth and misoprostol. Mothers listen to other mothers, so this result is important.
An interesting result that can help shape future programming is that we asked women their opinions on the best ways to share information with the community about bleeding at birth and misoprostol. Women from Ulanga mentioned dramas and community meetings (30%), while women in Kilombero and Morogoro Rural mentioned posters and radio as the best means to share information. But most frequently, women across the districts mentioned that community health workers would be the best way to share information about these topics. VSI has always recognized the important role these volunteers and traditional birth attendants can play as trusted members of the community, and we will continue to do so.
As a supporter of our program in Tanzania you played a part to spread the word at the village level about the role misoprostol can have to save women’s lives in childbirth. And the women are listening! But, there is still much to do and to understand about our past efforts to ensure women can access misoprostol when and where they need it most. The reason is clear: One woman lost is one too many—especially when we have the tools, medicines and knowledge to prevent it. We invite you to follow our progress during this important assessment phase. Together we can make a difference and save women’s lives.
On March 8th VSI celebrated International Women’s Day. We take this day each year to celebrate the women in our programs – the women we serve and the women that serve others. This year as a global community we recognized how far we have already come in improving the lives of women around the world, and yet there is still so much left to accomplish.
VSI is in the midst of a robust country assessment that takes a holistic approach to determine availability of misoprostol, with an eye towards making targeted improvements in Tanzania. For instance, in one component we are finalizing a report on a survey we conducted amongst 405 providers across three representative districts to gauge knowledge and use of misoprostol for women’s health. Preliminary results suggest that training is having the positive influence expected on awareness and use, but that training coverage is low and supplies of essential medicines such as misoprostol are spotty, nullifying the impact of training when supplies are not at hand. To have the intended affect at the community-level, we need to ensure essential medicines reach women in need. The women in this photo deserve it. This will increasingly be the focus of VSI’s work in the coming months.
When we save women’s lives, we strengthen entire communities, so walk this last mile with us. With your help we can celebrate women and equip healthcare providers who serve women in need.
As the year comes to a close, Team VSI is busy wrapping up the year-end activities and reflecting on the progress and impact of our work in 2011. In the final quarter of 2011, VSI built upon its previous training efforts and trained 392 providers in Zanzibar to use life-saving misoprostol tablets. Since our project’s inception we have provided training to 2,531 providers in the country, but more work is to be done in the islands.
Through the years our work in Tanzania has been highlighted with stories of women and providers who have made a difference to our work. They are the example of how simple and innovative medical solutions can make an everlasting impact on families and entire communities. Monaisha and her daughter Ramla are such examples. As a mother living in a remote and rural area of Tanzania, Monaisha knows the dangers of childbirth and laments the obstacles that force pregnant women to deliver at home, by themselves. As a program beneficiary, Monaisha swallowed her three tablets after the birth of Ramla, thereby protecting her against deadly hemorrhaging. Knowing the tablets’ benefits firsthand, Monaisha shared, “Since misoprostol came into my community, we have not seen a mother die. It will be very important to have in the health facility."
As we look ahead to 2012 we promise to stay focused on reaching women where they are. With your support, we will continue to bring health solutions like misoprostol tablets to more hard-to-reach communities to make pregnancy and childbirth safer. Your partnership in our efforts to improve the lives of women in places where the need is greatest means a lot to us. We hope you will consider renewing your valued contribution. Together we are stronger and can achieve more.
For more information on VSI, read our recently published Biennial Report, covering programmatic activity and achievements during 2009-2010. The Report encapsulates the mission-driven work of our organization to improve women’s health by increasing access – access to health technologies and essential care.
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Technical Advisor, Communications and Development