Government of Canada, Foreign Affairs, Trade, and Development; US Fund for UNICEF; and the Bill & Melinda Gates Foundation.

BackgroundThe standard 11-days IMCI (Integrated Management of Childhood Illness) training course (standard IMCI) has faced barriers such as high cost to scale up. Distance learning IMCI training program was developed as an alternative to the standard IMCI course. This article presents the evaluation results of the implementation of distance learning IMCI training program in Tanzania.MethodsFrom December 2012 to end of June 2015, a total of 4806 health care providers (HCP) were trained on distance learning IMCI from 1427 health facilities {HF) in 68 districts in Tanzania. Clinical assessments were done at the end of each course and on follow up visits of health facilities 4 to 6 weeks after training. The results of those assessments are used to compare performance of health care providers trained in distance learning IMCI with those trained in the standard IMCI course. Statistical analysis is done by comparing proportions of those with appropriate performances using four WHO priority performance indicators as well as cost of conducting the courses. In addition, the perspectives of health care providers, IMCI course facilitators, policy makers and partners were gathered using either focussed group discussions or structured questionnaires.ResultsDistance learning IMCI allowed clusters of training courses to take place in parallel, allowing rapid expansion of IMCI coverage. Health care providers trained in distance learning IMCI performed equally well as those trained in the standard IMCI course in assessing Main Symptoms, treating sick children and counselling caretakers appropriately. They performed better in assessing Danger Signs. Distance learning IMCI gave a 70% reduction in cost of conducting the training courses.ConclusionDistance learning IMCI is an alternative to scaling up IMCI as it provides an effective option with significant cost reduction in conducting training courses.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3336-y) contains supplementary material, which is available to authorized users.

A cross-sectional study was carried out in Mkuranga District of Tanzania with the aim of comparing the ability of trained and untrained traditional birth attendants (TBAs) in identifying women with danger signs for developing complications during pregnancy and childbirth as well as their referral practices. Study findings revealed that majority of the TBAs (86.5%) had not received any training. Trained TBAs were more knowledgeable on danger signs during pregnancy and childbirth and were more likely to refer women with complications to a health facility, compared to untrained TBAs. The authors recommend that in resource constrained countries like Tanzania and especially in remote rural areas, TBAs should be trained on early identification of mothers with obstetrical complications and on their prompt referral to health facilities that can provide emergency obstetric care. RÉSUMÉReconnaissance des grossesses à haut risque et les pratiques d'orientation des malades vers les sagesfemmes traditionnelles dans le District de Mkuranga, Coast Région, Tanzanie. Une étude transversale a été menée dans le District de Mkuranga en Tanzanie en vue de comparer le capacité des sages-femmes traditionnelles (SFT) qui ont reçu une formation et celles qui ne l'ont pas reçu, afin de reconnaîte les femmes qui sont en danger de développer des complications pendant la grossesse et l'accouchement aussi bien que leur pratique d'orientation des malades. Les résultats ont montré que la majorité des sages-femmes traditionnelles (SFT) (86,5%) n'ont reçu aucune formation. Les SFTs qui ont reçu une formation étaient plus renseignées sur les indices de danger pendant la grossesse et l'accouchement et elles avaient plus la possibilité d'orienter les femmes qui ont des complications vers un service de santé comparés aux femmes qui n'ont pas reçu de formation. Les auteurs préconisent que dans les pays qui n'ont pas de resources tel la Tanzanie et surtout dans les régions rurales, les SFTs devraient être formées sur la façon d'identifier tôt les mères qui ont des complications obstétriques ainsi que sur la façon d'orienter les malades vers les services de santé qui pourraient assurer des soins obstétriques d'urgence. (Rev Afr Santé Reprod 2005; 9[1]: 113-122)

IntroductionFacility interventions to improve quality of care around childbirth are known but need to be packaged, tested and institutionalised within health systems to impact on maternal and newborn outcomes.MethodsWe conducted cross-sectional assessments at baseline (2016) and after 18 months of provider-led implementation of UNICEF/WHO’s Every Mother Every Newborn Quality Improvement (EMEN-QI) standards (preceding the WHO Standards for improving quality of maternal and newborn care in health facilities). 19 hospitals and health centres (2.8M catchment population) in Bangladesh, Ghana and Tanzania were involved and 24 from adjoining districts served for ‘comparison’. We interviewed 43 facility managers and 818 providers, observed 1516 client–provider interactions, reviewed 12 020 records and exit-interviewed 1826 newly delivered women. We computed a 39-criteria institutionalisation score combining clinical, patient rights and cross-cutting domains from EMEN-QI and used routine/District Health Information System V.2 data to assess the impact on perinatal and maternal mortality.ResultsEMEN-QI standards institutionalisation score increased from 61% to 80% during EMEN-QI implementation, exceeding 75% target. All mortality indicators showed a downward trajectory though not all reached statistical significance. Newborn case-fatality rate fell significantly by 25% in Bangladesh (RR=0·75 (95% CI=0·59 to 0·96), p=0·017) and 85% in Tanzania (RR=0.15 (95% CI=0.08 to 0.29), p<0.001), but not in Ghana. Similarly, stillbirth (RR=0.64 (95% CI=0.45 to 0.92), p<0.01) and perinatal mortality in Tanzania reduced significantly (RR=0.59 (95% CI=0.40 to 0.87), p=0.007). Institutional maternal mortality ratios generally reduced but were only significant in Ghana: 362/100 000 to 207/100 000 livebirths (RR=0.57 (95% CI=0.33 to 0.99), p=0.046). Routine mortality data from comparison facilities were limited and scarce. Systematic death audits and clinical mentorship drove these achievements but challenges still remain around human resource management and equipment maintenance systems.ConclusionInstitutionalisation of the UNICEF/WHO EMEN-QI standards as a package is feasible within existing health systems and may reduce mortality around childbirth. Critical gaps around sustainability must be fundamental considerations for scale-up.

Background BackgroundIn 2012, the UN Commission on Life Saving Commodities (UNCoLSC) articulated a series of recommendations to expand access to 13 life-saving reproductive, maternal, newborn and child health (RMNCH) commodities with the greatest potential to reduce preventable deaths. We conducted a five-year longitudinal assessment of progress towards achieving these recommendations among countries in sub-Saharan Africa and Southeast Asia. Methods MethodsBetween 2013 and 2017, national reviews were undertaken at two time points among 14 countries with a high burden of preventable maternal-child deaths who were receiving support from a multi-UN agency RMNCH technical support and financing mechanism. Data were drawn from national health documentation (e.g. strategic plans, policies, guidelines); logistics management information systems; national household and health facility surveys; and interviews with governments and development partners. Results ResultsOver time, the percent of health facilities with stock availability showed a statistically significant increase of five percentage points from 69% to 74% (median). Recent training at health facility also displayed a significant increase of eight percentage points from 38% to 46% (median). National RMNCH coordination mechanisms, treatment guidelines, and national training curricula and job-aids were near fully redressed. However, countries continue to face persistent supply chain challenges including national stock-outs, tracking commodities throughout the supply chain, and strengthening medicine control laboratories. Conclusions ConclusionsWhile substantial progress has been made in improving access to life-saving commodities, including stock availability and workforce training at health facilities, additional efforts are required to improve regulatory efficiency, enhance commodity quality and safety, and reduce supply chain fragmentation.