Even as she sits amid the tranquil thickets of bright green pigeon peas and clusters of broad-leafed ensete trees, Sumni Ali Haji has no doubt how difficult perilous life is in this remote corner of Zanzibar—especially for mothers and their children.
In early 2017, Sumni's son Hassan Faki nearly bled to death when he was less than 24 hours old. Born at home in Kachongwe, a speck of a village on Zanzibar's Unguja island, Hassan’s umbilical cord had bled so profusely that his face had gone pale and his skin, cool to the touch. Her last child—her sixth birth at home—had died for unknown reasons soon after birth. She was desperate not to lose another child.
Her ordeal is not uncommon. Despite high rates of antenatal care and relatively good geographical access to health facilities, nearly one in three deliveries in Zanzibar occur at home, and occurrence of preventable maternal and neonatal deaths remain unacceptably high. One in 18 children will not live to their fifth birthday.
Getting Hassan to the hospital was not going to be easy, Sumni knew. There were no ambulances available, and with the onset of the rainy season, the dirt roads—not easily navigable during the dry months—had become a soupy mix of mud and jagged rocks. Taxi drivers often refuse to come under such conditions. To make matters worse, Sumni’s husband, she said, had shown little concern for her well-being during her pregnancy and, anyway, was nowhere to be found the night of the birth.
That’s when Sumni called Amina Rashid Bakar, a Community Health Volunteer (CHV) trained by D-tree International’s Safer Deliveries program. The CHVs and the Safer Deliveries program serve as a crucial link connecting even Zanzibar’s remotest communities to the national health system. Delivering in a health facility is an important step in reducing maternal and neonatal mortality, and D-tree has succeeded in having 74 percent of the women registered in its program deliver in a health facility, compared to 55 percent in the same regions during the most recent population-based survey (2015).
Here’s how it works: Equipped with a decision-support app on their mobile phones, Amina and other CHVs visit clients three times during pregnancy and three times after delivery to assist with developing a birth plan. During their visits, CHVs screen for danger signs, referring patients to the appropriate level of health facility depending on the severity of the danger sign. CHVs also counsel women about healthy behaviors, note pregnancy outcome, and facilitate postpartum check-up in a health facility.
The connections don’t end there. The data CHVs collect using the D-tree mobile app are synchronized with a cloud-based server, where they can be aggregated or parsed to highlight healthcare trends, such the number of home deliveries per shehia, or village, and perinatal deaths. Those trends are then regularly reviewed in the form of online dashboards by Zanzibar’s District Health Management Teams to inform their decisions and follow-up actions. The Safer Deliveries program also links women to savings groups and community drivers so that women have money and transport prepared in advance of delivery to facilitate timely transport to a health facility.
The system doesn’t solve every challenge a mother faces—in the case of Sumni, Amina had registered her months earlier in the Safer Deliveries program, but Sumni’s family remained leery. And when it came for Sumni to give birth, her family summoned a traditional birth attendant to Sumni's home. The umbilical hemorrhage wasn't noticed until after she left.
Still, the system saves lives. When Amina heard Sumni had given birth at home, she headed to Kachongwe. “I came four hours after the baby was born. I knew the danger signs, and I saw the baby was bleeding very severely from the cord,” says Amina. “I asked the mother, ‘How long has the baby been bleeding?’ ‘All night. He has lost his color, and his eyes are yellow.’ “
Amina called a driver registered with the Safer Deliveries program, who responded immediately and rushed the child to Matemwe PHCU+, about five kilometers away. Matemwe is designated as a Primary Health Care Plus-level facility that is capable of providing basic health services, including delivery services. "I'm very happy with Amina," says Sumni. "As you can see my baby is alive today and very happy."
So, too, are thousands of other children, thanks to D-tree, its partners and the Ministry of Health. Together, they have scaled up the Safer Deliveries program 10 of 11 districts in Zanzibar. Working with 404 CHVs and 67 supervisors, the program aims to reach 30,000 women per year, which represents 80 percent of all pregnant women program-supported districts. All told, more than 37,500 women have been reached to date.
They include Sumni's neighbor Patma Mcha, who also credits Amina and the Safer Deliveries program for saving her baby, Hajra Haji Pili, now six months old. Amina had registered Patma in the program and encouraged her to receive antenatal screenings at the closest health facility—Matemwe PHCU+. Patma did so and was told on her last visit that her baby was breech presentation. She was advised to give birth at Kivunge Hospital, about 6 kilometers in the opposite direction, because Kivunge is designated as a “cottage hospital,” a facility better equipped to handle complicated births. “When Patma was in labor she called me to help find the transport … because she tried to find other means of transport without succeeding,” recalls Amina. “I called the driver and came immediately, the driver picked me on the way going to the client’s home, we pick the client immediately and she was even not able to walk.”
With Amina’s assistance, Kivunge Hospital admitted Patma and safely delivered Hajra, Patma's fourth child. “This service was really good as they received me well and I had peace,” says Patma. “We are poor. There is no transport to our village and the road is very bad. My husband is not working and while I make a little money selling bread, business is not good.” Patma said that with Amina's intervention, the driver agreed to take her to the hospital and be repaid later.
The driver’s offer was a sign of trust, certainly. But it was much more than that. It was a sign that by linking pregnant women and their newborns to critical healthcare, as D-tree and its partners are doing, lives can be saved.
For more information on D-tree International's innovative work in Tanzania and around the globe, visit: https://www.d-tree.org/ .