1. Saving a Generation: Maternal, Newborn and Child Health (MNCH) Eastern and Southern Africa Aga Khan Health Services

2. Today’s presentation Situation of Maternal, Newborn and Child Health (MNCH) in Sub-Saharan Africa, with a particular focus on Tanzania Approaches and impact of community interventions to improve mother and child health outcomes

3. ESA: maternal mortality amongst the highest in the world “In 2010, close to 58,000 women [across Eastern and Southern Africa] lost their lives in pregnancy and childbirth, accounting for more than 1/5 of all such deaths in the world. That’s close to 10 deaths every hour.” - UNICEF

4. Tanzania’s maternal mortality rates are amongst the worst in an already bad situation Amongst highest maternal mortality rates in the world, Tanzania ranks 21 st globally, tied with Afghanistan.

5. Child mortality rates are also unconscionably high Tanzania Under 5 mortality rate: 81 / 1000 live births Infant mortality rate: 51 / 1000 live births Neonatal mortality rate: 26 / 1000 live births The neonatal mortality rate is the first 28 days after birth, and in Tanzania accounts for over 30% of all child deaths.

6. Largely, the problem is no skilled attendant at delivery…

7. …and most deaths are largely preventable

8. But, there is progress in both maternal mortality rate…

9. …and in child mortality rate

10. Still, there are large challenges in Tanzania’s health sector Within health sector:.Weak health infrastructure.Limited human resources.Poor referral systems.Inadequate equipment and supplies Community:.Inadequate community involvement and participation in health Other factors:.Education levels.Economic, social, & cultural issues.Gender dynamics

11. Still, there are large challenges in Tanzania’s health sector Within health sector:.Weak health infrastructure.Limited human resources.Poor referral systems.Inadequate equipment and supplies Community:.Inadequate community involvement and participation in health Other factors:.Education levels.Economic, social, & cultural issues.Gender dynamics

12. Why do we work in the community? In Tanzania: Out of a population of 40 million, 80% live in rural areas In rural areas, health infrastructure and services are limited Most people live below the poverty line and cannot afford to travel for health services Outreach aims to: Develop a relationship with the communities Stimulate behavioral changes that improve health and prevent disease Improve maternal, newborn and child health indicators

13. And what exactly do we do? Community support Service delivery in communities Community Meetings and Interactions Health promotion activities Develop links with referral health facilities

14. Links established through comms systems Ambulance services Feedback mechanism Follow-up Government referral hospital Aga Khan Health Services PCM Public Health Facility

15. Teleconsultation Linkage

16. Service delivery in communities

17. Community meetings and interactions Mobile health reach: Regular outreach mobile health visits to under- served rural areas Community training and empowerment Support to community health workers

18. Health promotion activities – education & entertainment Community health camps: Create demand Raise awareness – prevention, treatment care, social services Change attitudes to foster behavioral change

19. Outpatients at public health centres rose 6.5x last year…

20. …and deliveries in health facilities rose 11x