Cracking the measurement nut for maternal and newborn health. Innovations and applications for quality of care in Southern Tanzania

In this study, we will pilot, implement and evaluate a novel system to document and process health information collected in rural health facilities, to feed into the District Health Information System (DHIS-2) in Tandahimba district in Southern Tanzania. The system has been developed by Shifo, a Swedish Non-Governmental Organization, and is based on Smart Paper Technology (SPT). which allows scanning of traditional health facility registers.

By using a unique identifier, information is accumulated for each pregnant woman and her newborn. By this the information is available on care received for each woman, thus both nominator and denominator data are derived from the same system. This also allows the generation of effective coverage and mortality and morbidity indicators.

The system uses scannable smart paper forms for antenatal, intrapartum and postpartum care, which are modelled on the in-facility health management information system (HMIS / MTUHA) registers currently used in health facilities in Tanzania. Health care providers document each antenatal visit, delivery and postpartum care and postnatal visits on these forms instead of in the HMIS registers.

At the end of each month, without the need for tallying or summarising data, the smart paper forms are scanned and the information linked to the unique identifier is processed electronically to produce a pregnancy cohort. Once the information is digitized, indicators can easily be fed back to health care providers and district health managers through automated mobile phone messages.

This is a multi-country intervention project supported by the Government of Canada via its Partnerships for Strengthening Maternal, Newborn and Child Health (PS-MNCH). World Vision Canada (WVC) is the lead agency in consortium with other Canadian partners including Nutrition International (NI), HarvestPlus (H+), the Canadian Society for International Health (CSIH), the University of Toronto’s Dalla Lana School of Public Health (UofT) and the Hospital for Sick Children (HSC).

The University of Toronto is a key Monitoring and Evaluation (M&E) partner for the ENRICH and is responsible for providing overall technical and scientific guidance for monitoring and evaluation of the project over the life of the project. A major component of M&E is design and implementation of baseline, mid-term and end line in Kenya, Tanzania, Pakistan and Bangladesh in collaboration with in-country academic or research institutions.

Project Aims

The main aims of the project are to reduce maternal and child mortality through directly addressing malnutrition in the first 1000 days (from conception to child’s second birthday) in targeted regions in each country and inform national health and nutrition policies in these settings.

IHI will work with University of Toronto Canada in November 2018 to undertake Midterm evaluation in the intervention sites only. Main objectives for mid-term evaluation is to evaluate the progress of the program since inception as well as lessons learned to improve implementation in the second half of the program.

The program interventions are taking place in 3 districts in Shinyanga region (Kahama, Shinyanga rural and Kishapu) and 2 districts in Singida region (Manyoni and Ikungi). The overall evaluation design uses a quasi-experimental mixed method approach with repeated cross-sectional surveys at the baseline, mid-term and end line in five intervention districts and two control sites.

Specific objectives

1, To improve delivery and utilization of gender-responsive essential health and nutrition services to mothers, pregnant and lactating women (PLW), new-borns and children under five (CU5).

2. To increase consumption of nutritious foods and supplements by mothers, PLW, new-borns and CU5; and iii) To strengthen gender-responsive governance, policy and public engagement in maternal, new-born and child health in the target regions.