Bloomberg Philanthropies, New York, NY, USA.
Thamini Uhai, Dar es Salaam, Tanzania.
Glob Health Sci Pract. 2022 Apr 29;10(2). doi: 10.9745/GHSP-D-21-00484. Print 2022 Apr 28.
The Program to Reduce Maternal Deaths in Tanzania was a 13-year (2006-2019) effort in the Kigoma region that evolved over 3 phases to improve and sustain the availability of, access to, and demand for high-quality maternal and reproductive health care services. The Program intended to bring high-quality care closer to more communities. Cutting across the Program was the routine collection of monitoring and evaluation data. The Program achieved significant reductions in maternal and perinatal mortality, a significant increase in the modern contraceptive prevalence rate, and a significant decline in the unmet need for contraception. By 2017, it was apparent that the Program was on track to meet or surpass many of the targets established by the Government of Tanzania. Over the following 2-plus years, efforts to sustain Program interventions intensified. In April 2019, the Program fully transitioned to Government of Tanzania oversight. Four key lessons were learned during implementation that are relevant to governments, donors, and implementing organizations working to reduce maternal mortality: (1) multistakeholder partnerships are critical; (2) demand creation for services, while critical, must rest on a foundation of well-functioning and high-quality clinical services; (3) it is imperative to not only collect robust monitoring and evaluation data, but to be responsive in real time to what the data reveal; and, (4) it is necessary to develop a deliberate sustainability strategy from the start. The Program in Kigoma demonstrates that decentralizing high-quality maternal and reproductive health services in remote, low-resource settings is both feasible and effective and should be considered in places with similar contexts. By embedding the Program in the existing health system, and through efforts to build local capacity, the improvements seen in Kigoma are likely to be sustained. Follow-up evaluations are planned, providing an opportunity to more directly assess sustainability.
坦桑尼亚减少孕产妇死亡项目是在基戈马地区开展的一项为期 13 年（2006-2019 年）的工作，历经三个阶段，旨在改善和维持高质量孕产妇和生殖健康服务的可及性、获得性和需求。该项目旨在将高质量的护理服务带到更多的社区。贯穿整个项目的是常规收集监测和评估数据。该项目在孕产妇和围产儿死亡率方面取得了显著降低，现代避孕普及率显著提高，避孕需求未得到满足的情况显著下降。到 2017 年，该项目显然有望实现或超过坦桑尼亚政府设定的许多目标。在接下来的两年多时间里，维持项目干预措施的努力得到了加强。2019 年 4 月，该项目完全过渡到坦桑尼亚政府的监督之下。在实施过程中，有四个关键经验教训与致力于降低孕产妇死亡率的政府、捐助者和实施组织相关：（1）多方利益攸关方伙伴关系至关重要；（2）服务需求的创造虽然至关重要，但必须建立在运作良好和高质量的临床服务基础上；（3）不仅要收集强有力的监测和评估数据，而且要实时响应数据所揭示的内容；（4）从一开始就必须制定深思熟虑的可持续性战略。基戈马的项目表明，在偏远、资源匮乏的环境中下放高质量的孕产妇和生殖健康服务不仅可行而且有效，在具有类似背景的地方应该考虑这样做。通过将项目嵌入现有的卫生系统，并努力建立当地能力，基戈马所看到的改善可能会持续下去。计划进行后续评估，为更直接评估可持续性提供机会。
