Imagine being transported—unconscious—in order to safely deliver your baby. That’s exactly what happened to Anna during a prolonged labor. While Anna had traveled to her village dispensary when she began to labor, the health care providers quickly determined that her labor was obstructed—and to save her, and her baby’s life, she would need an emergency caesarean-section (CS). That’s when a private taxi was called to get Anna to Shinyanga Regional Referral Hospital, where she immediately underwent a CS, delivering a healthy baby girl.1
Anna’s driver was part of an emergency transportation system established under the m-mama Project —or, Mobilizing Maternal Health—that throughout Tanzania’s Shinyanga region, is saving lives.
For the last three years, Pathfinder’s m-mama program, in partnership with the Touch Foundation and the Regional Health Management Team (RHMT) of Shinyanga, has worked to address the ‘three delays’ that contribute to maternal and neonatal emergencies. These ‘three delays’ have direct impacts on mothers’ and babies’ health and survival. They are:
- Delays in making the decision to seek care
- Delays in identification of—and transport to—a medical facility
- Delays in receipt of adequate, and appropriate, treatment
M-mama has developed an innovative three-tiered approach to removing these three delays: engaging the community; providing emergency transport for mothers and babies; and strengthening the local health systems so when mothers and babies arrive at a health facility, they receive the quality care they need.
Step 1: Engaging the Community
Community engagement is at the heart of M-Mama’s success. Throughout Shinyanga, the m-mama program has developed ‘Community Care Groups’, and leaders of these groups conduct monthly meetings with groups of pregnant and postpartum women.
Facilitators ensure that all women in the groups have access to the toll-free number developed for the emergency transportation system and identify women exhibiting ‘danger signs’ during their pregnancies. The m-mama program has distributed more than 30,000 information, education, and communication materials, disseminating critical maternal and neonatal health messages across the region and building awareness about the emergency transport program.
Step 2: Establishing a Dispatch Center and Providing Emergency Transport for Mothers
The next step in addressing the ‘three delays’ was ensuring that when women needed care, they could get to local health facilities. To do this, m-mama first developed a dispatch center. This involved developing a mobile application, setting toll-free numbers for users and drivers, and recruiting and training dispatchers. M-mama also coordinated emergency transportation options for ambulances and private taxis and set up systems so private taxis were reimbursed properly.
M-mama engaged a network of local community taxi drivers in places where ambulances weren’t readily available. Expectant moms—or their families and neighbors—can now make toll-free calls 24/7 to a local dispatch center, where call handlers assess the patient’s condition using the “m-mama App,” which was designed to determine what kind of care the patient needed.
To ensure the best outcomes, dispatchers participated in detailed trainings on maternal and newborn health and triaging difficult cases from the m-mama program staff. If it is determined that care is required, the nearest ambulance driver or community taxi driver is identified on the app, and they receive a request to take the woman to the closest health facility.
Before the inception of m-mama, taxi drivers would often refuse to transfer patients, as rates were negotiable and couldn’t be agreed upon. M-mama addressed this challenge by setting pre-negotiated rates and paying taxi drivers directly upon completion of their trips
Step 3: Strengthening Local Health Systems
The third component of m-mama was to ensure that once women received transport, the care they got was what they needed. Pathfinder conducted basic emergency obstetric and newborn care trainings, developed specifically to reduce maternal and newborn mortality.
Pathfinder trained 30 health care providers that served 15 local facilities and worked to ensure mothers and babies received quality care when they arrived. To ensure that these trainings translated into real-world scenarios, the m-mama project tailored supportive supervision, linking providers with clinical mentorship to ensure they had the right skills to provide quality care. These skills included managing pre-eclampsia and eclampsia, ensuring availability of essential medicine and supplies, and supporting the correct use of the partograph, a graphic record of key data recorded during a woman’s labor.
Today, m-mama is up and running in all six districts of Tanzania’s Shinyanga region, and is providing life-saving care to more than 140,000 women in the 15 facilities supported by the program. Community taxis have transported more than 9,000 women in the six districts, and in the upcoming six years, the program will be scaled to 14 districts.
- Established four toll-free numbers for m-mama users, with 10 billboards displaying the numbers in the region
- Distributed 30,000 leaflets and 800 posters about the program
- Supported 5,796 emergency transportations
- Engaged 220 healthcare workers in trainings on basic emergency obstetric and newborn care and neonatal intensive care
- Ensured sustainability:
- Year 1: Project paid 100% of community taxi costs
- Year 2: Project paid 50% and government paid 50%
- Year 3: Government paid 100% of community taxi costs
- Reached 7,391 women with sexual and reproductive health information
- Supported 97% (3,180) of mothers who attended sessions to deliver at health facilities
For more details on m-mama, including results, see our Fact Sheet: m-mama – Mobilizing Maternal Health