Phase 2 CCBRT MATERNITY HOSPITAL

Women Centered Care: Providers as change agents

Advocacy for Respectful Maternal Care

Presented by Dr. Brenda D’mello Comprehensive Community Based Rehabilitation in Tanzania www.ccbrt.or.tz Comprehensive

Community Advocacy

Disability Inclusive Maternal Presented by Dr. Brenda D’mello

8000 maternal deaths a year (TDHS 2010) 45,000 newborn deaths. 51,000 still birth Save the children Report 2009

Promise to work towards dignity in childbirth with no fear of disability, death or disrespect One Woman One Bed

90.2 % Facility Delivery Rate TDHS 2010 The Provider: Caring & Respectful

On The Front line in contact with Patient Supportive Leadership & management behaviour change Culture Change CCBRT Maternal Health Strategy

Phase 1 Phase 2 CAPACITY BUILDING CCBRT MATERNITY • Improve quality of care HOSPITAL • Upgrade health centers • Absorb at least 14,000 and dispensaries to deliveries a year absorb greater delivery loads • Strengthen referral system

DECONGEST MUNICIPAL HOSPITALS !

Target • Temeke Facilities • Amana • Mwanyanamala • Buguruni • Sinza • Kigamboni • Vijibweni • Zakhem • Mnazi moja • Tabata 4 million+ • Chanika • Tandale • Tegeta • Kunduchi 111,000 deliveries per year • Kimara • Round Table Investment in Capacity Building

Reducing maternal and

newborn INFRASTRUCTURE TRAINING deaths through improvement quality of services

AWARENESS Disability inclusive DATA/REFERRAL

“Building partnerships and working in collaboration” Interact and influence

Training Conducted BEmoNC 169 Perinatal education 23 Continous medical education: - Infection prevention 111 - Anaestetic refresher 30 - Normal Labour & Delivery ~250 - Med. Attendants orientation 13 Coaching & mentoring (Nurses) 85 Coaching mentoring (AMO/CO/NM) ~250 Standards based Anaesthetic training (MNH) 13 Competency training Doctors skills update 71 Coaching & mentoring Disability awareness for HCW 237 Quality Improvement teams 16 Changing the Heart of the Provider

Testimony From a patient Cured from Fistula Recognize Champions Trained Managers are Teachers Investing in Infrastructure 2 maternity wards renovated 3 Theatres KMC and post natal ward Creating Conducive Working Spaces

OLD KITCHEN NEW POST NATAL WARD Improved Flows Supporting Privacy Improved Flows/Privacy Disability Inclusive care

Training in sign Language; Creating Access and promoting Equity Measuring

• QI team measure routine indicators every quarter • TD, LB, MM, SB, ND, CS, LCVE • Joint leadership /Management teams conduct Standards Based Assessments every 6 months • Quarterly meeting to share results • Share Best Practices. • Celebrate Success STANDARD BASED MANAGEMENT & RECOGNITION (SBMR) SCORES Maternal & Newborn Health 9 CCBRT supported public facilities Dar es Salaam 100 90

90 81 78 80 73 71 71 68 70 66 63 62 62 5860 58 59 60 53 49 50

40 36 37 32 31 BASE LINE

ACHIEVED ACHIEVED PER ASSESSMENT 28 29 30 26 26 24 Mar-11 21 21 22 20 20 17 17 Sep-11 12 10 12

TOTAL TOTAL % 9 9 9 10 5 5 Sep-12 4 3 2 0 0 Jun-13

SINZA

AMANA

TEMEKE

VIJIBWENI

BUGURUNI

KIGAMBONI

RANGITATU

MNAZIMOJA MWANANYAMALA KINONDONI TEMEKE ILALA KINONDONI TEMEKE TEMEKE TEMEKE ILALA ILALA HEALTH FACILITY PER DISTRICT OVERVIEW OF AVERAGE REGIONAL SBMR SCORES SEPT 2012 - JUN 2013 Maternal & Newborn Health 16 CCBRT supported public facilities Dar es Salaam

100%

90%

80% 75.80%

2013

- 70%

59.60% 58.98% 60% 56.33% 55.80% 55.75% 52.50% 50% Average score Baseline 44.80% Average score Sep 12 40% Average score Jun 13

30% AVERAGE AVERAGE SPMR PERCENTAGES 2012 20% 15%

10% 9% 10% 3%

0% ILALA MUNICIPAL KINONDONI MUNICIPAL TEMEKE MUNICIPAL DAR REGION MUNICIPAL Success Story : BUGURUNI HC

BEFORE APRIL 2010 NOW : APRIL 2011 EMPTY WARD FULL WARD Deliveries conducted: New Sites (AUZ)

Deliveries 2011 Deliveries 2012 Mnazi Mmoja Health 32 616 Centre 835 Tandale Dispensary 406 495 Kimara Dispensary 344 352 Tegeta Dispensary 167 180 Kunduchi Disp 107 2665 Round Table Disp 3185 209 Tabata NBC Disp 125 1392 Chanika Disp 949 Tracking Maternal and Newborn Deaths Data element 2011 2012

Total deliveries 97,787 108,054

Maternal deaths Regional Data -not only 16 sites

Total Maternal deaths 266 252 (14)

MMR /100,000 272 230

Neonatal deaths

Total Neonatal deaths 2190 2130 (60) CCBRTCCBRT Maternity Maternity Hospital Hospital Work WorkIn Progress In Progress

Comprehensive Integrated Respectful Inclusiive Maternal and Newborn care “A bad system will beat a good person every time" Dr. Edwards Deming (The Father of Total Quality Management)