President and Fellows of Harvard College

THABITI: Empowering mothers and protecting children through surgical systems strengthening

Maternal and perinatal health

THABITI will empower women and protect children by eliminating the barriers that Tanzanian women and children face accessing high-quality, comprehensive obstetric surgery and anesthesia care.

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

Lack of access to quality surgical care contributes to high rates of preventable deaths and disabilities especially among women and children living in resource-constrained settings such as Tanzania.THABITI proposes to leverage Harvard’s expertise in strengthening global surgical systems and CCBRT’s expertise in providing life-changing surgical care through improving 1) access to healthcare facilities that provide surgery and anesthesia through community navigators and emergency care transport; 2) quality of healthcare through infrastructure enhancement, workforce up-skilling and continuous quality measurement and improvement; and 3) sustainable health care provision by linking communities to higher quality facilities via an innovative financing mechanism and referral model.This comprehensive community-to-facility health system strengthening intervention has the potential to save lives, prevent disability, and rehabilitate and restore the dignity of more than one million vulnerable women and children

Problem Statement

Pregnancy is a time of joyful expectancy, but in Tanzania, where the lifetime risk of dying from pregnancy-related causes is 1 in 24—200 times higher than in the USA—pregnancy is often a treacherous, unpredictable journey. For every mother who dies, 20 additional women suffer birth-related disabilities like fistula, and their newborns may suffer cerebral palsy, learning difficulties, and other injuries. This tragedy affects the poorest, most vulnerable women.These causes of death are avoidable and are often related to delays in the timely recognition of a delivery emergency, and timely access to quality treatment. At the facility level, contributing factors include workforce shortages, gaps in comprehensive surgical skills of facility staff, inadequate infrastructure, and weak referral and data utilization systems. In rural regions, delays in seeking care and lack of transport to a healthcare facility present significant barriers to accessing facility birth. Significant change can only occur through a multilevel, multifaceted systems-strengthening approach that ensures that pregnant women have continuous access to quality care, served by a skilled and motivated workforce. To date, investment in single simple initiatives to address these complex and interacting barriers has had limited success.

Solution Overview

Our solution targets four regions in Tanzania, hardest hit by maternal death and disability. It aims to improve access to safe and respectful care, including surgery, during and following pregnancy, preventing disability and improving outcomes for all women and newborns. We propose a three-pronged approach to improve: 1) the ability of women to reach comprehensive maternal healthcare, including surgery and anesthesia; 2) the quality of care at health facilities and; 3) and sustainable healthcare provision through linking communities to higher quality facilities via an innovative financing and referral model.Access to facilities will be enhanced by community navigators, community-based financing, and emergency transportation. An innovative, incentive-based financing intervention will link women’s access to care at high-quality facilities with improved capacity at those facilities. At the facility level, a capacity fund will address specific infrastructure needs. An inter-facility referral system will be strengthened through an information application to triage patients and connect facilities. Finally, CCBRT’s experience in the provision of upskilling training courses and mentorship will enhance the workforce, and quality of care will be comprehensively measured and addressed based on deficits identified by each facility. We will provide fistula repair and rehabilitation for those patients whose care—or lack of access to it—caused this dreaded obstetric complication. This solution draws from CCBRT’s 25-year experience in community engagement and capacity-building and Harvard’s experience in global research, monitoring, and evaluation of surgical systems. Implementation will engage local government and work from and within the current national strategy to strengthen existing health systems.

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