Barely four years ago Babayu resident Asha Salum was completely restless when she thought of how best to give birth to her first child in this world.

Limited options were available when it came to choose a hospital that would ease her heavy duty ambition to safely deliver her first baby. Best of the least alternatives was to pack then collect some supplies, enough to sustain her for the next few days that she will be away from home.

“I had to travel all the way to Bahi where there were relatively better health services than here. By then it remained as the best option in an effort to accomplish this lifetime humanitarian mission. I knew I would have to be alone there with minimal support from my close family members but at least I was assured of safety particularly for my unborn baby,” Said Asha.

The new mother had to sacrifice all the traditional habits linked with giving birth such as getting frequent well-wishing visits from her family and close friends.

She had to endure all this because the situation at the Babayu dispensary wasn’t that reassuring. She also had to incur some additional cost that she wouldn’t have to had she given birth at the Babayu dispensary

“Four years ago health services and facilities here were pathetic when I had to deliver my first child. The dispensary had only four small rooms, one of them had to be used for both maternal and outpatients in a way lacking privacy. The labor room was so small that It couldn’t accommodate two women at a time. One had to sleep on the floor, as there was no waiting room. To make matters even worse there was no power at night that opened a huge risk if you were to deliver a baby at night. It was a concern that worried me to the extent of ‘migrating’ to Bahi where the facilities and services were much better than ours,” narrated Asha with a long face as she was reminiscing about the situation.

With funds from the Irish Aid the Mkapa Fellows Program Phase III came to restore hope to the people of Babayu who have never seen any renovation done to their dispensary ever since it was built in 1973.

“I was just a young boy when the late Mwl. Julius Kambarage Nyerere came here to open this facility. Now I am an old man as you can see and I am glad that I could witness allimportant improvements done to this facility. It was enough by then but as the population kept growing, the facility remained the same. It reached a point where the population outweighed facilities and services to render the community short of satisfaction”, recalled Mzee Kanyamala Hassan, the Babayu hamlet’s chairman while adoring the newly renovated buildings.

For more than 48 years the people of this village had to rely on this facility which failed to meet their satisfaction in terms of health services. To them the refurbishment, state of the art facilities and highly improved services doesn’t just bring them massive peace of mind but rather added hope for a successful future. Four months ago Asha gave birth to her second child whom she named Sameer, only this time she didn’t have to ‘migrate’ to Bahi and instead just spent a few minutes walking from her home to the newly renovated Babayu dispensary. This time she had it all, the well-wishing highly frequent visits by friends and family members, adequate support lined up with encouragement and above all, high quality maternal services. Not to mention the huge composure and alleviated cost.

She says “giving birth to my second child was short of stress. This time I didn’t have to go to Bahi because our dispensary is at its very best. There is sufficient room for women who are in labor and above all much more privacy now than before. It is a comfortable and conducive environment for us and I wasn’t worried at all this time.”

The project did not end at renovating the building alone, it went an extra mile and installed a rain-water harvesting system that now provides huge relief to patients as well as healthcare providers. Dr Joel Charles who is a facility in charge of the Babayu dispensary confirms how much the intervention has been useful.

“Dodoma Region has long spells of dry weather during a year culminating in scarcity of water. Before the renovation we would spend up to Tshs 3,000 per day on water. The new installed rainwater harvesting system has eased cost. We can harvest up to 20,000L of water during the rainy season, enough to sustain for some months. Now even those visiting patients are more assured of water availability than they were before.”

In addition to reserve water availability the project added ice on the cake for installation of solar power good enough to improve availability and reliability of services for 24 hours. These interventions apart from improving the situation at the facility they are also environmentally friendly and sustainable solutions.

“We are grateful for this renovation because now women from our village will not have to walk long distances anymore in search of better facilities and services… In the past it was not surprising to hear some of the women had given birth on their way to the health facility in the neighbouring district of Bahi. Now all the needed services are within reach at the top of our fingertips as we are looking forward to having even higher quality facilities in the future” commented Mzee Kanyamala, his cool face lighting up with joy and unique confidence.

Jesca Juma was already four months pregnant (her first pregnancy) and yet not booked for antenatal care (ANC) when she noticed an unusual situation for her pregnancy. She noticed fluid leaking from her private parts, worried she decided to call Burhani Ramadhan Omari a Community Health Worker (CHW) in Goima village in Chemba district, Dodoma.

“It was evening when I noticed that there was fluid leaking from my private parts. I was worried and the only thing that came to my mind was to call Burhani because he is known here for connecting sick people with health care workers at our dispensary. He is famous here and thanks God he arrived in time.”

Jesca delayed booking herself for (ANC) and already she had an early ruptured membrane caused by underlying conditions which mostly causes excessive bleeding, a life-threatening infection, or obstetric fistula. It is required that a pregnant woman start ANC services at least within 2 months to help Health providers detect any threat at an earlier stage and address them timely.

This kind of delay is most common in rural areas and is even worse in an environment with ineffective referral systems that link communities with health facilities for early emergency response. Goima village had a similar challenge where emergency pregnancy complications were dealt manually through filling of paper-based forms and letters, a process which prolonged arrival and preparedness of the health facility.

Thanks to the innovation of a quick and reliable mobile App that helps to facilitate emergencyresponse like this in Chemba District to save lives. Burhani is among 34 CHW linked with 18 health facilities in Chemba empowered by Mkapa Fellow Program Phase III project with mobile phones installed with a digital App termed as Community Health Assistance Information and Decision (CHAID) tool that helps to respond with healthcare challenges in community through the Irish Aid support. When he arrived at Jesca’s home, the assessment got his attention on what he believed could be a life threatening condition.

“The MFP III project gave us this mobile phone and in it they have installed an application which guides us to assess clients through tailored questions. When I was assessing Jesca, I noticed a danger sign through guided questions from the CHAID tool and it guided me to click a referral as she was in the danger category. I filled the form in the CHAID and pushed a button that alerted the Medical Officer Incharge at Goima Dispensary,” narrated Burhan.

Miles away, Dr. Samson Iman Makowe’s mobile phone squealed. On his screen was the referral message from Mr. Burhan, the CHW alerting on the condition of the client which needs immediate attention. Samson figured what to do. Immediately he alerted his team to get prepared.

“I was home that evening when Jesca arrived at the Dispensary, we were all set for an emergency task. Thanks, it wasn’t complicated, we handled it perfectly. She experienced premature rapture of membrane and it was an inevitable abortion, so we had to administer oxytocin to argument expulsion of conception materials,” said Dr. Simon Makowe

The CHAID tool system tackles the three delays that stand in the way of women and children accessing high-quality health care: delays in making the decision to seek care, reaching Care, and receiving proper care at a health facility.

Community Health Care workers like Burhan have been working closely to link the communities with health facilities by providing sensitization through education and follow ups while making timely referral decisions for any identified danger sign among women and children. To complement their work, MFP III innovation to introduce the CHAID tool has been instrumental not only for an emergency referral like this but also to collect and administer data including tracking of clients for easy follow up.

“This tool is very useful, and it has completely simplified Buruhani’s work. With the tool Buruani can directly refer the client for immediate care. It has also been very easy for me to make all the initial preparations even before the client arrives at the facility because there is an option of seeing the cause of referral. I can say with tools we have reduced the client management delay especially when it comes to management of pregnant women presenting with dangersigns and has significantly strengthened the community facility linkages.” said Dr. Makowe.

Thanks to the support from the Irish Aid and collaboration with the Ministry of Health Community development Gender and Children (MoHCDGEC) and the President’s Office Regional administration and Local Governmen (PORALG), to date the Benjamin Mkapa Foundation through its led project MFP III have been able to scale up this innovation to over 1000 CHWs in different regions across Tanzania.