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Endline Study Report ENDLINE STUDY REPORT JUNE 2020 Regional Maternal Newborn and Child Health Strengthening in Tanzania Project Partners: Catholic University of Health and Allied Sciences University of Calgary Agriteam Canada Consulting Ltd Canadian Paediatric Society Mbarara University of Science and Technology Save the Mothers Mwanza Regional Health Management Team Misungwi & Kwimba Districts Table of Contents List of Tables ................................................................................................................................................ iii List of Figures ............................................................................................................................................... iv Study Team and Acknowledgements ............................................................................................................ v Acronyms .................................................................................................................................................... vii Executive Summary .................................................................................................................................... viii 1 Introduction ............................................................................................................................................. 1 1.1 Project Description: Mama na Mtoto .............................................................................................. 1 1.2 Study Context ................................................................................................................................... 1 1.2.1 MNCH in Tanzania .................................................................................................................. 1 1.2.2 Tanzanian Health System ....................................................................................................... 2 1.2.3 Misungwi and Kwimba Districts, Mwanza Region ................................................................. 3 1.3 Objectives of Endline Study ............................................................................................................. 3 2 Methodology ........................................................................................................................................... 4 2.1 Project Evaluation Plan .................................................................................................................... 4 2.2 Endline Study Overview ................................................................................................................... 5 2.3 Research Methods ........................................................................................................................... 7 2.3.1 Qualitative Inquiry ................................................................................................................. 7 2.3.2 Health Facility Survey ............................................................................................................. 9 2.3.3 MNCH Coverage Survey ....................................................................................................... 13 2.3.4 CHW Registry ....................................................................................................................... 16 3 Results .................................................................................................................................................... 18 3.1 Qualitative Inquiry.......................................................................................................................... 18 3.1.1 Participant Characteristics ................................................................................................... 18 3.1.2 Key Qualitative Themes ....................................................................................................... 19 3.2 Health Facility Survey ..................................................................................................................... 33 3.2.1 Health Facility Characteristics .............................................................................................. 33 3.2.2 Key Health Facility Indicators ............................................................................................... 35 3.2.3 MNCH Service Readiness ..................................................................................................... 37 3.2.4 BEmONC and CEmONC Signal Functions ............................................................................. 39 3.3 MNCH Coverage Survey ................................................................................................................. 41 3.3.1 Household Characteristics ................................................................................................... 41 3.3.2 Woman Characteristics ........................................................................................................ 43 3.3.3 Child Characteristics ............................................................................................................ 45 Mama na Mtoto Endline Report – Version 29 June 2020 i 3.3.4 Key MNCH Indicators ........................................................................................................... 46 3.3.5 CHW Activity ........................................................................................................................ 47 3.4 CHW Registry.................................................................................................................................. 48 3.4.1 CHW Characteristics ............................................................................................................ 48 3.4.2 CHW Supervisors.................................................................................................................. 48 3.4.3 CHW Retention .................................................................................................................... 49 4 Dissemination ........................................................................................................................................ 50 4.1 Dissemination Process ................................................................................................................... 50 4.2 Data Review Workshops ................................................................................................................ 50 4.3 District Dissemination .................................................................................................................... 50 4.3.1 District Data Champions ...................................................................................................... 50 4.3.2 Stakeholders ........................................................................................................................ 51 4.3.3 Beneficiaries ......................................................................................................................... 52 4.3.4 Mama na Mtoto Experience Showcase Symposium............................................................ 53 5 Discussion .............................................................................................................................................. 54 5.1 Key Achievements .......................................................................................................................... 54 5.1.1 Improved Facility-Based MNCH Service Provision ............................................................... 54 5.1.2 Increased MNCH Care-Seeking at Facilities ......................................................................... 54 5.1.3 Active District-Wide CHW Network Increases MNCH Service Demand .............................. 55 5.1.4 Enhanced Male Engagement in MNCH and Changing Gender Roles in Communities ........ 55 5.2 Gaps and Actions ............................................................................................................................ 56 5.2.1 Persisting Referral Chain Gaps Risk Maternal and Newborn Lives ...................................... 56 5.2.2 Community and District Supports Needed to Sustain CHW Network ................................. 56 5.2.3 High Unmet Need for Contraception Persists: Facility Services Not Meeting Demand ...... 57 5.2.4 Opportunities for Facility Waste Disposal Improvements Remain ...................................... 57 5.3 Study Limitations and Strengths .................................................................................................... 58 6 District Sign-Off ...................................................................................................................................... 60 7 References ............................................................................................................................................. 61 Mama na Mtoto Endline Report – Version 29 June 2020 ii List of Tables Table 1: Signal Functions for Routine Delivery Care, BEmONC, and CEmONC ............................................. 2 Table 2: Estimated 2019 Misungwi and Kwimba District Population ........................................................... 3 Table 3: Summary of Endline Study Research Methods ............................................................................... 5 Table 4: Health Facility Survey Key Indicator Definitions ........................................................................... 11 Table 5: Health Facility Survey MNCH Service Readiness Score Criteria ...................................................
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