Dar es Salaam, Tanzania – Hundreds of women sit under two shady trees at Malamba Mawili health center, chanting a song led by nurse Sarah Simama. The lyrics of the song portray a mother of many children:
Look at that woman!
She is struggling with her children—
one in her right hand,
one in her left,
another wrapped in front and behind her
and a slew of toddlers running in front of her.
Each lyric is accompanied by fun, articulate gestures—it’s a Billboard hit … for family planning. A song unlike any other, Simama dreamed it up to deliver a message with impact that draws women from neighboring communities. They come to listen, learn and decide for themselves how to plan their pregnancies in the best interest of their families. They come to access friendly, woman-centered, high-quality health care.
When she started her program 13 months ago, Simama treated a few women per week. Today, more than 100 arrive to access the high-quality health services offered by this dedicated and dynamic nurse. For Simama, being a nurse is not just a profession; it’s her passion. A wife and mother of four, the 44-year-old uses every opportunity available to advocate for women and empower them with knowledge about reproductive health so they can have healthier families.
“I always wanted to be a nurse, ever since I was a child. I even asked my mother several times why she didn’t go for the profession. In the village where I grew up, nurses and doctors were seen as very important people in the community, especially when they saved a person’s life,” she says.
As the matron in charge at Malamba Mawili Dispensary in Ubungo municipality, Simama has led by example to ensure women in her community have access to high-quality family planning services in a warm and welcoming facility. Throughout her career, from nursing school to Iringa Referral Hospital and Njiro Health Center’s nursing and midwifery department, Simama recognized the great need among women for information about reproductive health and pregnancy spacing in an environment that put them first. While working in an integrated maternal health clinic early in her career, Simama discovered that many women waited for long periods of time to see a health provider, leaving many frustrated. Others just left the clinic.
“I used to feel so bad that women were waiting many hours in my health facility. They looked desperate. I wanted to change that and make them enjoy [the experience], especially during the family planning session to make the session more participatory,” she says.
At Malamba Mawili, where she has worked since July 2018, she met many women who wanted to space their pregnancies but lacked information about family planning methods. Trained as a family planning provider and coach by The Challenge Initiative (TCI)-Tupange Pamoja project, Simama has been a champion in sensitizing women to the family planning services available to them. The Jhpiego-led project, which is funded by the Bill & Melinda Gates Foundation in collaboration with the Government of Tanzania, has been working in five regions, including Dar es Salaam, to scale up voluntary family planning services to reach more women, save lives and help build healthy, resilient communities.
The Tanzania government launched a new family planning initiative in 2012 when it pledged to increase the availability of modern contraception methods at all levels of its health system. Recognizing that healthier families lead to a more prosperous nation, Tanzania committed to increase its spending on family planning commodities by about 20 percent, from $6.1 million to $7.3 million by 2020.
Tanzania has engaged policymakers, strengthened outreach services, and challenged traditional norms and family sizes. With one of the highest child marriage prevalence rates in the world, the government’s commitment to reform key policies related to age of marriage, reduce teenage pregnancy and increase youth-friendly reproductive health facilities reflects its vision for a nation of healthier girls and women.
For example, family planning services reached 267,407 women in the Dar es Salaam region from July 2018 to June 2019. Of those, 80% received a long-acting reversible method in TCI-supported facilities.
Simama is among those skilled, confident health providers committed to meet clients where they are and offer health messages that speak to their needs. Educating women on family planning through song was her way of conveying a strong message that women wouldn’t easily forget. Through a variety of integrated approaches and outreach, she has worked to expand family planning efforts to other service areas within her facility over the past three years, increasing acceptance and reducing missed opportunities to consider contraception.
Simama remembers one of her first clients, a 37-year-old mother who had given birth seven times. “She looked older than her age and was very desperate not to have more babies,” she says. “Unfortunately, her husband also was not well informed about modern family planning and contraception. I took her through a family planning session and asked her husband to come as well.”
After their counseling session, the couple decided voluntarily to choose a family planning method right for them. “Now they are rejuvenated,” Simama says.
A Song That Sticks
Simama’s use of song spread quickly among government health providers who support the TCI project.
“From the first time, I saw her singing and dancing a song that has lyrics about the importance of family planning and the risks to women’s health associated with not accessing family planning, I was interested and decided to follow up,” says Rose Mnzava, who leads the TCI project in Tanzania.
TCI’s work in women’s health is making an impact.
“Women who attend family planning sessions at the facility are now increasing. They have become the champions to advocate for their partners and other women in their community,” Mnzava says. “I have never met any nurse like Sarah, who is so passionate. That song is so touching, and even when sung at home, it’s easy to pick up by other woman and even a husband because the message is powerful and tells the truth.”