By Gaudiosa Tibaijuka and Katie Caiola
Iringa, Tanzania—Tatu doesn’t know how she became infected with the virus that causes AIDS, but the 18-year-old is doing all she can to protect her unborn baby from becoming infected too. On a cool day in the southern highlands of Tanzania’s Iringa region, Tatu stood with nine other pregnant women to await her appointment at the antenatal care (ANC) clinic at a Health Centre in Makete District.
ANC services help women, including those living with HIV, maintain normal pregnancies by preventing and detecting health problems and complications, and addressing them promptly. As part of this care, health providers use a “focused antenatal care” (FANC) approach, which tailors care to a woman’s individual needs. This integrated, innovative approach, advocated by Jhpiego, is particularly important for HIV-positive women, as it ensures that mothers have access to a comprehensive package of HIV services. These strengthened services include ongoing counseling, identification and management of common illnesses, such as tuberculosis, and distribution of antiretrovirals. A woman may need to take antiretroviral therapy (three drugs) for life, which reduces the risk of transmission of the virus to her baby, or a combination of drugs used in the short term to prevent her baby from becoming infected.
In Tanzania, Jhpiego has helped establish FANC services in 3,293 health facilities—69 percent of all facilities in the country—and educated 6,426 health care workers on how best to provide these vital services. This work has been supported by the U.S. Agency for International Development’s Mothers and Infants, Safe, Healthy and Alive (MAISHA) Program, with funding from the President’s Malaria Initiative. Other partners that support implementation of FANC include the Ministry of Health and Social Welfare, the National AIDS Control Program, UNICEF, UNFPA, the African Development Bank and local government entities.
Tatu’s initial visit to the ANC clinic provided her with information critical to the health of her unborn child: “I knew I was infected the first day I attended the clinic for my pregnancy,” says Tatu, as she waited to be seen by a health care professional. “I wouldn’t have known my status if I hadn’t attended the ANC clinic and would have gotten AIDS faster. I am benefiting from this facility.”
In Makete District, FANC services began in 2004, with the support of the U.S. Agency for International Development through Jhpiego Tanzania’s Primary Health Care Institute and regional and district health teams. The aim of the intervention was to strengthen and improve antenatal services at the Makete District Council’s 33 health facilities, which offer reproductive and child health services to more than 31,000 women of childbearing age.
Like all pregnant women who come to the ANC clinic, Tatu received counselling on how to prevent malaria and sexually transmitted infections, and on how to prepare for a clean and safe delivery. She is also monitored for serious complications like anemia and pre-eclampsia. During each ANC visit, Tatu learns the status of her HIV infection and is screened for possible opportunistic infections like tuberculosis. She is also linked to a Care and Treatment Centre to assess her need for antiretroviral drugs. To help Tatu financially, she has been referred to a support group for HIV-positive women that undertakes income-generating activities with the help of a nongovernmental organization.
Health facilities have seen vast improvements in the quality of care since FANC was introduced, according to Esther Mary Ngogo, the District Reproductive and Child Health Coordinator of Makete District Council. “Most women and their family members are aware that HIV, malaria and anemia are rampant in the area, and can contribute to deaths of women and newborns if advice from the ANC clinics is not considered adequately,” said Ngogo. “I have seen that Makete District health care providers are increasingly emphasizing what are the danger signs in pregnancy, labor and postnatal periods for both mother and newborn and advocating immediate reporting to nearest health facility.”
All 33 health facilities in Makete now have one or more service providers trained in FANC. These health care providers have helped pregnant women organize birth plans that include identifying a specific health facility and arranging for money and transport at the time of the baby’s birth. Services for the prevention of mother-to-child transmission of HIV (PMTCT) are also available at all health facilities where preventive care and treatment are being provided to mothers with HIV.
Like many HIV-positive women, Tatu isn’t sure how she contracted the virus. Her husband has delayed being tested. “He sometimes claims he tested and he is negative but I do not believe that…,” Tatu says warily. Despite these difficulties, she has been very pleased with the care and support she has received through the MAISHA program. “I feel cheerful whenever I come for my pregnancy check-up,” she says. “I get time to talk about my progress; providers give me options in addressing problems in addition to getting medicines and estimating my immunity [CD4 count].”
The encouraging experiences of pregnant women, such as Tatu, have encouraged health care providers to strengthen their outreach to families living in rural areas. As a result, more and more mothers-to-be are seeking out clinics with staff who have been trained in the FANC approach. With higher-quality care accessible, communities have come together to mobilize and help develop and furnish clinic space as well as provide transportation to clinics for pregnant women and mothers, especially during emergencies.
In some villages, young men have organized efforts to ensure that mothers get to health facilities, using a locally made wheelchair or stretcher if no other means of transport is available.
Ngogo says an increase in male involvement in other reproductive and child health services is becoming evident. For example, some men are now escorting their wives to ANC clinics and taking a more active role in the health of their families. With more support from community members, as well as family members, expectant mothers no longer have to bear the burden of pregnancy care alone.