Reaching the Poorly Served
Tanzania is facing challenges achieving Millennium Development Goal 4 on child mortality and is severely off track on Millennium Development Goal 5 on maternal health. The maternal mortality rate is 454 per 100,000 live births, well above the 2015 target of 133 per 100,000.
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Pastoralist communities face even more inequitable access to institutional sexual and reproductive health information and services with severe consequences for women and girls. The figures in Ngorongoro district, inhabited primarily by pastoralist Maasai (85 per cent) are in excess of 600 maternal deaths per 100,000 live births.
In response to this challenge and building on a successful HIV and AIDS programme in the district, ACORD has launched a three year programme designed to increase access to integrated sexual and reproductive health services for women and adolescent girls and reduce maternal and child mortality. Located in Arusha Region in north-eastern Tanzania, Ngorongoro is a remote district inhabited mainly by pastoralists, agro pastoralists and hunter populations. Challenges in access to health services are compounded by the unique pastoralist livelihoods strategies and settlement patterns and the deeply revered traditional practices which influence health seeking practices in particular of women and girls.
The programme, which will be implemented in partnership with Ngorongoro NGOs Network (NNGONET), was developed in close consultation with the district health management team with a view to effectively complement district efforts to build an integrated health system that addresses the sexual and reproductive health needs of women and adolescent girls. It will also seek to reduce harmful traditional practices that have negative impact on female health, particularly female genital mutilation and strengthens access to information and services.
“There is need for cultural leaders to embrace the project by opening up to discussions and guiding the communities on encouraging women to deliver in health facilities, instead of depending on traditional birth attendants,” according to a male traditional leader from Samunge Ward, Loliondo division. “This will reduce the number of deaths experienced in the communities.”
The programme will empower women to make informed choices in relation to their sexual and reproductive health, giving them more autonomy and also greater confidence to engage with structures and institutions relevant to ensuring equitable access to maternal and child health services.
“Given the long distances and the cost of traveling, mothers are reluctant to go to the health facilities for delivery,” says a trained traditional birth attendant from Arash Ward Health Centre. “Since they come to us, it is our responsibility to educate them about the importance of visiting the health facilities to be examined and also ensure they deliver at the health centre if they are HIV positive.”
Through a baseline study conducted in collaboration with the district authorities, civil society organisations and community leaders, the programme will complement efforts by Ngorongoro District Health Management to not only improve the health outcomes among women and adolescent girls in this region, but also provide evidence-based information for advocacy at national level for better health policies and practices that address the special needs of marginalised populations in Tanzania, particularly the pastoralist community.
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“Currently the Tanzania curriculum in secondary school does not adequately address issues of sexual and reproductive health,” says Haji Muzeei, head teacher, Nainokanoka Secondary school, Ngorongoro Division. “If the project supports schools to provide additional awareness and education, it will go a long way in improving awareness among the young girls in school. Teachers’ skills in sexual reproductive health also need to be improved to enable them handle issues in a community that deeply values some negative practices and understand how to handle the unique challenges girls face.”
Sexual and reproductive health rights is a priority area in ACORD’s right to health strategy which contributes to realising universal access to health services for marginalised groups in 17 countries where we work.