GHC Policy Communications Coordinator Vince Blaser is traveling in Zambia and Tanzania to visit member programs and report on policy connections. This is the fifth of his reports.
KARATU, Tanzania – A family recently called 41-year-old taxi driver Max J. Sikoyo at about midnight. An HIV-positive woman was suffering from an opportunistic infection and needed to be transported to the hospital. She died in route. Before taking off to pick up a client on market day here in Karatu, Sikoyo told me this story as both a reason for applying the training he received from the Minnesota International Health Volunteers (MIHV) Tanzania Child Survival Project, funded by the USAID, as well as the challenges that come along with the aims of the small program.
Sikoyo and Daniel Domician Sanka, 35, another taxi driver, both said that the program has been beneficial to themselves and the community but added that they would like to see fuel costs subsidized by MIHV because some of the rides they give do not get reimbursed. Innocent Augustino, 28, the monitoring and evaluation coordinator of the program, said he understands the drivers’ concerns but added the request for subsidizing fuel costs is not sustainable – a message consistently driven home by MIHV-Tanzania Country Director Jolene Mullins.
Although MIHV-Tanzania is focused on child survival, it truly embraces the buzz around integration of services around President Obama’s Global Health Initiative by delivering training and behavior change communications on maternal and newborn care, family planning, malaria, control of diarrheal disease and prevention of acute respiratory infections such as pneumonia.
One of the major components is Men Active in Sustaining Health Action (MAISHA) driver program, which trains taxi drivers in the region to convey health messages, assist in emergency transport in clients and distribute condoms. Another major component is the training of traditional birth attendants (TBAs) and community owned resource persons (CORPS) – with the TBAs leading “Survive and Thrive” groups to model healthy behaviors and support young mothers and their children.
Over in nearby Changarawe village, the benefits of the program are clear to Susan Stephen Welwel, 49, secretary of the traditional birth attendants in the village and a member of the village counsel. The number of women dying because of pregnancy has gone down since MIHV has trained TBAs and CORPs – Welwel is sure of it. However, she and other TBAs are still waiting on supplies from the district health office that Welwel believes would make even more of a difference.
The program just completed its mid-term review with some very substantial improvements from the beginning of the project on many of their indicators – such as the percentage of women who received postpartum care within 72 hours of birth (20 percent to 92 percent) and the percentage of children under two experiencing danger signs in the past two weeks who were brought to a health facility (38 percent to 60 percent). There is work to do on other indicators – such as a downtick the percentage of mothers of children 0 to 23 months who talked to their partner about family planning (51 percent to 31 percent) – giving MIHV-Tanzania the onus to use the small program’s flexibility to meet the program’s targets.
MIHV-Tanzania is somewhat unique from the other projects I have viewed so far in that it focused entirely on one district. The clear advantage is that staff and volunteers for the program know the community extremely well. Mullins said this knowledge leads to a deep knowledge of “all of their challenges,” and the realization that “some are way out or your rhelm.” She said the program helps addresses some those needs where it can be sustainable – such as a recently launching income generation portion of the “Survive and Thrive” groups, or working in concert with the Canadian Physicians for Aid and Relief’s efforts on food security, HIV/AIDS and reproductive health in Karatu.
Overall, Mullins is happy she to be in a smaller and more focused program – allowing her and her all Tanzanian staff to be flexible. Programs such as this definitely have their benefits beyond health to the districts they serve, but programs addressing major priorities of health ministries also have their place. I am currently visiting one such program – the Elizabeth Glaser Pediatric AIDS Foundation – in the Arusha region, and I welcome your thoughts and questions on larger, wider-reaching projects and small. targeted projects.