Project profile — Accelerating Maternal, Newborn and Child Health in Zanzibar

The expected intermediate outcomes for this project include: (1) strengthened health system to deliver equitable and integrated health services, including improvement of the referral system; and (2) increased coverage of quality emergency obstetric care, newborn and child health services, including high impact nutrition interventions.

Results achieved as of the end of the project (October 2019) include: (1) trained and supervised 1,760 community health volunteers across 10 districts in Zanzibar and provided information about safe delivery practices, risk factors in pregnancy, family planning, child nutrition, hygiene and sanitation and standard health checks for children and newborns. This has helped increase the use of essential health services in these districts; (2) developed maternal and perinatal death surveillance and response systems at central, district and facility levels, alongside community and health facility guidelines and tools for identifying, reporting and reviewing deaths to inform evidence-based maternal mortality interventions. This has led to a reduction in health facility-based maternal mortality from 277 per 100,000 live births in 2016 to 152 per 100,000 live births in 2018 and a reduction in neonatal deaths from 11.3 per 1,000 live births in 2017 to 8.5 per 1,000 live births in 2018; (3) strengthened the capacity of human resources for health through improved training for nurses and midwives, supported higher education for five obstetrician gynecologists and nine midwives who now work as lecturers at the College of Health Sciences at the State University of Zanzibar, reviewed the College of Health Sciences’ midwifery and nursing’ curriculum, and established mentorship programs in Pemba and Unguja; (4) refurbished and upgraded six primary health care units for 24 hours a day/seven days a week access to emergency obstetric and newborn care and basic maternity services; (5) procured blood bank equipment for Zanzibar Blood Transfusion Services, resulting in the program being able to provide 94% of the 16,000 units of blood requested in 2018; (6) improved nutrition status among children under five by supporting the development of the Zanzibar Multisectoral Nutrition Action Plan July 2019 - June 2024; and (7) improved the nutrition status of children under five by facilitating access to community-based services promoting optimal maternal, infant and young child nutrition, water, hygiene and sanitation, and early childhood development and health practices. For example, a total of 42,354 pregnant women and 102,621 caregivers participated in regular counselling group sessions organized by community health volunteers. These improvements build on recent achievements in Tanzanian nutrition. Though national-level results are not entirely a direct attribute to any one project, the Tanzania National Nutrition Survey 2018 indicates that the proportion of infants below six months who received exclusive breastfeeding increased from 19.7% in 2014 to 30.0% in 2018.At the same time, the proportion of children receiving minimum acceptable diet increased from 8.4% in 2014 to 14.0% in 2018. Also, the proportion of children receiving vitamin A supplementation increased from 58.2% to 78.9%, while children receiving deworming increased from 68.4% to 80.7%. In addition, childhood stunting decreased from 24.4% in 2014 to 21.5% in 2018, and acute malnutrition decreased from 7.2% to 6.1%.