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Improving Access to Reproductive and Maternal Health Services

One Tanzania Healthcare Worker’s Skills-Building Journey

In the Simiyu Region of Tanzania, long-acting and reversible contraceptives (LARCs) have not been available to most women—only to those who could travel 100 kilometers to Somanda Regional Referral Hospital. For those women who couldn’t accommodate trip, which is two hours each way, the Ikungulyabashashi Dispensary—which serves a community of 5,000 people in Simiyu Region—could provide family planning clients with contraceptive pills and injectable contraceptives. A provider at the dispensary shared, “For about ten years we have been referring clients to Somanda Hospital and only a few clients could go to Somanda; the rest either opted for short-term methods or stayed without a family planning method.” Improving access to reproductive and maternal health services—including family planning services and LARCs in particular—was a critical challenge.

“For about ten years we have been referring clients to Somanda Hospital and only a few clients could go to Somanda; the rest either opted for short-term methods or stayed without a family planning method.”

Uzazi Uzima Project: Improving Access to Reproductive and Maternal Health Services

The Uzazi Uzima Project, implemented from 2017 through early 2021 in Simiyu Region, aimed to reduce maternal and newborn mortality and morbidity by improving the availability of quality reproductive, maternal, newborn, and adolescent health (RMNCAH) services and subsequent utilization of those services, including family planning. One key aspect of Uzazi Uzima (meaning “Safe Deliveries” in Swahili) is to enhance the knowledge and skills of health workers to deliver quality RMNCAH services.

A Quick Fix in the Community

Healthcare worker Shija Shigemela provides family planning services at the Ikungulyabashashi Dispensary. Image courtesy of Uzazi Uzima.

Healthcare worker Shija Shigemela provides family planning services at the Ikungulyabashashi Dispensary. Image courtesy of Uzazi Uzima.

Shija Shigemela is a healthcare worker at the Ikungulyabashashi Dispensary. In 2018, Shija was selected to attend a two-week comprehensive family planning training, followed by a certification process three months later. Because Shija had not yet attained full competence in the insertion of intrauterine contraceptive devices (IUDs or IUCDs), he was linked with Uzazi Uzima’s outreach team for further practice and skills enhancement. One year later, Shija was reassessed for certification, and as a result of his job attachment with Uzazi Uzima, he was found to be among the most competent providers—able to provide proper health education and counseling on more types of family planning services, including LARCs.

Shija is now providing the full range of family planning services to the community of Ikungulyabashashi, enabling women to access LARCs locally, rather than be referred to distant health centers, which has increased women’s satisfaction and improved access to quality RMNCAH services. A provider at the dispensary said:

“Before, women would complain of being pregnant because they could not get a method of their choice or because they forgot to take pills since they were the only methods provided, but now you would not hear this challenge from women.”

Ikungulyabashashi dispensary is now reaching about 15 to 20 women with family planning services per week. Shija said: “I have targets that have helped me in my skills that I have to attend to family planning clients every day, no matter how busy it gets in the clinic.”

“I have targets that have helped me in my skills that I have to attend to family planning clients every day, no matter how busy it gets in the clinic.”

Conclusion

Since the inception of Uzazi Uzima, nearly 34,000 clients have received a family planning method in Simiyu Region. As the project progressed, there was an upward trend in the number of clients reached with family planning methods, with a large majority selecting LARCs—so those 34,000 clients represent 123,737 couple-years of protection overall.

The Uzazi Uzima project is a partnership between Amref Health Africa and Marie Stopes. The project was implemented from January 2017 through March 2021 with funding from the Government of Canada through Global Affairs Canada. Learn more about Uzazi Uzima.

A landscape image of a village near the dry salt lake Eyasi in northern Tanzania. Image credit: Pixabay user jambogyuri
Shiphrah Kuria

RMNCAH Regional Manager, Amref Health Africa

Dr. Shiphrah Kuria is an Obstetrician/Gynecologist and public health specialist who holds a doctorate in public health, currently working as the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) Regional Manager at Amref Health Africa. She is responsible for providing technical oversight over multicounty SRHR and MNCH projects, coordination with partners including donors and Ministries of Health (MoH), and strengthening both the formal health and community systems for sustainable health improvement. She has been involved in several research initiatives looking at the effects of the COVID-19 pandemic and the associated responses on vulnerable groups, particularly women, girls, and children. Dr. Kuria has an excellent understanding of the health context in Sub-Saharan Africa, government/MoH procedures, service provision, and management of health facilities. She has worked in Kenya, South Sudan, Ethiopia, Uganda, Tanzania, Malawi, and Zambia. Before joining Amref she worked as a front line health worker in Kenya and as a policymaker/program manager at the national reproductive health program.

Serafina Mkuwa

Programme Manager, RMNCAH, Amref Health Africa, Tanzania

Dr. Serafina Mkuwa is a public health specialist with Degree of Medicine. She has over 13 years of experience in public health programming and health systems strengthening interventions. Within Amref, she has worked as a National Program Coordinator for Pamoja Tunaweza—an SRHR alliance implemented by nine organizations: five from the South (Tanzania) and four from the North (Netherlands)—and as a Program Manager for Research and Advocacy, where she pioneered establishment of a local Institutional Research Board (IRB) for Amref and was involved in conducting a number of research studies and evidence-based advocacy. Prior to joining Amref Health Africa, Dr. Mkuwa worked with Benjamin Mkapa Foundation (a local NGO) as M&E officer and later on as a Project Manager. Before that she worked at MUHAS as a clinical Research Scientist for HIV Vaccine trials and practiced general medicine at Muhimbili National Hospital while employed by the Ministry of Health. She was elected by female doctor members to serve as a President of the Medical Women Association of Tanzania for seven years, where she led several mass campaigns with teams of female medical doctors for community breast and cervical cancer screening—reaching more than 80,000 women with screening services. Dr. Mkuwa has vast experienced in working with multilateral and bilateral donors, including PEPFAR, GAC (Global Affairs Canada), DFATD, SIDA Sweden, DFID through HDIF, Big Lottery fund, Allen and Ovary, UN –Trust Fund, UNFPA, UNICEF, Amref Northern Offices, and the Dutch Ministry of Foreign Affairs (Netherlands). At the national and local level she interacts closely with various Ministries, local government authorities and departments, and local agencies and partner organizations.

Sarah Kosgei

Networks and Partnerships Manager, Amref Health Africa

Sarah is the Networks and Partnerships Manager at the Institute of Capacity Development. She has over 10 years’ experience providing leadership to multi-country programs geared towards strengthening the capacity of the health system for sustainable health in Eastern, Central, and Southern Africa. She also part of the Women in Global Health – Africa Hub secretariat domiciled at Amref Health Africa, a Regional Chapter that provides a platform for discussions and a collaborative space for gender-transformative leadership within Africa. Sarah is also a member of the Universal Health Coverage (UHC) Human Resources for Health (HRH) sub-committee in Kenya. She has degrees in Public Health and an Executive Masters in Business Administration (Global Health, Leadership and Management). Sarah is a passionate advocate for primary health care and gender equality in sub-Saharan Africa.

Alex Omari

East Africa KM Officer, Knowledge SUCCESS, Amref Health Africa

Alex is the Technical Family Planning/Reproductive Health Officer at Amref Health Africa’s Institute of Capacity Development. He works as the Regional Knowledge Management Officer (East Africa) for the Knowledge SUCCESS project. Alex has over 8 years’ experience in adolescent and youth sexual and reproductive health (AYSRH) program design, implementation, research, and advocacy. He is currently a Technical Working Group member for the AYSRH program at the Ministry of Health in Kenya. Alex is a website contributor/writer for Youth for Change and the outgoing Kenya Country Coordinator for the International Youth Alliance for Family Planning (IYAFP). He holds a Bachelor of Science (Population Health) and a Master of Public Health (Reproductive Health) from Kenyatta University, Kenya. He is currently pursuing his second Master's Degree in Public Policy at the School of Government and Public Policy (SGPP) in Indonesia, where he is also a writing scholar and website contributor for the Strategic Review Journal.

Diana Mukami

Digital Learning Director and Head of Programmes, Amref Health Africa

Diana is the Digital Learning Director and Head of Programmes at Amref Health Africa’s Institute of Capacity Development. She has experience in project planning, design, development, implementation, management, and evaluation. Since 2005, Diana has been involved in distance education programmes in the public and private health sectors. These have included the implementation of in-service and pre-service training programmes for health workers in countries such as Kenya, Uganda, Tanzania, Zambia, Malawi, Senegal, and Lesotho, in partnership with Ministries of Health, regulatory bodies, health worker training institutions, and funding organisations. Diana believes that technology, used the right way, contributes significantly towards the development of responsive human resources for health in Africa. Diana holds a degree in social sciences, a post-graduate degree in international relations, and a post-baccalaureate certificate in instructional design from Athabasca University. Outside of work, Diana is a voracious reader and has lived many lives through books. She also enjoys traveling to new places.

Jerome Mackay

Technical Advisor, Monitoring & Evaluation, Amref Health Africa, Tanzania

Mr. Jerome Steven Mackay is a trained social scientist with over ten years of technical expertise in international development, specializing in Results-based Monitoring, Evaluation, Research and Learning (RbMERL) in health and development areas including HIV/AIDS/Tuberculosis, sexual and reproductive health, women’s empowerment, financial inclusion, and education management. Mr. Mackay holds a Masters of Science in Project Planning and Management (MSc.PPM) from Mzumbe University and a Post Graduate Diploma in Trade Policy and Trade Law (ESAMI). He has a number of local and international certifications in project management, MERL, and information and communication technologies (ICT). He has managed large financial portfolios in line with policies and regulations for donors and organizations including the Bill and Melinda Gates Foundation, USAID, Australia Aid (AUSAID), Financial Sector Deepening Trust Tanzania (FSDT), Centers for Disease Control, Deloitte Consulting (TZ), and John Snow, Inc. (JSI). Mr. Mackay has vast experience in planning and implementing new and innovative projects and programs, including participatory approaches for planning, implementation, monitoring, quality assurance, and evaluation; strategy development; design and implementation of various studies including baselines, needs assessment and program/project reviews; training trainers; and workshop facilitation. He has also acquired skills and experience in project coordination and management; e-communication, networking, and facilitating meetings with people from diverse backgrounds and cultures; and organizing multi-stakeholder meetings and workshops. He also has expertise in data management using various softwares and online platforms including ODK®, DATIM®, DHIS2®, IPRS, Epi info, and SPSS for Windows®.

Florence Temu

Country Director, Tanzania, Amref Health Africa

Dr. Florence Temu is the Country Director for Amref Health Africa in Tanzania. As a Country Director, Florence provides oversight for the country program, leads Amref's strategic and technical direction and identifying health intervention priorities, managing donor relations, and driving strategies for fundraising and resource mobilization. Before assuming this role, Dr. Florence had worked for Amref Health Africa in Ethiopia and Tanzania as a Project Manager, Head of Programmes, Deputy Country Director, and Country Director. With Amref, Florence has spearheaded a number of initiatives that include the development of country strategies, technical reviews, and development of program-specific strategies. She has served as a technical advisor on Non-Communicable Diseases programming, and led program development and design for a range of health interventions (in Adolescent and Youth Sexual and Reproductive Health; Maternal, Newborn, and Child Health; HIV and AIDS; and Water, Sanitation, and Hygiene). Before joining Amref, she was the Head of Cancer Prevention Services Division at Ocean Road Cancer Institute in Tanzania and a general medical practitioner and researcher under maternal and HIV research projects at Muhimbili National Hospital. Dr. Temu holds a Degree in Medicine, a Masters in Public Health, a Diploma in Palliative Care, and a University certificate in Geriatric Health Care Management. Florence had served as Vice Chairperson for the Medical Women Association of Tanzania, and is a member of the Institute of Directors of Tanzania, Global Women Leadership Network, and White Ribbon Alliance Tanzania’s Board of Directors.

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