Njiro Belinda J, Ngowi Jackline E, Mlunde Linda, Munishi Castory, Kapologwe Ntuli, Kengia James T, Deng Linda, Timbrell Alice, Kitinya Wilson J, Sunguya Bruno F
School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
President's Office Regional Administration and Local Government, Dodoma, Tanzania.
PLOS Glob Public Health. 2023 Jun 21;3(6):e0002097. doi: 10.1371/journal.pgph.0002097. eCollection 2023.
Maternal mortality comprises about 10% of all deaths among women of reproductive age (15-49 years). More than 90% of such deaths occur in low- and middle-income countries (LMIC). In this study, we aimed to document lessons learnt and best practices toward sustainability of the m-mama program for reducing maternal and newborn mortality in Tanzania. We conducted a qualitative study from February to March 2022 in Kahama and Kishapu district councils of Shinyanga region. A total of 20 Key Informant Interviews (KII) and four Focused Group Discussions (FGDs) were conducted among key stakeholders. The participants included implementing partners and beneficiaries, Community Care groups (CCGs) facilitators, health facility staff, drivers and dispatchers. We gathered data on their experience with the program, services offered, and recommendations to improve program sustainability. We based the discussion of our findings on the integrated sustainability framework (ISF). Thematic analysis was conducted to summarize the results. To ensure the sustainability of the program, these were recommended. First, active involvement of the government to complement community efforts, through the provision and maintenance of resources including a timely and inclusive budget, dedicated staff, infrastructure development and maintenance. Secondly, support from different stakeholders through a well-coordinated partnership with the government and local facilities. Third, continued capacity building for implementers, health care workers (HCWs) and community health workers (CHWs) and community awareness to increase program trust and services utilization. Dissemination and sharing of evidence and lesson learnt from successful program activities and close monitoring of implemented activities is necessary to ensure smooth, well-coordinated delivery of proposed strategies. Considering the temporality of the external funding, for successful implementation of the program, we propose a package of three key actions; first, strengthening government ownership and engagement at an earlier stage, secondly, promoting community awareness and commitment and lastly, maintaining a well-coordinated multi-stakeholder' involvement during program implementation.
孕产妇死亡约占育龄妇女(15至49岁)死亡总数的10%。此类死亡中90%以上发生在低收入和中等收入国家。在本研究中,我们旨在记录从“m-mama”项目中汲取的经验教训以及最佳实践,以实现该项目在坦桑尼亚减少孕产妇和新生儿死亡方面的可持续性。2022年2月至3月,我们在希尼安加地区的卡哈马和基沙普区议会开展了一项定性研究。共对关键利益相关者进行了20次关键 informant访谈(KII)和4次焦点小组讨论(FGD)。参与者包括实施伙伴和受益人、社区护理小组(CCG)协调员、医疗机构工作人员、司机和调度员。我们收集了他们对该项目的经验、提供的服务以及关于提高项目可持续性的建议的数据。我们基于综合可持续性框架(ISF)对研究结果进行了讨论。进行了主题分析以总结结果。为确保该项目的可持续性,提出了以下建议。首先,政府积极参与以补充社区努力,通过提供和维护资源,包括及时且包容的预算、专职工作人员、基础设施建设和维护。其次,不同利益相关者通过与政府和当地设施建立协调良好的伙伴关系提供支持。第三,持续为实施者、医护人员(HCW)和社区卫生工作者(CHW)开展能力建设,并提高社区意识,以增加对项目的信任和服务利用率。传播和分享成功项目活动的证据和经验教训,并密切监测已实施的活动,对于确保顺利、协调良好地实施拟议战略至关重要。考虑到外部资金的临时性,为成功实施该项目,我们提出了一揽子三项关键行动;首先,在早期加强政府的主导权和参与度,其次,提高社区意识和承诺,最后,在项目实施期间保持多利益相关者的协调良好参与。