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. 

Chambalo Village located about three kilometres from Chemba District’s town center in Dodoma Region, is where you are bound to meet Theresia Nkhambi, a Community Health Worker (CHW) who has nothing more than excessive passion, dedication and an unwavering commitment in saving women’s lives.

She extraordinarily endures a daily walking distance of an average of 10 kilometres. Why? Her objective is visiting families for follow-ups and imparting them with awareness education on health related issues linked to Reproductive, Maternal, Newborn Child & Adolescent Health (RMNCAH).

Like in any other Tanzania rural settings, villagers are commonly associated with embracing several myths which sidelines them to access useful medical care at health facilities and Chambalo Villagers are no exception.

Highly vulnerable are women, particularly the pregnant ones who are more likely to consult traditional healers in resolving any health-related crisis. The common or rather widespread myth in Chambalo Village is that pregnant women attending clinics are more likely to be bewitched and consequently lose their young babies.

Ms Theresia is a native of this village. The name Chambalo is from the Burunge language meaning ‘hidden’. As a CHW, Theresia is gradually changing the narrative in her village by ensuring that it is no longer hidden from the access of healthcare services and the villagers are exposed to necessary health knowledge awareness.

Ms Theresia is among 114 Community Health Workers deployed by the Mkapa Foundation under the Mkapa Fellows Program Phase III advent. This provides linkages between communities and health facilities through provision of education and referral to patients who need urgent or further consultations.

Also they have been very instrumental in sensitizing women on the importance of attending clinics when they are pregnant to avoid maternal deaths that could otherwise be easily preventable.

The MFP III in collaboration with other stakeholders is complementing government initiatives by addressing the national challenges facing maternal health in Tanzania including high Maternal Mortality Ratio through deployment of these CHWs in rural settings.

Evidence shows that CHWs have been a way out to many communities who for decades have faced limited access to maternal health information camouflaged with traditions and customs that are affecting access to healthcare and services.

Theresia, concurrently rises up with the sun to attend her daily duties as a CHW. She is unfazed by daily walking of long distances, but rather obsessed to stage a fight against the reluctance of her own people through healthcare awareness education that she consistently spreads around the village.

“When I first started there was a bit of a hike because most people couldn’t grasp the importance of the knowledge that I was sharing with them. Therefore most of them never paid attention to me and to them it felt like a waste of time. But I am no quitter so I kept pushing day after day until they started showing a positive response towards me and my work” said Theresia.

Theresia does not take her work as a Community Health Worker lightly. She makes sure that everyone is safe and if someone needs further attention, she will go that extra mile to make sure that this person gets the needed attention. She remembers a woman that she had helped recently who had a persistent coughing and never wanted to go to the dispensary to seek medical attention.

“I told her that she needed to go to the dispensary to consult a doctor. She agreed and subsequently tested positive for HIV. She was unaware of her status afte earlier failing to attend dispensary whenever she was not feeling well. She was glad that my initiative to engage her on the importance of seeking medical care at the facility came at the right time and now she has started receiving her ARVs and her health is substantially much better than before,” added Theresia.

Describing the great impact that has been brought at the facility level due to the presence of the CHWs in the community, Dr. Admond Chiwanga, the facility incharge at Chambalo Dispensary, says the percentage of the ANC visits to the dispensary has increased from 20% when there was no CHW to about 70-90% after the CHW started the much needed Empowerment

“Thanks to the MFP III that brought these CHWs as they have been of significant

help in building strong links between us and the community. Theresia goes places where I can’t and brings in people with different issues especially those concerning maternal health,” Dr. Chiwanga added.

Chemba district has 114 villages which through the support of the MFP III each village is staffed by one CHW who are providing links between communities and the health facilities and breaking barriers include myth associated with lack of knowledge on health issues among villages.

“She is a good friend and cares about our wellbeing” says Zakia Iddi Ramadhan who just gave birth three weeks ago at the Chambalo Dispensary

“I was not sure if I was going to give birth at the dispensary had it not been for Theresias’ persuasion. She found me unwell with a pregnancy that was just over 12 weeks and she wouldn’t let me stay home without booking for Antenatal Clinic. Thanks to her, just three weeks ago I safely and soundly delivered my baby at the dispensary”.

For Theresia, she feels like her work has just started with confidence that she is going to empower her community on health awareness issues.

“…Now that I can witness the results I am even more motivated than before. It is clear that my work has planted a seed that grew into a fruit bearing tree. Even the men who were once reluctant to take their wives to the dispensary for Antenatal Clinic, are more eager to do that now,” concludes Theresia.

Located about 120 kilometres north of the Tanzanian capital Dodoma enroute to Babati or Arusha, a hospital in Chemba District stands conspicuosly to serve people of the place and its neighborhood.

Despite a well-constructed tarmac road and cool breeze blowing along the way, it might take you close to two hours for safety considerations when you have a careful driver who doesn’t opt for a flat-out gas pedal.

Along the way to this remote yet vibrant destination, you are bound to be fascinated by the breathtaking picture-resque of the colourful landscape beauty sparkling on either side of the Dodoma-Babati road. As you go, time happens to run surprisingly fast and unnoticed.

Noticeably, as you come close to this growing but still a low-density population township, Chemba, sparkling white-painted buildings add a special outlook to the hilly landscape silently blessing your arrival all the way. Here you are at the Chemba District Hospital with its Medical Officer (DMO) “Dr. Deogratius Baltazari Masim” extending a warm welcome to you and second to none brand of hospitality.

He is in charge of medical activities with a well organised team capable of planning and coordinating your visit with key briefings ahead of starting the field exploration.

Dr. Masim has been excited to host the Mkapa Foundation team while opening a wide smile. “Whenever I see the Mkapa Foundation I feel that they are one family with the people of Chemba”, he said.

Established in 2013, the Chemba District Council is one of the eight district councils of Dodoma City.

Before MFP III made an intervention three years ago, Dr Masim admits that medical services in this particular district left much to be desired . The district was Characterised by inadequate manpower that led to poor health services and facilities placed the people of Chemba at great health risks. They endured torrid moments only for Mkapa Foundation to timely step in as top class saviour.

The Mkapa Foundation project got underway with deployment of 9 skilled health care providers in 9 health facilities and 114 Community Health Workers in all 114 villages of Chemba District.

“The skilled manpower has been keen in improving the quality of facilities in our facilities coupled with accessibility of services to the marginalized communities. The Community Health Workers deployed to our villages have been extremely helpful in creating a great link between our facilities and communities. They have been very instrumental in sending out the proper health education to the communities that address negative myths, beliefs and customs thus improving the utilization of health services especially for the pregnant women and children” Says Dr. Masim.

Dr. Masim’s testimony has been backed by District Health Secretary Aziza Hamisi.

Complimenting Dr. Masim’s words, Ms Aziza says that the district had a critical shortage of Skilled Healthcare Workers and some of the facilities in the District were still under control of the Medical Attendants.

She says 

“When the MFP III gave us 9 new skilled healthcare workers it sounded like we just picked up a piece of diamond from an open ground.. We were overjoyed… while assigning them stations to cover the likes of Mwailanje dispensary that were inoperative. It was no surprise that villagers endured a walk up to seven kilometres in search of health care services. HOWEVER, with the support from MFP III that works closely with the Government, these communities can finally get the services nearer or within their catchment area.”

Stressing more on the program contribution is Ms. Tatu Rashidi, a District Coordinator for Reproductive and child health. Ms Tatu expressed how the Maternal and Child Health indicators have significantly changed since the initiation of the project in Chemba.

 She says

“…before the project most pregnant women booked for their first Antenatal Visit 12 weeks AHEAD of pregnancy but now the numbers have changed from 13% of the women who started ANC before 12 weeks in 2018 to 19% in 2019 and it went up to 24% in 2020”.

 For the other indicators such four or more hospital visits for pregnant women and facility delivery Ms. Tatu says “…in 2018 it was just 44% of pregnant women who had four or more visits to the health facility but in 2019 we had 66% and in 2020 we had 73%…we have also observed changes in terms of facility delivery, in 2018 there were only 34% of facility delivery it went up to 48% in 2019 and in 2020 we had 52%. All these have been largely contributed upon by the facility and community level initiatives that the MFP III have been implementing”

Ms. Tatu Rashidi believes that the MFP III has improved the medical services from where they were three years ago. She is positive that this year they will see a much higher rise in the indicators which they regard as a success to the District of Chemba and its people.

The Mkapa Foundation took the Mkapa Fellows Program Phase III to Chemba DC for the purpose of improving the healthcare services and the lives of people of Chemba, a mission that has made a significant improvement as contrasted to the past three years.

Just at the beginning of the second half 2019 he landed his one year contract with Mkapa Foundation under the Mkapa Fellows Program phase III. Dr. Joel Charles was then stationed at Babayu Dispensary by the Chemba Council’s Health Management Team led by the Councils Health Secretary, Ms. Aziza Hamisi.

Ms Aziza says that the deployment of Dr. Joel and eight other Skilled Healthcare Workers by the MFP III to them felt like an awaited miracle that finally came into being. 

“When the MFP III gave us nine new skilled healthcare workers, it felt like we just found a loose diamond in the sand” – recalled Ms. Aziza

But when Joel arrived at the Babayu Dispensary he found himself in a challenging situation. The dispensary was understaffed with just a medical attendant to help him and a working environment that was unfriendly. At this moment Joel imagined his future at this place was hanging by a loose thread. 

Lucky for him the people of Babayu were eager to get a Doctor for quite some time so they vowed to keep this one. The village health committee and other leaders together with the people of Babayu extended Joel all the support he needed to smoothen his work both at the Babayu dispensary as well as at their village. 

As if that was not enough Joel witnessed the renovation of Babayu dispensary, a facility that was built in 1973 and had since then never been renovated. It had only four small rooms, which weren’t enough to begin with let alone other challenges in the likes of reliable power and water supply. 

Dr. Joel was concluding a year in his contract with the Mkapa Foundation under the Mkapa Fellows Program phase III and settling in at the Babayu dispensary when the government announced vacancies.He applied and consequently was able to secure a place in the government payroll, then stationed at the same facility “Babayu Dispensary” that he previously worked under the MFP III project.

“When the MFP III gave us nine new skilled healthcare workers, it felt like we just found a loose diamond in the sand.” she recalled.

But when Joel arrived at the Babayu Dispensary he found himself in a challenging situation. The dispensary was understaffed with just a medical attendant to help him and a working environment that was unfriendly. At this moment Joel imagined his future at this place was hanging by a loose thread. 

Lucky for him the people of Babayu were eager to get a Doctor for quite some time so they vowed to keep this one. The village health committee and other leaders together with the people of Babayu extended Joel all the support he needed to smoothen his work both at the Babayu dispensary as well as at their village. 

As if that was not enough Joel witnessed the renovation of Babayu dispensary, a facility that was built in 1973 and had since then never been renovated. It had only four small rooms, which weren’t enough to begin with let alone other challenges in the likes of reliable power and water supply. 

Dr. Joel was concluding a year in his contract with the Mkapa Foundation under the Mkapa Fellows Program phase III and settling in at the Babayu dispensary when the government announced vacancies.He applied and consequently was able to secure a place in the government payroll, then stationed at the same facility “Babayu Dispensary” that he previously worked under the MFP III project.

“When the government announced vacancies I applied and out of a large number of those who were interested, I was lucky to secure this post. Now I work here as a government employee at the same station that I was previously working under contract with the Mkapa Foundation, I am used to this community and happy to serve them,” he said.

Joel is one among the 18 skilled healthcare workers who were mainstreamed and retained into the government system out of the 96 Health workers who were deployed in various stations under the MFP III . 

The presence of Dr. Joel at the Babayu dispensary, where he is now the health facility in-charge, has changed a lot as contrasted to the past when there was scarcity of skilled healthcare providers. Dr. Joel received an addition to his staff, a nurse from the government who now works with a stunning hand-in-glove cooperation in serving the Babayu Community through meeting their health needs.

Having a reliable team of healthcare providers and an improved facility has resulted in an increased facility deliveries as compared to the past. Now the facility delivers up to 15 pregnant women per month, a 4-fold increase from the previous 4 deliveries.

“After the addition of staff a lot has changed. For example now we can have up to 15 deliveries per month as compared to 4 or 5 when we were understaffed with a smaller unrenovated facility. Most of the women opted for the Bahi district because the facilities and services there were better than here but now we have both the staff and top quality facility”

The presence of Joel and other 8 skilled health care workers who are deployed in Chemba DC contributed to the availability of top notch health services and now the community relishes quality services from the skilled healthcare providers who have been placed in the hard to reach understaffed facilities. 

When Otilia Mhagama and three other nurse midwives’ colleagues arrived at Nyasho Health Centre in Musoma for their first deployment in January 2021, they were reflecting on what would be their main task at the Health Centre. 

Little they could had known that their arrival was just a thrill for Dr. Hillary Mohamed, a Medical Officer in-charge, who managed the understaffed health center that have a total of 13 nurses and an average of 11 deliveries per day with less than four nurses in a daily roaster; caring for labor & delivery, and post-natal wards.

Otilia and her colleagues are among 93 midwives allocated through the USAID Afya Endelevu Activity implemented by Benjamin Mkapa Foundation to strengthen delivery of quality Reproductive Maternal and Child health services in Mara and Geita regions.

Located at the heart Centre of Musoma municipal, Nyasho facility attracts a high-volume of pregnant women and children who mostly are queued for about an average of 3 hours waiting for services due to shortage of nurses and it serves as Musoma municipal council facility. For the Medical Officer In-charge, Dr. Hillary Mohamed, the support of these four newly deployed nurses including nurse Otilia is a life-changing experience.

The support came at the right time. Due to shortage of nurse-midwives, we were working under tension especially when there was a Caesarean- Section emergency. But today, we thank God, these staff have improved daily roster and patient care which have also improved client flow and reduced unnecessary referrals. – Said Dr. Hillary

Today, with the present of nurses like Otilia and her midwives’ colleagues, they have improved service delivery including management of Cesarean Sections from 31 for the period of October to December 2020 to 56 clients for the past three months of January to March 2021. First ANC attendance has improved from 271 to 315 and facility delivery has also increased from 612 to 766 in the same quarter.

We used to refer clients to the regional referral hospital because we didn’t have adequate manpower to conduct thorough clinical assessment of pregnant women including care and support during labor and delivery – Added Dr. Hillary.

Clients’ confidence and trust on healthcare workers at Nyasho Health Centre have improved because they see changes in how they are receiving services. Waiting time has significantly reduced and all healthcare workers feel appreciated for the work they do from their clients. This is a very rewarding experience, and they hope they can continue to provide quality of care and reach more women and children for reproductive and Child health services. Afya Endelevu identified the needs at Nyasho Health Centre by looking into their unmet services delivery needs using service delivery data, client volume and workload which informed the allocation.

Through the support of the USAID, the Afya Endelevu Activity led by Benjamin Mkapa in close collaboration with the MOHCDGEC, PORALG and LGAs with a goal of Strengthening delivery of quality HIV, TB and reproductive, maternal, and child health (RMCH) services in high-disease burden areas with shortages of health workers through sustainable investments of HRH in Tanzania has managed to allocate 988 HCWs in 16 Region.