Graham Atkinson, Amref Health Africa in Canada

I’ve recently returned from an exciting trip to Tanzania where I had the privilege of visiting health facilities in Geita Region that are under construction as part of the Canada-Africa Initiative to Address Maternal, Newborn and Child Mortality (CAIA-MNCM) program. Overall this program is a partnership among four Canadian organizations—Amref Health Africa, Christian Children’s Fund of CanadaCentre for Global Child Health at The Hospital for Sick Children (SickKids) and WaterAid Canada. With support from the Government of Canada this four-year program (2016 to 2020) is being implemented across 20 districts in Ethiopia, Kenya, Malawi and Tanzania.

Kakora dispensary – CAIA-MNCM team

My trip took me to Geita, Tanzania, a small town south of Lake Victoria, and west of the Serengeti primarily known for its gold mine. Amref Health Africa is currently implementing a project in the region to reduce the number maternal and newborn deaths. The population is mostly rural, and agriculture is the main way of life.

In the region, several factors combine to create high maternal and newborn death rates, often from preventable causes. One of these factors is an under-resourced health system that struggles to provide quality health care to a remote and rural population.

Kokora dispensary – existing pit latrine to be replaced by ventilated improved pit latrines.

One of the critical strategies to reducing these deaths is to improve the infrastructure at health facilities in order to improve the quality of care patients can get. To complement this, Amref Health Africa also provides equipment and supplies, trains health workers and uses a community approach to improving maternal and newborn health. Community education on health and nutrition is a major preventive strategy, but it also aims to increase the number of patients who travel to health facilities to receive care. Health facilities therefore need improved infrastructure in order to handle a growing number of patients while offering better quality of care.

My trip to Geita focused on the construction side of our work. I was traveling with colleagues from WaterAid, our partners in this project. Together we are working on making significant improvements to the infrastructure at 12 health facilities spread out across Geita and Nyang’hwale districts. These health facilities are currently operational and range from remote and small dispensaries to large health centres located closer to urban centres. Amref Health Africa is renovating and expanding maternity wards and building operating theatres, while WaterAid is improving Water, Sanitation and Hygiene (WASH) infrastructure including supplying clean water, building sanitation facilities, and improving the safe and environmentally responsible handling of medical waste.

Construction site of water storage tank

The health facilities we are targeting face challenges in providing quality care given their current state. Many lack electricity, clean running water, adequate sanitary facilities, and the appropriate space to handle patients. Our focus is to ensure that facilities can offer quality maternal care including housing women who have traveled to health facilities before going into labour, having a skilled health worker deliver the baby, handling complications and obstetric emergencies, and offering post-natal care.

Visiting them in their current state, I would describe the typical health centre as having one small room with around 10 beds which serves as a maternal waiting room, a labour ward, and a recovery room. A small space has been set aside as a delivery/operating room, but can barely handle more than one patient at a time. Women, whether waiting to deliver or recovering after delivery, must walk outside to use a pit latrine to go to the washroom. There is not always running water within the maternity ward, and even if the health facility is connected to the grid, electricity is nonetheless unreliable and scarce.

Through this project Amref Health Africa is working to expand maternity wards and labour wards. This means that facilities will be able to accommodate women awaiting labour separately from those in labour and from those recovering after delivery. Operating theatres will be constructed so that complications, such as emergency caesarian sections, can be handled in an appropriate space that meets the standards of the Ministry of Health. These will be properly equipped by the project and health workers will be trained on emergency obstetric care, and caring for sick and small newborns. Flush toilets will be built at health facilities within the maternity wards so that women no longer have to walk outside and use pit latrines. A combination of boreholes and rain-water harvesting systems, storage tanks, water treatment systems, and piping will ensure clean running water. Waste will be connected to septic systems. New incinerators and placenta pits will also be built to improve the handling of medical waste.

Construction site incinerator, ash pit and placenta pit

It always amazes me to see the incredible work being done by health workers in facilities that have so few resources available to them. Visiting these health facilities at the start of construction really showed that they are in desperate need of improvements. The excitement among health workers at the prospect of these improvements was evident. I look forward to seeing the progress and returning to Geita to see firsthand the improvements to health care delivery as a result of this project.

During our recent MAMATOTO Holiday fundraising campaign, Canadian supporters contributed more than $23,000 to the Canada-Africa Initiative to Address Maternal, Newborn and Child Mortality! The funds raised will help us meet the total budget for the project, and ensure we can complete all of the vital activities we have planned.