From Birth Data To Safe Births: Improving Maternity Care in Kigoma, Tanzania

It is a universal right for every woman to have access to comprehensive maternal and reproductive care. While recognized in principle, we see globally that gaps in access continue to put women’s and newborns’ lives at risk, even resulting in preventable deaths. It is through efforts such as the Maternal and Reproductive Health in Tanzania Project that partnerships, data and evaluation, and local action can converge to improve and expand life-saving care for those who are often the most vulnerable.

The Centers for Disease Control and Prevention (CDC) recently produced a range of final reports assessing the project’s effects on reproductive health and emergency obstetric care capacity in the Kigoma region of Tanzania. These reports are publicly available on the Global Health Data Exchange website.

At the start of this project in 2012, the western region of Kigoma experienced one of the highest maternal mortality rates in the world. In an effort to reduce maternal deaths in the region, project partners developed a multi-phased approach to improve access to and utilization of comprehensive emergency obstetric and newborn care. This involved first decentralizing emergency care down from hospitals to health centers and using non-physician clinicians. Once emergency obstetric care was more widely available, program implementers worked to improve and sustain quality of care, informed by CDC-led monitoring and evaluation activities.

For seven years, CDC led evaluation activities for the Maternal and Reproductive Health Project, guiding and assisting local partners in collecting and analyzing data to assess changes in maternal mortality. Program evaluation activities included conducting periodic health facility assessments, monitoring all pregnancy outcomes and enhancing the detection of region-wide maternal mortality in health facilities.

Findings show that between 2013 and 2018, facilities became able to perform a broader range of life-saving clinical interventions, increasing on average from 2.8 kinds of interventions to 4.7 per facility. Moreover, the institutional maternal mortality ratio across all health facilities declined by 43% (from 303 to 174 maternal deaths per 100,000 live births in health facilities). Importantly, CDC’s collaboration with project partners also strengthened the country’s ability to detect, report, review, and analyze maternal deaths and their causes.

CDC’s Division of Reproductive Health was recognized for the work in Kigoma in November 2020, receiving one of the agency’s highest honors, the CDC Honor Award for Excellence in Surveillance and Health Monitoring (International). The award was given in recognition of its outstanding technical competence, extraordinary leadership, and scientific expertise to assist in continuous monitoring and evaluation of maternal mortality reduction efforts.

One of the hopeful lasting legacies of this work is that these findings demonstrate that maternal mortality is not an intractable problem, and that deaths from pregnancy-related causes can be prevented with a data-driven approach appropriate for the local conditions.

Special thanks to Bloomberg Philanthropies and Fondation H&B Agerup for funding this important project and to implementing partners Thamini Uhai, Vital Strategies and EngenderHealth.