Make Motherhood Safe for Tanzanian Women

by Kupona Foundation
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Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
CCBRT's Dr. Brenda delivers real-time training
CCBRT's Dr. Brenda delivers real-time training

Since 2007, Kupona’s implementing partner, CCBRT, has been working with the Government of Tanzania through an unprecedented Public Private Partnership to reduce the staggering number of preventable maternal and newborn deaths in Tanzania and to prevent disability as a result of complications in pregnancy and childbirth. CCBRT is working in 16 public health facilities in Dar es Salaam to improve their standards of clinical care as part of the Regional Capacity Building Program – in tandem with construction of the new Maternity and Newborn Hospital (photos below!) The following first-hand account provides the perspective of a doctor managing one of the 16 facilities.

“A short while ago, this Health Centre was understaffed, ill equipped and almost empty. Now Buguruni has a thriving delivery unit and is leading clinical care standards in the region.” 

So what has changed? And to what does Dr. Mbaga - Medical Officer in charge of the improved facility - attribute Buguruni’s success?

“Since the Regional Capacity Building Program for Maternal and Newborn Healthcare began in Dar es Salaam in 2010, we have seen many changes. But I believe it is the on-going training provided by the program that has transformed our work. In the past, my staff weren’t always confident enough to make good clinical decisions, but mentoring, coaching and on-the-job practice has helped us become more competent and knowledgeable.”

Particularly noticeable, according to Dr. Mbaga, is the confidence with which nurses and midwives are now able to handle emergencies. “You can’t practice in an emergency – at that stage, you work by instinct – but you need to practice to perform well under pressure.” Since the program began, regular drills have become part of the routine of the health centre. “If the labor ward is quiet, we’ll gather together and work through an obstetric scenario, sometimes practicing three or four times until we get it right. Reviewing our clinical care like this, every day, helps us to improve constantly, and I see that my staff are much more capable as a result.”

One of the other keys to boosting motivation, Dr. Mbaga believes, is acknowledging the work people do, and the difficult environment in which they do it. “I always try and give positive feedback to my staff,” she explains. “It doesn’t cost anything but they appreciate it so much. People like to see their work recognized.”

Clinical standards have improved in all 16 of the sites in which CCBRT’s Regional Capacity Building Program is working. Buguruni has had impressive gains, with adherence to defined clinical standards increasing from 12% to 90% over the first three years of the program. It seems that practice, mentoring and good communication – all relatively low-cost, low-energy investments – are some of the factors behind that success.

Moving in to one of the first buildings in the new Maternity and Newborn Hospital

We’ve reached an exciting milestone as we begin to move in to our new medical store warehouse! This is a proud moment for Kupona. It should be for you, too. The medical store will serve both the existing Disability Hospital and the new facility, as we streamline and integrate support services. 

Seeing progress and mobilizing resources

In late January, Executive Director Abbey Kocan visited CCBRT. Read about her visit on our blog, or visit our Facebook page to see the latest construction photos.

As construction continues, you can begin to visualize the new hospital filled with mothers and babies who might not have had access to safe maternal and newborn care without the new facility. This blog describing a recent study in neighboring Kenya illustrates the economic and human cost of maternal death. The study states, “A mother’s death ignites a chain of disruption, economic loss, and emotional pain that often leads to the death of her baby, diminished educational and life opportunities for her surviving children, and a deepening cycle of poverty for her family.”

Access to quality maternal and newborn care. Eliminating needless maternal deaths. This is what it’s all about. It’s been a multi-year journey, and there is more work to be done to mobilize the necessary resources. Many of you have supported us from the beginning. Thank you. If it’s been a few years since you’ve made a gift, please consider another tax-deductible contribution today. We need your help.

Moving in to the new medical store warehouse
Moving in to the new medical store warehouse
Construction continues in February 2014
Construction continues in February 2014
Canteen and laundry facilities are ready for use
Canteen and laundry facilities are ready for use
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Fistula ward. Photo credit: Benjamin Eagle
Fistula ward. Photo credit: Benjamin Eagle

At Kupona Foundation, we are proud of the progress on the ground in Tanzania, including ongoing construction of the hospital, the strengthening of the maternal and newborn healthcare system in Dar es Salaam, and the hardworking healthcare providers at our CCBRT Disability Hospital who are changing lives every day. The following is an excerpt from the CEO of CCBRT’s New Year’s message. You can read the entire message and see more construction photos on our blog. Stay up to date on our progress and activities by liking us on Facebook or following us on Twitter.

Looking back at 2013, we are incredibly grateful for your support. Thank you for being part of our work. 

A message from Erwin Telemans, CEO of CCBRT

“Happy New Year to all of our supporters and friends! The New Year is a time for reflection upon last year’s achievements and successes, and for planning how to build upon these in the year to come. As I reflect upon the year that CCBRT has had, I cannot thank you enough for your support.

Our maternal and newborn healthcare programme was integrated into the organisational strategy for the first time in 2013, and in response the Capacity Building and Maternity and Newborn Hospital teams were merged to form a single, comprehensive programme. Over 248,000 hours were spent on construction of our new Maternity and Newborn Hospital, and the facility is really starting to take shape. Since we started construction in December 2011, 4,620 tonnes of concrete, 81,445 concrete blocks, 22,988 metres of electrical cable and 11,467 square metres of roofing have all been used to create the incredible pictures that you see today. Work will continue at full speed in 2014 as we look to HR recruitment plans and move towards securing the funding required for annual running costs.

Capacity building in the sixteen facilities also continued, with incredible achievements in the improvement of clinical standards across the region of Dar es Salaam since the beginning of the programme in 2010. 56% of sites now provide 24 hour seven day a week Basic Emergency Obstetric care and C-Section rates are moving closer to the WHO recommended guidelines. Furthermore, the average quality assessment scores in the region have increased by 13.6% in the last six months alone, and maternal and neonatal deaths are beginning to decline in the region.

This year, we continued to break records in the fistula department as we increased the number of surgeries conducted once again. Recent data shows that, with over 680 women treated in both the Disability Hospital and our rural partner facilities, CCBRT is now one of the largest providers of fistula surgery in the world.

As always at this time of year, I am incredibly grateful to all of our staff and supporters who make it possible for us to change the lives of over one million people in Tanzania each year. I hope you all had a wonderful holiday season with your family, and wish you all the best for the year ahead.”

Maternity & Newborn Hospital Construction Dec. '13
Maternity & Newborn Hospital Construction Dec. '13
Maternal health training (capacity building)
Maternal health training (capacity building)
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Asha
Asha

Asha’s* Story (*name changed to protect privacy)

When she was 38 years old, Asha gave birth at home. She was in labor for three days. Tragically, the baby did not survive. After this terrible ordeal, Asha realized that she could no longer control her urine. Her husband left her, unable to deal with the problem. “I did not understand the condition or know whether it could be treated.” Consequently, Asha lived with obstetric fistula for 15 years.

Asha faced daily struggles and was ostracized from her community. “I wanted to pray in my local mosque, but was unable to because people complained about the smell. It made me feel isolated and depressed.” It wasn’t until her stepson heard about CCBRT’s fistula program on the radio that she thought her condition was treatable. A CCBRT ambassador helped to arrange Asha’s journey to the hospital after receiving the money for the ticket from CCBRT via M-PESA mobile money. Asha is incredibly grateful to CCBRT. “Thank you very much to CCBRT…thank you very much for giving me my life back.”

While there have been recent changes in Kupona Foundation’s leadership, the focus on saving women like Asha, and close connection to CCBRT’s activities remains.

Ms. Abbey Kocan took over as Executive Director of Kupona Foundation in early September when Kupona’s founding Executive Director, Ms. Katie Flanagan, stepped down to spend more time with her family. Katie will join Kupona’s Board of Directors in 2014. Abbey spent five months leading the development of CCBRT’s five-year strategy in Dar es Salaam in 2012. She is honored to have the opportunity to build upon the solid base laid by Katie to help CCBRT achieve its strategic priorities over the years to come. CCBRT’s CEO, Mr. Erwin Telemans, joined Abbey in New York City last week for a series of meetings with partners and donors to share updates on activities, construction and immediate funding priorities.

One of those priorities is the expansion of CCBRT’s obstetric fistula ward. Due in large part to an awareness raising campaign and the innovative use of mobile money to reach the poorest women living in remote areas, 595 women received life changing fistula operations in 2012 - over 50% more than in 2011. With up to 3,000 new cases of fistula each year in Tanzania, most often due to prolonged obstructed labor, there is a growing need. CCBRT has a goal of increasing surgeries to 1,000 per year. Doubling the ward capacity will help achieve that goal. Starting at prevention, construction of the CCBRT Maternity and Newborn Hospital remains on track. The new hospital is expected to open in the second half of 2015. Combined with ongoing maternal health capacity building efforts in 16 lower level facilities in Dar es Salaam, Kupona Foundation and CCBRT will continue to work toward preventing obstetric fistula and other disabilities, sparing women like Asha from years of pain and suffering.

Your support of Kupona Foundation and CCBRT is critical to achieving our shared vision of a Tanzania where people have access to quality disability services as well as safe maternal and newborn healthcare. Your gift counts. Thank you.

Construction continues in Dar es Salaam!
Construction continues in Dar es Salaam!
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Pres. and Mrs. Bush visit CCBRT
Pres. and Mrs. Bush visit CCBRT

As many of you have likely seen or read, Kupona's implementing partner CCBRT welcomed some very special visitors earlier this month.  On July 2nd, the First Ladies of Ghana, South Africa, and Mozambique toured CCBRT along with other distinguished guests from the African First Ladies Summit hosted by The Bush Center and ExxonMobil.  A day later, CCBRT was honored to receive President and Mrs. George W. Bush themselves on a tour of our main campus, with a special presentation in our fistula ward.

These visits came at the end of what has been a very busy and exciting few months for Kupona and CCBRT.  Even as construction on the new Maternity and Newborn Hospital continues, we have seen a dramatic expansion of support for and awareness of our efforts to improve maternal health across the Dar es Salaam region.  In April a film crew visited CCBRT to shoot footage for a documentary about access to essential surgery in the developing world, and in June, Kupona Board member hosted a reception that raised enough funding for a full-time nurse-midwife for one year.  Add in celebrations of the first ever International Day to End Obstetric Fistula, an EUR 8.5 million grant from the German Development Bank KfW, a series of efforts in promoting "LEAN" management across the organization, and it is clear that CCBRT is better poised than ever to have a serious impact on the health infrastructure in Tanzania. 

Construction continues on CCBRT MH
Construction continues on CCBRT MH

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Last Friday, April 5, marked the beginning of the 1,000-day countdown until the target date for achieving the UN Millennium Development Goals.  We know it is going to be extremely difficult, if not impossible, to achieve the expectations in Tanzania set by MDG #5: to reduce the maternal mortality ratio by three quarters and to achieve universal access to reproductive health.  However, over the last several years, as Kupona/CCBRT's work in women's health has grown to include a partnership not only with the Government of Tanzania but also with a variety of stakeholders in the Tanzanian health infrastructure, we have been encouraged and motivated by the progress being made. 

Our program to address Dar es Salaam's key problems in maternal health began in 2010 with a comprehensive program including training, investments in infrastructure and equipment, continuous follow-up, mentoring and coaching in 16 public facilities, and at the same time improving the engagement of the community in maternal health care.

This has resulted in:

  • Increased availability of comprehensive emergency obstetric care (CEmOC)
  • Increased number of live saving caesarean sections
  • Designated operating theaters for maternal health increased from 4 to 7.
  • Decongestion of the three overcrowded district hospitals by increasing the number of deliveries performed in  lower level facilities from 7.8% (2008) to 27.2%(2012)
  • Training a total of 1,899 facility staff trained in various areas; including a critical minimum number of staff per facility trained in basic emergency obstetric and neonatal care and in the top 5 causes of maternal deaths
  • Quality assessment scores (SBMR) have increased from 9 to 55%. Buguruni Health Centre achieved a score of 81 per cent, becoming the first nationally recognised site for excellence in safe delivery.
  • Increased community awareness on safe motherhood and disability prevention; 991 community health care workers, community leaders and health facility governing board members trained.

The progress is tremendous, and we have every reason to believe that 2013 will see similar accomplishments.  Still, we heed the call from the UNFPA and others to step up our efforts to improve maternal health. Not only will our capacity building program implement more trainings, infrastructural improvements, and awareness raising activities, but our new maternity and newborn hospital will take firmer shape, with construction (begun in December 2011) continuing impressively, and recruitment of key personnel to lead the hospital beginning over the next several months.

 

We cannot stress enough how critical your support has been to improving the situation facing mothers in Tanzania.  We look forward to your continued support and look forward to sharing the additional achievements it makes possible.

Construction on our maternity hospital continues
Construction on our maternity hospital continues

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Organization Information

Kupona Foundation

Location: Washington, DC - USA
Website:
Facebook: Facebook Page
Twitter: @KuponaFdn
Project Leader:
Susana Oguntoye
Executive Director
Washington, DC - District of Columbia United States
$144,433 raised of $400,000 goal
 
2,048 donations
$255,567 to go
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