Tanzania: rights and responsibilities

The Rights and Responsibilities (R & R) project, supported by the Challenge Fund, is managed by a capable team of three: Augustino Mwashiga manages the whole programme; Herman Mbunda manages the Preventing Mother-to-Mother Transmission (PMTCT)/HIV project; and Ethel Mhina is the lead for the R & R project.

After a day of briefings, updates and planning, we decided to spend the next day visiting one of the nearest rural health centres in Salawe.

The Salawe health centre serves nine villages in total with a population of 16,900 people.

The centre has 18 staff:

• three doctors
• one registered nurse who is also the midwife
• three ‘unregistered’ nurse midwives who do not have nursing diplomas
• one health officer who is in charge of health, immunisation and water, sanitation and hygiene (WASH) education
• a lab assistant, five medical attendants, a watchman, two cooks and a driver.

The Salawe health centre handles on average about 60-80 births per month, but according to Dr Faustine Mariganya, this is only 50% of the births that take place in the area – the rest take place at home, with the complicated births being referred to the district hospital.

No ambulance

As the health centre no longer has an ambulance, if there is a complication it falls on the woman’s family to hire the one vehicle in Salawe to transport her to the district hospital. If the ambulance was available this service would be free.

It’s 80km to the Salawe centre from the farthest village, and the closest is about seven or eight. Other than walking, the only other way to get to the centre is by bicycle.

Dr Faustine cites lack of transport as one of the main reasons for women choosing to give birth at home.

And with only one trained midwife for a population of 16,900, it would be impossible for the health centre to cope if all deliveries were to take place there.

These are some of the issues that the R & R project is hoping to address.

From the grassroots up

The project team aim to influence the governing bodies of the village-level dispensaries, ward-level health centres, district-level hospital and the district health boards.

They work with community members before they get elected to these bodies, raising their skills and building their confidence to play a key role in shaping health planning and budgeting right from the village up to district-level.

The R & R project will also train village-level volunteers who will train community members, village health committees, children’s clubs and women’s groups so that they can articulate their health needs, be assertive within planning processes and understand their own role and responsibility in staying healthy.

This grassroots and district-level work will feed into the national-level advocacy work done by our Dar es Salaam team, engaging with the multi-stakeholder working groups, which is where the main macro-level health planning takes place.

Save the Children plans to engage with the country coordination and facilitation process, lead by the World Health Organization, as a way of articulating grassroots human resources for health (HRH) needs.

We also aim to contribute to shaping HRH policy in Tanzania so that the government can deliver on the Every Woman, Every Child commitments and The National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania.

Find out more about our work in Tanzania