Bill & Melinda Gates Foundation

Midwives Take Action: When Women Need Emergency Care

May 08, 2014

As a midwife, I am all too familiar with the challenge of women arriving too late to the hospital to give birth. On many occasions throughout my career, I have attended to women who have travelled for days to get to the hospital. Many of these women did not survive childbirth. It is heartbreaking to know that their lives could have been saved if only they had received professional care sooner. Over the years, we have advocated for a stronger focus on maternal and newborn health, and the Government of Tanzania made important promises and commitments on these issues. We are now faced with the challenge of holding the government accountable and ensuring these promises materialize.

Last year, the White Ribbon Alliance Tanzania brought together national leaders engaged in maternal and newborn health, including representatives from the media, government, civil society groups and professional associations, to design a strategy to ensure that the Tanzanian government delivers on its commitment to women and newborns. Specifically, this group focused on the government’s promise to provide Comprehensive Emergency Obstetric Care (CEmONC) in at least half of all health centers in the country by 2015. 

Together we decided to focus on the commitment to CEmONC because we listened to the local population who asked for these health services to be available closer to their homes. We also made this decision because the majority of the 24 women in Tanzania, who die every day in childbirth, do so because of the lack of emergency care.

In order to advocate on this issue, we needed to gather evidence that showed the government was off track in delivering on this particular promise. To start, we carried out a full assessment in 10 government-run facilities in the Rukwa Region. We engaged with community leaders, media and district officials as we moved throughout the area. Despite a picturesque landscape, moving around Rukwa is a treacherous journey through dirt tracks that lead to rural health centers—many of which are beyond the reach of telephone signal.

As we gathered the data, we found that for a population of 1 million, there were over 10 health centers throughout the district, but not a single one of them was providing the level of care that the government had promised.

We shared our evidence with the district officials, and pushed the leadership to budget adequately for emergency obstetric care. During this time, we also met with national leaders and the Parliamentary Safe Motherhood Group to ensure emergency obstetric care was adequately budgeted for in the 2014-2015 budget cycle.

To draw global attention to this issue, and to talk about the gap between promises and implementation, Dr. Jasper Nduasinde, the White Ribbon Alliance focal person in the region and the only surgeon in the area, testified about this challenge during the United Nations General Assembly meetings in New York. We then called on our politicians to act. The Parliamentary Safe Motherhood Group rallied politicians to sign a petition to the government to prioritize this issue. We also called for a meeting with the Prime Minister, and spoke to him at great lengths on what could be done to change this critical situation. He promised to take action.

Finally, we produced a short video about Elvina Makongolo, the midwife in Mtowisa who works tirelessly to save women’s lives, as a tool for others to advocate on this issue.

As we mobilize to make change happen, we keep hearing the personal accounts of husbands losing their wives, children losing their mothers, and families losing their aunties, sisters and nieces. Citizens want change and they are pushing for it. In Rukwa alone, over 16,000 people have signed a petition advocating that the district officials and their MPs prioritize a budget for Comprehensive Emergency Care. Moreover, on White Ribbon Day in Rukwa, the Minister of Health spoke on behalf of the Prime Minister to say that this budget must be prioritized across the country.

We believe that the Prime Minister has become this campaigns’ greatest ally. We know that Tanzanian President Kikwete cares about the women of our nation. He has committed greatly to preventing these tragic deaths, but we cannot stop until women can access emergency lifesaving care near their homes. It is their right to do so.

 
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