Supporting midwifery roles in Tanzania

A resident of Ubungo Kibango, Ms Diana Mosha shares that when she was at secondary school, she never, in her wildest imaginations, thought that an expectant mother can die so easily over senseless demands when in labour.

Until she joined a certain university within the city to study maternal health and midwifery. In 2005, when she was about to graduate she was attached at a district hospital in Dar es Salaam as student on field to perform practical lessons.

According to her, it was unfortunate that within a week when she started field training, she witnessed a pregnant woman who come in for delivery at the respective hospital, die because she did not have a delivery kit.
Ms Mosha stressed that,” It was on Sunday around midnight, when the pregnant woman come at the hospital but, she did not come along with cotton wool, a razor blade and other related tools. The nurse in -charge told her, she would not be attended unless she brought with her the delivery kit.
But, the pregnant woman was in excruciating pain and she did not have money to buy the kit and so the nurse in-charge insisted that they would not attend to her otherwise.
After Ms Mosha realized she had money in her pocket, she quickly rushed outside the hospital to go and buy the delivery kit and lucky enough managed to buy the items but when she came back she found the woman had died with her unborn baby.
“From that day, I promised myself not to specialize in maternal and neonatal but to specialize in pharmaceutical so that I am able to sell medicine and support women in need of delivery kits,” she says.
Reduction of maternal and new-born deaths is a high priority for all given the persistently high maternal and new-born morbidity and mortality rates over the past two decades in African countries and Tanzania in general.
It is one of the major concerns addressed by various global and national commitments, and reflected in the targets of the Millennium Development Goals, Tanzania Vision 2025, the National Strategy for Growth and Reduction of Poverty (NSGRP-MKUKUTA), and the Primary Health Services Development Program (PHSDP-MMAM), among others.
Maternal deaths are caused by factors attributable to pregnancy, childbirth and poor quality of health services. New-born deaths are related to the same issues and occur mostly during the first week of life. Improving access to quality health services for the mother and new-born requires evidence-based and goal-oriented health and social policies and interventions that are informed by best practices.
In particular, the government of is striving to fight against maternal and neonatal deaths in the country, death related to the matter is still is challenge in the country.
A 2021 State of the World’s Midwifery report issued by the UNFPA, the International Confederation of Midwives (ICM), and World Health Organization (WHO) showed that if governments invested much in midwives, 4.3 million lives could be saved every year by 2035, a number that includes maternal deaths, neonatal deaths, and stillbirths.
Also the Health Demographic and Malaria Indicator Survey 2015/16 report indicates that 556 maternal death out of 100,000 live births occur every year, the number is still not satisfying,
Tanzania Midwives Association (TAMA) President Ms Feddy Mwanga said that the government should invest heavily in improving the working environment with quality equipment and well-skilled workers to support safe births and fight maternal and neonatal deaths in the country.
According to her, despite several strides taken by the government and stakeholders to increase the number of hospitals and health centres, maternal and neonatal mortality rate was still high.
She made the remarks in Dar es Salaam during a media orientation session ahead of the 2022 International Day of the Midwife on May 5, that was celebrated in Dodoma at its climax on May 7.
The event themed “Invest in Midwives:  Save lives” was organized collaboratively by the United Nations Population Fund (UNFPA), TAMA and Jakaya Mrisho Kikwete Foundation.
“More concerted efforts were highly needed to address the challenges by making sure that hospitals, health centres and dispensaries are well equipped for the country to attain its development endeavours,” she said.
She explained that midwives are the backbone of maternal health systems so there should be a conducive environment for them to operate in which include enough and quality equipment, regular training and capacity building so as to support safe delivery.
Mwanga said in efforts to support safe delivery, TAMA will continue educating midwives in rural areas on the importance of encouraging pregnant mothers to attend clinics and go to deliver in hospitals.
UNFPA officer-in-charge, Dr David Wilfred Ochan said the International Day of the Midwives is an opportunity to look at the data and come up with better strategies on how to invest in the midwifery force in Tanzania so that they can realize their significant contribution towards accelerating progress toward national and global development aspirations.
He noted that most maternal deaths are considered preventable, particularly in the presence of high-quality care from skilled, motivated, regulated and supported health professionals during pregnancy, and during and after childbirth.
“We all understand that economic growth is highly dependent on the health of its citizens; therefore, the community needs to recognize the contribution of midwives and appreciate the work done by midwives and those with midwifery skills in saving the lives of mothers and children in the country, in contributing to adolescent health, reducing HIV infection and managing gender-based violence cases,” he noted.  
He said UNFPA Tanzania has continued to work the Ministry of Health and TAMA to achieve the various goals that include renovation of health facilities including birthing wards and operating rooms in some regions (Kigoma, Dodoma, Simiyu, Zanzibar) so that they can provide emergency surgical services (EmONC).
“Purchase of various equipment and machinery to enable safe delivery care and to provide maternal and child care easily in renovated health facilities as well as capacity building of midwives to provide emergency maternal and child care across the regions of Mara, Mwanza, Geita, Shinyanga, Dar-es-salaam and Dodoma has been underway,” he said.
Furaha Mafuru, UNFPA programme officer noted that reports show that there is a global shortage of 1.1 million sexual, reproductive, maternal, new-born and adolescent health care providers where 900,000 are midwives.
Mafuru wanted midwives to be treated as equals and respected partners at all levels which includes encouraging and enabling a work environment where midwife-led continuity of care can flourish.
“We should also engage midwives in policy and planning decisions at all levels of the health system and improve institutional capacity to help midwives be leaders and advocates for high-quality respectful maternity care,” she added.
The government has prioritized the reduction of maternal and new-born deaths and stillbirths in line with global efforts as advocated by the global Sustainable Development Goals (SDG 3)