“Once you know something, it’s hard to un-know it, and you will be compelled to act.” This is a quote from IBM’s Ginni Rometty at the 2014 CGI Annual Meeting. It means a lot to me because, in large part, that’s why I do this. I spent five months at Comprehensive Community Based Rehabilitation in Tanzania (‘CCBRT’) in 2012, and learned about the organization and what they were doing. I was compelled to act by joining Kupona Foundation. Likewise, CCBRT’s 20-year history working in the community in Tanzania led to the recognition that many of the conditions treated at its Disability Hospital (obstetric fistula, cleft lip/palate, clubfoot, pediatric cataract…) could be prevented or identified early and easily corrected. There was a gap. And we were compelled to act. What does Ms. Rometty's quote mean to you?
This is a longer report than we often share. If you have three minutes, watch this YouTube video, which provides a great overview of the maternal and newborn healthcare program that YOU are helping make possible.
If you have time, I encourage you to read on to learn more about the work that you’re supporting, and to check out photos of the latest construction and our capacity building team at work!
On October 24th, CCBRT will be celebrating its 20th Anniversary with an event at the construction site of the Maternity and Newborn Hospital - and we want you to join us for the celebration! Follow our live tweets of the event on Twitter (@KuponaFdn) and check out Kupona Foundation’s Facebook page for photos and updates of the day’s activities. We look forward to celebrating our accomplishments and sharing plans for the future with the supporters who are behind our successes.
We cannot thank you enough for what you’ve done to help make accessible quality maternal and newborn healthcare in Tanzania a reality. Your donations to Kupona are directly improving the quality of maternal and newborn healthcare available in Dar es Salaam. Contributions will enable us to complete construction on the Maternity and Newborn Hospital on schedule and bring quality medical services to more mothers and newborns in high-risk health situations. With your help, Kupona Foundation and CCBRT look forward to serving the women and children of Tanzania for the next 20 years and beyond!
With gratitude,
Abbey
A look at maternal and newborn healthcare in Dar es Salaam: the past, present and future.
October 12th, 2014 will mark CCBRT’s twentieth year of service to some of Tanzania’s most vulnerable populations, including pregnant mothers and newborns. Maternal and newborn healthcare in Tanzania has come a long way in the last 20 years. With your help and through our implementing partner, CCBRT, we will strive to ensure that every expectant mother and baby in Dar es Salaam has access to high quality and affordable healthcare in the years to come.
The Past: Twenty years ago, maternal and newborn healthcare providers and facilities in Tanzania did not receive the necessary attention or support to enable them to adequately serve their surrounding populations. The three regional hospitals in Dar es Salaam[1] that now perform most of the deliveries in the city, Temeke, Amana and Mwanyanamala, were not built until 2004. Caesarean sections were only performed at hospitals, rather than at lower level health centers, which meant that women in labor had to travel a longer distance to access emergency services. Furthermore, residents of Dar es Salaam did not trust that lower level health facilities could provide quality healthcare services, which caused significant overcrowding at the municipal maternity and regional hospitals. Tanzania’s national hospital, Muhimbili, had the only maternity unit that operated 24 hours a day; maternity units at other facilities were only open during the mornings.
The Present: With the understanding that many health facilities were overcrowded while some were underutilized, and that many of these facilities could significantly improve their quality of care with some basic investments in human and physical resources, CCBRT established its Maternity and Newborn Healthcare Program in 2010. Since 2010, CCBRT staff have been contributing to capacity building efforts in public health facilities throughout Dar es Salaam, which includes advocating for and investing in respectful and inclusive maternal care as well as training doctors, nurses, anesthetic officers and supporting staff in the most up-to-date maternal and newborn healthcare practices. The capacity building program is also conducting on-the-job training and mentorship for its trainees in Basic Emergency Obstetric and Newborn Care to support their continuous education. CCBRT’s investments in infrastructure and human resources are significantly raising the standards of care in medical situations that were considered hopeless when the program first began.
Just a few months ago, CCBRT added 6 more health facilities in Dar es Salaam to our Maternity and Newborn Healthcare Capacity Building Program, bringing the total number of health facilities supported by CCBRT to 22. These health facilities were selected as partner healthcare centers because they had the staffing potential and adequate existing infrastructure to succeed in enticing patients to use them. Additionally, all of these health centers serve densely populated areas of Dar es Salaam. When CCBRT conducted assessments of these 6 healthcare facilities in April, we found that the facilities were operating well below their delivery capacity. Now, healthcare providers in these facilities are being trained to improve their skills and management systems, and are simultaneously being equipped with the physical resources necessary to close the medical equipment and infrastructure gaps. To combat the distrust of these lower level health facilities in the neighborhoods in which they are located, CCBRT is conducting local sensitization and awareness campaigns that highlight the support that is being given to its partner health centers and to encourage mothers to deliver their babies at these facilities.
The Future: When it opens in 2016, the CCBRT Maternity and Newborn Hospital will be accessible to patients 24 hours a day and will serve all of the Dar es Salaam region, which is home to over 8 million people. The hospital is projected to perform 15,000 high-risk deliveries a year and will serve women who are experiencing delivery complications such as eclampsia, hemorrhaging and severe anemia; women with disabilities; young women under the age of 18; women with a history of obstetric fistula (who must have a C-section to ensure safety for mother and baby); and newborns with birth asphyxia and low birth weight. These patients will be referred from lower level health centers and hospitals that to do not have the capacity or expertise to care for them, and will receive treatment at CCBRT from the most qualified clinicians in the region. We are in the process of seeking out the best obstetric/gynecologists, anesthesiologists, neonatologists, qualified nurses, midwives and pediatricians – training new healthcare providers within Tanzania (not taking them away from the existing healthcare facilities!), and from abroad for specialists that are not available within the country or region. Through your contributions, you are helping to make this high caliber life-saving care for mothers and babies in Dar es Salaam available for all.
Because of your support, the Maternity and Newborn Hospital will be entering “Phase 5” of construction in the new few weeks. This means construction will soon commence on the outside walls and roofing elements. Plans will be confirmed for the final parts of the building that still need to be constructed, as well as the interior finishing.
Kupona and CCBRT: Confused about how Kupona Foundation fits in? New York-based Kupona was established in 2009 to help connect donations, resources and technical expertise to CCBRT, and to raise awareness about CCBRT’s work. If you have questions or suggestions, send us an email! info@kuponafoundation.org
Congratulations if you made it through the entire report! Many thanks for your ongoing support.
[1] The region of Dar es Salaam has a population of 4.36 million per 2012 national census data.
The last few months have been a time for celebration at CCBRT. The first phase of our maternal and newborn healthcare program came to an end, and the results have been phenomenal. With your support we were able to train healthcare teams in 16 facilities, develop hospital infrastructure, distribute life-saving equipment and increase community awareness around safe pregnancy and childbirth.
Since 2010, when the first phase of our capacity building program began, you have helped us to achieve some incredible results:
Dr. Kawawa is the Coordinator of the Regional Capacity Building Program and is a strong partner of CCBRT; a partnership that couldn’t have been built without your support. Dr. Kawawa brings over 40 years of experience in public health to the program, and told us of the great results she has seen over the past few years, particularly in strengthening the healthcare system.
“Since 2010 we’ve seen tremendous improvements and vivid results. The program has created links between different parts of the system. We’ve seen departments working more effectively together within health facilities, and managers working more closely with health practitioners. We’ve seen our work in facilities strengthened by what we do in communities and vice versa. And we’ve also created links between the national, regional and district health teams so that we all communicate better and understand each other. The whole network is closer as a result.”
Construction of the new CCBRT Maternity and Newborn Hospital has also moved forward in leaps and bounds since our last update. This facility is on track to open at the end of 2015, and will provide high quality maternal and newborn healthcare services for emergency and high risk cases in the region of Dar es Salaam. The facility will conduct over 15,000 quality deliveries every year, and will add 200 beds to the region, relieving facilities that are currently overwhelmed by demand.
Your contributions and support have made all of this progress possible, but the struggle isn’t over. Tanzania is still one of the most challenging places in the world to become a mother, and we need you to recruit more support for our cause. When potential supporters hear us talking about why they should make a donation today, they listen. But when your friends and family hear you talk about our work as someone who is already a supporter and knows that we are making a difference, they’ll act.
Today, we are asking for a few clicks of your mouse: take 5 minutes to share our GlobalGiving page with your contacts and tell them why you decided to donate to us and why they should do the same.
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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.
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.”
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.
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