Averting Maternal Death and Disability in an Urban Network of Care in Dar es Salaam, Tanzania: A Descriptive Case Study

Abstract

The non-governmental organization Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) developed a multi-facility maternal and neonatal Network of Care (NOC) among 22 government hospitals and catchment facilities operating across Dar es Salaam. While facility delivery rates were above 90% in the Dar es Salaam region, the quality of services was substandard, leading to an excess of preventable maternal and neonatal morbidity and mortality. In partnership with the Dar es Salaam regional health authorities CCBRT developed a plan to improve the quality of service delivery at childbirth by through a system strengthening approach, capacitating lower-level facilities to provide routine care during pregnancy and uncomplicated deliveries, as well as improving care at secondary level referral hospitals and developing an interconnected strengthened referral system. The Regional-CCBRT partnership implemented interventions across the continuum of care that included clinical training in basic and comprehensive emergency obstetric care, investments in infrastructure, and a rigorous maternal and perinatal death audit and follow-up program. Routine data generated were reflected upon at quarterly quality improvement meetings to follow up on problems identified. The government has initiated the replication of the model. This descriptive case study uses the four domains of the Networks of Care framework to document the wide-ranging efforts made to build and maintain the CCBRT Network of Care in order to solve for specific challenges in maternal and neonatal health service delivery in the urban context of the Dar es Salaam region.

A tale of 22 cities: utilisation patterns and content of maternal care in large African cities

“…This can be helpful in identifying sites for future study of success factors contributing to high and low performance. 71 Such future studies should be contextualised within each country, to understand the impact of country-level policies and health provision vis-à-vis the situation in the city(ies) studied. While there were no clear overarching patterns linking utilisation, sector, level of provision and content with city characteristics, there were several points that this study has helped bring to the fore.…”

Networks of care to strengthen primary healthcare in resource constrained settings

“…A case study suggests that the check-ins improved teamwork, which facilitated a decline in hospital maternal and perinatal deaths. 26 T h e n e t wo r k i n M e t ro -M a n i l a , Philippines, is credited with transforming the professional culture and creating trust between clinicians at a tertiary public sector hospital and public and private midwifery clinics. Qualitative data show that previous mistrust between these healthcare workers was allayed when the network leader began visiting midwifery clinics in the catchment area to meet the midwives and saw that they provided good care.…”

“…For example, a sense of purpose and confidence derived from the collaborative formation of a public-private sector network in Dar es Salaam, Tanzania, is believed to have motivated senior healthcare workers to check-in with colleagues to offer assistance in providing care. A case study suggests that the check-ins improved teamwork, which facilitated a decline in hospital maternal and perinatal deaths 26…”

Harnessing the Power of Networks of Care for Universal Health Coverage

“…12 The NOC approach, a style of integrated health delivery, is described in a multi-method scoping study and case studies from six diverse implementation settings. [1][2][3][4][5][6] The articles provide a set of practicable, measurable means to bridge Networks of Care and Universal Health Coverage.…”

“…NOC become the means by which health systems achieve better health outcomes more efficiently. 3,4,6 Too often, subnational governments and health facilities lack the autonomy and flexibility to allocate resources and manage services to monitor and respond to changing population needs. The NOC approach offers the possibility to learn from and improve subnational health management, financing and governance, including direct contracting to fill gaps in the public sector offerings.…”