Integrated Management of Pregnancy and Childbirth in Tanzania
The intrapartum period represents a time of high risk for women and newborns in Tanzania. Our project focuses on increasing utilization of high quality, evidence based care provided by midwives in the rural Lakes Region of Western Tanzania in alignment with the Ministry of Health and Social Welfare's (MoHSW) Road Map Strategic Plan to Accelerate the Reduction of Maternal, Newborn and Child Deaths. NYUCN is partnering with MoHSW, Tanzanian Nursing and Midwifery Council, Touch Foundation, Expert24 and Tigo to implement and evaluate an integrated obstetric practice and referral improvement intervention linking midwives at frontline health centers with providers at district hospital, utilizing innovative m-Health technology, provider and patient incentives, and social marketing. We have four aims 1.Provide the first electronic version of WHO's Integrated Management of Pregnancy and Childbirth IMPC guidelines for realtime screening and tracking on smart phones,eIMPC 2.Crosstrain midwives and clinicians for enhanced AP IP care and obstetrical emergency transfers using eIMPC 3. Incentivize utilization of assisted delivery services through pay for performance to midwives, and conditional cash transfers for low risk women to deliver at clinics, while referring high risk women to district hospital. This component will use the TigoPesa mobile banking service and include community engagement social marketing sessions prior to intervention rollout 4. Conduct a cluster randomized controlled trial (20 health facilities). Outcome metrics will include rates of preeclampsia screening, contraception use, assisted deliveries at clinics, emergency obstetric care at district hospital, and reduction in disability adjusted life years via cost effectiveness analysis to compare the integrated intervention verses standard care.