CAMPAIGNING FOR ACCOUNTABILITY IN TANZANIA
December 28, 2015In rural Tanzania women and their newborns were dying from lack of emergency care such as C-sections. Rose Mlay explains how WRA Tanzania held the government to account for its commitments to improving health centres so that many lives are now being saved.
“Our government has promised that half of all health centres should provide Comprehensive Emergency Obstetric and Newborn Care (CEmONC), and so our goal was to hold them accountable. This has been a national campaign, but we targeted one region, Rukwa. When we started, only one in ten of the Districts was able to provide this level of care. To achieve our goal we needed to make sure that council plans included a specific budget line to pay for this, and I’m happy to say that Rukwa now has this budget line in place - something which had never happened before our campaign.
As a result, we have also been successful in our goal (which is also the government target) that half of health centres provide CEmONC. Five out of ten health centres in Rukwa now have CEmoNC in place.
For instance, in one district alone 59 women were provided with emergency care in the space of one month. Forty of these women had C-sections, and the doctor told us that without this emergency care it’s likely that half of these women would have died, together with their babies. In another health centre, the numbers of women giving birth increased from zero to 17; this shows they now have trust in the health centre to save their lives in emergencies.
Health workers are saying that our campaign is very effective, and we have a letter from the Ministry of Health affirming that they are pleased with the advocacy work of WRA Tanzania.
The feedback is that we have ‘acted as the glue’ between many partners – health workers, the community, district and regional officials – who had not previously coordinated their efforts.
Various elements helped us to succeed. It was important that we were working with everybody concerned, and that we had a clear focus on CEmONC. It was effective that we showed the state of health centres before our campaign, showed the gap in services, provided a budget analysis and had a meeting with the Prime Minister. We were able to show him and others clearly the evidence of the problem, and to say – ‘this is what we can do to change it’. We also went to Rukwa every quarter and did constant monitoring and follow up.
People initially said that what we trying to do was impossible, that CEmONC is too expensive; they said we should try for ‘lower hanging fruit’ and that we were aiming too high. But now the doctors in Rukwa as well as many others have seen that it is possible to bring such rapid change.
Our media work has also been essential to the campaign. One of the WRA Tanzania partners is ITV Tanzania, and they had a number of shows on the issue. Afterwards they told us they had many calls from policy makers and from government people, as well as from other media.
Of course there are still challenges. We have seen budgets intended for health centres which were diverted elsewhere, and budgets which have been delayed. Not everything has gone to plan, and so it has been important to have flexibility – and always to go back to our goals.
Our top lesson has been on the power of convening. Bringing people together – including the Prime Minister, the Permanent Secretary, the Budget Commissioners, the community, health workers, legislators, students, religious leaders, the media – has been essential to our success. We always call on our members, inform them of progress, tell them that we are meeting the PM or Ministry of Health and we say ‘let us go together’. We share all of our messaging to the media so that partners can make edits and put their own logos on publications. We work together, not leaving anyone behind; we hold each other tight.”