interviewBy Jaffar Mjasiri
THE initial and continuing support of the World Lund Foundation maternal health project in the country has come from New York based Bloomberg Philanthropies.
This was followed by a total global grant of three years amounting to 488,500 US Dollars from Merck for Mothers based in Stockholm, Sweden for communication using ICT with a focus on clinical audits and continuous medical education of health workers.
In this interview which the WLF maternal health Project Manager, Mr Dismass Masumbuko granted to Our Staff writer, JAFFAR MJASIRI, highlights the project successes among others. Excerpts...
Q. What is World Lung Foundation?
A. It improves global health by strengthening local health capacity. The organization's key areas of emphasis are tobacco control, maternal and infant mortality prevention, tuberculosis, asthma and child lung health.
In Tanzania WLF project supports national efforts to reduce maternal and prenatal mortality by strengthening health services in three regions of the country, namely Kigoma, Morogoro and Coast regions.
Q. How is the WLF Maternal Health Project helping the country?
A. The project is helping to improve health workers' professional capacity and warn women about "danger signs in pregnancy," encouraging women to give birth in health facilities with a skilled birth attendant.
Q. What is functional upgrade of a health centre under the project?
A. There is an important distinction between a physical upgrade and a functional upgrade of a health centre. Functional upgrading assumes not just a building, but also a well equipped operation theatre and adequate supplies of electricity, water, blood, emergency drugs, surgical material and other indispensable consumables.
It also assumes adequate staffing of health workers who are appropriately trained and given regular supportive supervision for providing major obstetric surgery and anaesthesia. In addition, due attention has to be paid to sustainability, particularly staff retention, and decent living conditions in staff houses.
Q. Who is supporting the Information Communication Technology activities under the project?
A. The project has started developing ICT activities to support training, mentoring and communication for maternal health services. An ICT specialist has been hired and a partnership has been established with Ericsson Telecom (Sweden).
Staff from Ericsson and WLF visited Coast and Morogoro regions to negotiate partnerships with different operators, and network studies were conducted to assess connectivity and bandwidth. Telemedicine and e-learning will be viable at several WLF sites in Morogoro and Coast with the current infrastructure, and work is underway with Airtel (Tanzania) to initiate this.
In addition to Ericsson Telecom, WLF also partners with Shimba Telecom, South Africa, which has further developed the technology to improve network function so that the project can optimize ICT in distance learning.
WLF also works closely with the Division of Telemedicine in the Ministry of Health and Social Welfare where there is a plan to test the WLF local website in five hospitals in Dar es Salaam and in Coast.
Q. How do you prepare staff for e-learning?
A. In order to prepare staff for e-learning, computer training was held in April 2012 at all health centres in the WLF project, followed by the WLF ICT specialist visiting participating health centres for on-site supervision. Since May 2012, WLF has conducted weekly teleconferences with partner sites to enable health workers to discuss problematic cases and other issues.
These "virtual classrooms" are conducted through mobile phones provided to all health centres. We also benefit from the CUG system (Close User Group), which provides good quality sound when using identical service provider/ operators.
Q. Who are collaborating partners in this project?
A. One is Centre for Disease Control (CDC) Tanzania office. CDC Foundation monitors and evaluates the WLF project. An ecological evaluation was carried out during 2012 with a focus on the Ulanga District, Morogoro Region.
An extension of the monitoring and evaluating activities starts in 2013. Another partner is EngenderHealth. Collaboration with this organisation was initiated in 2011 and focused on minilaparotomy training for WLF partners.
The bilateral tubal ligation operations are ongoing and we intend to extend collaboration in 2013 seeking various modalities of synergy with the EngenderHealth teams in health centres, where WLF has supportive supervision.
Also Ericsson Telcom is working with us. Several visits by Ericsson Telcom representatives took place in 2012 with a focus on establishing a network for e-learning and internet-based lecturing. Field tests have been made in Rufiji and Kilombero districts.
Q. What are the major successes of the project in the three regions?
A. WLF supported facilities saw a 6.7 per cent increase in the number of deliveries from 2011 to 2012. The health centres were much more active in solving emergency obstetric problems and there was a reduction of 49 per cent in the proportion of patients in need of referral from health centres to hospitals.
In total, the health centres conducted four times more vacuum extractions in 2012 than in 2011, with a constant level of cesarean sections performed (6 per cent). While in general across the country, more severely ill women enter health centres and hospitals and many of them, we saw a general decrease in the Maternal Mortality Rate in WLF supported health facilities.
In Morogoro region, the maternal mortality ratio decreased by 22 per cent, while the corresponding reduction in Coast Region was 25 per cent. In the audit analysis we have noted an improved management of clinical cases that were saved and also a variable quality of intensive care, which underlines the need for continuous supportive supervision and refresher courses to maintain acquired skills.