For reference: EMBRACE Tushikmanane - where we are

With several weddings and a 60th birthday, I apologise to blog-readers for the long gap.

I am now back in the saddle, and we begin with a poisiton statement on 'EMBRACE-Tushikamane' - the project which we hope will lead to sustainable development to save many lives in rural Tanzania.

'EMBRACE-Tushikamane’ at August 2014

EMBRACE = Empowering Mothers & Babies to Receive Adequate Care & Equality

Tushikamane = We join together in solidarity

We would eventually like to set up women's groups throughout a 7,000 sq km area of rural Tanzania - the area served by Berega Mission Hospital. 

The purpose of the women's groups is to discuss the roots of the daily problems they face, in particular those which cause death in childbirth, or death of children.

Of course we already know that the roots of these problems include malnutrition, malaria, poor education, lack of transport, diarrhoeal disease, lack of health facilities, etc etc, but we need the women themselves to articulate this. This seems to be a vital preliminary to making the solutions sustainable: unless the community has self-direction, outside aid often does not lead to long-term progress.

We have chosen an area to begin in, and have community buy-in. (Tunguli - chosen because Berega already runs a rudimentary health centre, inpatient and maternity service there.) The area is inaccessible in rainy periods, and perhaps as many as 20,000 people live in the wider community served by the Health Centre.

Resources and manpower already available

The hospital director and his deputy are 100% behind the project, and have excellent skills in driving change and making things happen.

We have a Project Leader and her deputy ready to go. One is the previous matron of the hospital, and the other a bright, younger nurse. They are waiting to be told what to do and how to do it.

We have money for a year's salary and expenses, plus some reserves, and I am sure could get more when needed. There is constantly available accommodation if we deem part of the solution to be sending out volunteers. There is transport available if we pay for it. We have mapped the territory in detail.

All the charities working in this territory are fully on board and excited about what we are doing: Hands4Africa; BREAD; Mission Morogoro; and the Diocese of Worcester. Every year, representatives from these charities visits. The Director of H4A sometimes visits several times, to manage the projects they have set up - two plantations; a school; various other buildings; etc.

Ammalife houses the project and the funds. Their founder, Prof. Arri Coomarasamy, regularly goes to Tanzania for various academic collaborations.

Measurement

We intend to measure outcomes in several ways - firstly by things that actually happen arising from women's group discussions - eg new transport, school room, immunisation system, etc etc.

Secondly, we have completed a mapping exercise so that we have each hamlet name mapped out. The hospital can therefore record where deaths and other significant events are coming from, and we can therefore monitor, with time, any change in health demographics.

Thirdly, an important academic need is the observation of the process: what helps and what hinders? Given that women’s groups are the internationally favoured approach for tackling maternal and child death in rural Africa, we are well placed to inform the academic community as to practical roll-out of the guidance.

Immediate needs for EMBRACE Tushikamane

1.     How do we get someone to train and supervise the Project leaders? They, when trained and ready, will in their turn need to train and supervise the Community Facilitators who will lead the development of women’s groups on the ground.

We are looking for help for this with high level experts who themselves have informed the recent WHO guidance on this approach:

http://www.who.int/maternal_child_adolescent/documents/community-mobilization-maternal-newborn/en/

2.     To whom will they report? We will need to form an international working group, with strong local representation, but with expertise and support from key individuals and organisations outside of Tanzania. This might well need to involve an academic institution running a formal project and evaluation.

3.     Nevertheless, the reality is that the project will be driven from the UK. How can we know that things are happening as they should? How can we project-manage from 5000 miles away?

4.     How do we link to all those who might be doing similar work in Tanzania - especially those with funds?

5.     Through all of this we will need good communications, and good updates using social media. This is no small undertaking.

Longer-term needs

1.     How do we capture the issues being articulated?

2.     How do we prioritise them? I guess by the degree to which we think they might have a long-term effect on the dreadful mother and child mortality rates.

3.     How do we ensure that the intention to put in a solution gets turned into reality.

4.     How do we build enterprises into the solutions, such that economic growth occurs alongside other improvements?

5.     How do we ensure that good data gets collected in the hospital? This needs special attention. The hospital does have reasonable data collection at the moment. The majority of admissions, discharges, deaths and outcomes are recorded with fidelity in the ward and admission books.

However, for the project we would want data to be as accurate as possible. This might well need the sevices of a volunteer to set up a parallel data collection system for the purposes of the project, to include: deliveries; survival; complications; village and hamlet of origin; and attendance at women’s groups.

6.     Whereas the £ goes a long way in rural Tanzania, nevertheless ongoing funding will be needed, and this is likely to involve the troublesome process of grant applications.