Saving Lives of Mothers & Infants in Zanzibar

by D-tree International, Inc

Since our last update in July 2012, this project has grown and is now being scaled up to cover all women in Zanzibar. A total of 938 women have given birth in the program since November 2011 and the rate of births in a health facility remains steady at  at 71% (compared to just 33.6% when we began just over a year ago).

We have also been fortunate to receive world-wide recognition for the innovation and success of the project including an award for best cell phone app in health.  In addition, we received a significant Phase II grant from the Bill and Melinda Gates Foundation to reach more women and families.  As a result, we have boosted project staff and are discussing how the approach can be used beyond Zanzibar including other parts of Africa and in India. As part of this effort, we have written a paper on the project and plan to have it published in a medical journal to further disseminate the results.

In addition to helping almost 1000 women have safer deliveries, we have learned a lot about what elements of the project have led to its success.  These include:

  1. Greater engagement of family-based decision-makers. Women and families received ongoing education and encouragement to seek care at the facility during the pre- and postnatal periods, as well as for delivery. Family decision-makers were involved earlier on in pregnancy so as to avoid transfer delays in an emergency situation.  The mHealth application’s personalized messages citing the mothers’ risks that were actually identified through screening, and the actual name of the facility recommended for delivery helped support concrete decision-making. 
  2. Enhanced role of the traditional birth attendants. As the mobile technology users, they were given a legitimate role in the project as communicators and data collectors in lieu of their traditional role of delivering babies. The mHealth application provided the users with consistent messaging that supported the Ministry of Health’s protocols. The traditional birth attendants were motivated to adapt the mHealth for Safer Deliveries project’s approach because they felt they were providing a valued service to their communities. Their clients, the pregnant mothers and families, also appreciated their new role.  Performance-based financial incentives to compensate for the traditional birth attendants’ lost income from home deliveries reinforced their motivation to reach out to mothers and include them in the project. 
  3. Improved communication, data collection, and information sharing linked with the formal health system. The mobile technology generated useful information, and encouraged communication, and used appropriate technology given the skill levels of stakeholders, infrastructure, and resources available. The one maternal death and seven infant deaths observed during the project intervention period highlight the importance for future perinatal interventions in Zanzibar. With the data collected by the mHealth for Safer Deliveries project, the Ministry of Health and its district health management team are now better equipped with population-level and case-specific data to support the development of evidence-based interventions. The potential for the traditional birth attendant to improve infant death rates is considered promising. 
  4. Provision of needed transport that the health system could not otherwise provide. Difficulties accessing affordable and timely transport for routine or emergency deliveries emerged as a predominant barrier to many rural Zanzibari families. The first delay (lack of understanding of the benefits) in consenting to the facility appeared to be less of an obstacle. In other contexts, this may not be the case, so the project’s approach and use of the mobile technology must be adapted to each new context carefully. 

The success of this project has gained global attention and we have been successful in raising additional sources of funding to expand.  But it was the start we got through smaller donations that enabled us to demonstrate the value of this approach. For this we are very grateful to each of you for your support.  

Since our last update in April 2012, we have helped hundreds of additional mothers safely give birth.  A total of 629 women registered  have had healthy babies since the beginning of the program in November 2011. A striking 70% of these births have taken place at a health facility under skilled care rather than at home.  Health facilities and hospitals in the project areas saw their in-facility delivery rates more than double on average. 

With your help, we are over half way to our $10,000 fundraising goal!  THANK YOU.  It is not too late to contribute to the project again or to consider making a recurring monthly gift. We can also use your help spreading the word about this amazing project and the families it serves.  Please consider forwarding the site to your friends and family.

The success of this project has gained global attention and we are in the process of seeking additional sources of funding to expand so we can serve thousands of other women who might otherwise end up giving birth under risky conditions at home. 

Stories from the field

On a recent trip to Pemba Island to visit one of the project districts, we heard many requests to continue the project from all levels of participants including the government all the way down to the community health workers and the pregnant mothers we are targeting.   

As one of the project’s trained traditional birth attendants stated:

“Women are aware [of the risks] and are worried about giving birth at home, but they don’t have money to go to the facility. Some try to walk or go by cart if it’s daytime, but if it’s night they just deliver at home.” 

The following cases are from mothers who benefited from this project during the last 3 months.  They have become advocates for facility deliveries and wanted to personally say thank you for the support:

  • In April a mother named Mwanaidi was referred to Micheweni cottage where she had a prolonged labour.  She was induced and successfully delivered a healthy baby boy. After coming back for a postpartum visit, she said she wanted to know the owner of this project so that she could say even a single word of thanks. She indicated that she will not consider delivering at home during future pregnancies.  Her past home deliveries were unsuccessful and she now has her first healthy baby.     
  •  Another mother’s family called their Traditional Birth Attendant in June with labor pains and was experiencing eclampsia, which is a life-threatening condition if not treated promptly.  The pre-arranged driver rushed the pregnant mother to Nungwi facility where the facility staff immediately escorted the Mother to Mnazimoja hospital where they could manage the condition.  She delivered a healthy baby girl.  Now she is an advocate for hospital deliveries and helps spread the word to other mothers about the risks of home delivery.  She believes without the project transport and timely referral to the hospital she wouldn't have survived and may not have her lovely baby.

Thank you from the women of Pemba and Unguja for your interest and continued support to this project. Your donation allows us to keep this project running and to support the traditional birth attendants, who work to ensure that motherhood can be safe for women in Zanzibar.

Dear Friends,

I want to thank the many supporters who have contributed to our web campaign on GlobalGiving.  I thought you might be interested in the preliminary results from this project which we have just put together. For those of you who have already contributed, THANK YOU. For those of you who have not yet contributed, the deadline for this campaign is April 30, and your contribution will help continue the work outlined below.

With support from the Bill and Melinda Gates foundation,  D-tree International successfully implemented a pilot project in Zanzibar Tanzania to achieve safer deliveries. The project was begun in November 2011 and uses an open source mobile health (mHealth) application to reduce the informational, logistical, and financial barriers to in-facility births and post-partum care.  The project has trained 24 Traditional Birth Attendants (TBA) from the pilot areas of North A District and Micheweni District in the use of the mHealth application.  The TBAs successfully registered 682 pregnant mothers, of which 211 delivered during this period.  Between November 2011 and April 2012, health facilities and hospitals in the project areas saw their in-facility delivery rates more than double on average.  Additionally, there were no maternal deaths recorded among the registered mothers.

For information on preliminary results and the stories of 2 mothers benefiting from this project, please read the attached document.  


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Organization Information

D-tree International, Inc

Location: Weston, MASSACHUSETTS - USA
Website: http:/​/​​
D-tree International, Inc
Project Leader:
Alison Clark
Weston, MA United States

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