Increasing access to quality focused ANC: Tanzania experience 200007

1
Increasing access to quality focused ANC
Tanzania experience 2000/07

• FLEMAFA Conference, Kisarawe
• Gaudiosa Tibaijuka Senior Midwifery Advisor
• 31 Aug 2007

2
Objectives of FLEMAFA Conference

• Raise awareness regarding issues contributing to
  Maternal and Newborn morbidity and mortality.
• Share efforts underway to improve
  maternal-newborn-child health in Tanzania and
  Kisarawe in particular
• Hear from selected RCH partners in Tanzania (WRA,
  ACCESS/JHPIEGO)
• Identify ways to improve efforts done by MOHSW
  and other reproductive and child health partners
• Generate and share plan of action demonstrating
  the commitment of all participants to continue
  engagement within the local community and among
  individuals and organizations participating in
  the conference) in Kisarawe District

3
Objectives of Focused ANC presentation

• Share ACCESS/JHPIEGO experience in providing
  technical
• assistance to the MOHSW in the implementation of
  Focused ANC
• National Programme including malaria and syphilis
  in pregnancy
• through
• Introducing ACCESS Programme
• Describing the rationale for focused ANC
• Listing Partners and collaborators in Focused ANC
• Listing strategies used in implementing FANC
  programme in Tanzania
• Share program achievements and results
• Discuss challenges and opportunities

4

• Im going to fetch a baby. Its a dangerous
  journey and I may not return.
• Traditional African saying

5
This conference is the beginning of a journey
for us and for her representing women in
Kisarawe!!
6

• Are we committed to making her journey/ their
  journey safe?

7
Introduction

• ACCESS is a five-year global program in its third
  year of implementation aimed at reducing maternal
  and newborn deaths and improving the health of
  mothers and newborns
• JHPIEGO in partnership with Save the Children,
  Constella Futures, The Academy for Educational
  Development, The American College of Nurse
  Midwives and Interchurch Medical Assistance.

8
Focused Antenatal Care

• An approach to ANC that emphasizes
• Evidence-based
• Goal-directed actions
• Individualized woman-centered care
• Quality versus quantity of visits
• Care by a skilled provider

9
Goal of Focused Antenatal Care

• To promote maternal and newborn health
• and survival through
• Early detection and provision of treatment for
  existing diseases
• Promotion and maintenance of the physical, mental
  and social health of mother and baby through
  enhanced interpersonal skills on nutrition, PMTCT
  etc.
• Development of individual birth plans and
  complication readiness plans.
• Early detection and management of complications
  during pregnancy, labour, delivery and post
  partum through identification of danger signs

10
Partners

• Ministry of Health and Social Welfare at all
• levels
• National- RCHS, NMCP, NACP, HSIU and HRDD
• Zonal- ZRCH teams, ZTCs
• Regional- RHM teams
• District- DHM teams and others
• Other Collaborating Organizations
• White Ribbon Alliance
• IMA
• CSSC and other Tanzanian FBOs
• JSI/DELIVER

11
Routine practices proved not to be significant

• Numerous visits
• - Burdens women and health care system
• - Reduced number does not seem to affect
  pregnancy outcomes (WHO multi-center study,
  Villar et al 2001 )
• Some measurements and examinations
• Care based on risk assessment

12
Risk Approach

• Not an effective ANC strategy because
• Complications cannot be predicted hence, all
  pregnant women are at risk for developing
  complications
• Many low risk women develop complications
• Do not know how to recognize/respond to problems
• Have false sense of security
• Most high risk women give birth without
  complications
• Inefficient use of scarce resources

13
FANC Best practices

• Focused antenatal visits by skilled provider
• Detection and management of coexisting conditions
  and complications
• Birth preparedness and complication readiness
  planning
• Family planning, breastfeeding, danger signs,
  HIV/STIs, and nutrition counseling
• Tetanus toxoid
• Iron and folate
• Mebendazole -Helminth presumptive treatment
• SP for IPT of Malaria

14
IPT GOAL

• Presidential Malaria Initiative goal
• 85 IPTp uptake by 2009
• MOHSW targets
• 60 by 2007
• ACCESS is collaborating with other partners
• in reaching the PMI targets for IPT coverage in
• Tanzania

15
Birth Preparedness, and Complication Readiness

• Preparing for Normal Birth
• Identifying a skilled attendant and place of
  delivery
• Arranging finance, essential items
• Nutrition
• Readiness for Complications
• Early detection danger signs
• Designated decision maker(s)
• Emergency funds, communication
• Transport, blood donors

16
Tanzania Focused ANC Program Strategies and
approaches

• ACCESS uses Focused Antenatal Care as a platform
  for increasing
• access to quality maternal and newborn services
  through
• Influencing policy change, development of
  guidelines and standards for Focused ANC, Malaria
  Syphilis during pregnancy and Infection
  Prevention
• Advocacy and joint planning- working with policy
  makers at all levels national, regional,
  district and facility advocacy meetings
• Partnership and collaboration with stakeholders

17
Tanzania Focused ANC Program Strategies and
approaches cont

• Incorporating into pre service midwifery
  education Curriculum and learning package
  development
• In-service and pre-service training in public and
  private (Faith Based Organizations) sectors
• Introducing Standards based management approach
  for Performance Quality Improvement (PQI)
• Collaborate with community organisations mainly
  through White Ribbon Alliance

18
Program strategies and approaches cont

• Comprehensive coverage with FANC/MIP/SIP
• Regional advocacy meetings
• Regional TOTs for District trainers including RCH
  clinic in charges, RCH coordinators
• District based clinical training for ANC service
  providers
• ANC PSE Quality improvement processes
• Follow-up of trained facilities and schools using
  QI tools to monitor service trend

19
Program achievements

• Policy change for Focused ANC Malaria
  Intermittent Preventive Treatment, syphilis
  screening and treatment, infection prevention
  standard precaution practices
• Infection prevention national guidelines,
  training of national core team
• Job aids on FANC, Malaria and syphilis during
  pregnancy
• Provision of integrated ANC services- PMTCT, MIP,
  SIP, nutrition, STIs, FP etc
• RCH trainers, supervisors (zonal, regional and
  district RCHCos) and providers trained on Focused
  ANC clinical and teaching skills

20
Program achievements training

• Focused ANC introduced in Nursing Midwifery
  Certificate and Diploma national curricula
• All 55 Nursing and Midwifery Schools in Tanzania
  updated in focused ANC clinical and teaching
  skills- (110 tutors and 110 preceptors)
• All 22 cert schools and half of the remaining
  schools are equipped with training equipment,
  reference books and anatomical pelvic models
• System for rolling out Focused ANC nationwide
  established
• Standards-based management process for
  performance and quality improvement introduced to
  15 regions.

21
Standards Based Management A Performance and
quality Improvement Model
22
Indicator for success of program

• Intermittent preventive treatment for malaria
  increased from 0 to 18.4
• 50 of Tanzania households own a mosquito net
• 14 of families own Insecticide Treated Nets
• 47.1 gave birth at health facility
• 80 received TT at least once
• 61.1 received iron supplementation
• 94.3 received ANC from a health professional at
  least once.
• 
  
• Source TDHS 2004/05

23
Challenges and Opportunities

• Limited numbers of skilled providers
• Shortages especially of Sulfadoxine
  Pyrimethamine, RPR kits
• Poor data management recording, processing and
  use
• Quality antenatal care platform suited to
  introduction of other services e.g. PMTCT of HIV,
  Intermittent Preventive Treatment of malaria
  among infants
• National system for expanding quality ANC in
  place

24
Thank you for active listening!