18, 53304 Hwy 44, Spruce Grove Alberta, T7X 3L3

18, 53304 Hwy 44, Spruce Grove Alberta, T7X 3L3

C Users Boma Africa AppData Local Microsoft Windows Temporary Internet Files Low Content IE5 TGH24VG9 Screen Shot 2011 10 12 at 9 27 34 AM 1 png

  • Boma la Mama

18, 53304 Hwy 44, Spruce Grove Alberta, T7X 3L3

Phone 1-780-993-2662

Web site

Boma la Mama aims to decrease maternal and neonatal mortality in the Arusha region of Tanzania by establishing and operating a birth centre and a midwifery education program.

Prepared by: Leesha Mafuru, RM, BHScMid

Table of Contents

  • Table of Contents
/ 1
  • Executive Summary
/ 2
  • Objects

  • Introduction- Management Team
/ 3
  • Situational Analysis
/ 5
  • Why is pregnancy dangerous in Tanzania?
/ 5
  • Cost of Maternity Care
/ 6
  • Homebirth vs. Hospital
/ 6
  • Infant Health
/ 6
  • Goals, Objectives, and Activities
/ 7
  • Prenatal Clinic
/ 7
  • Birth Centre
/ 8
  • The midwifery model of Care
/ 8
  • Sustainability
/ 9
  • Critical Prerequisites
/ 10
  • Risk Assessment
/ 11
  • Formative Evaluation Plan
/ 11
  • Method
/ 12
  • Timeline & Budget
/ 12
  • Year 5 and beyond: Maintaining operations
/ 13
  • Staff & Responsibilities
/ 14
  • Conclusion
/ 15
  • Reference list
/ 16

Executive Summary

Childbearing women and their newborns in Tanzania, Africa face rates of sickness and death that create one of the greatest global health disparities between high and low income countries. Women struggle in the face of poverty, lack of birth facilities, infection, disease, and unsafe conditions. For every 1000 babies who are born in Tanzania, 26 will be stillborn, 25 will die shortly after birth and 45 will die before their first birthday. Compare this to babies born in Canada where 3 in 1000 will be stillborn, 4 shortly after birth and 5 before their first birthday. Further for every 100,000 live-births in Tanzania, 460 women will die compared to 12 in Canada (World Health Statistics, 2013 WHO).

The purpose of Boma la Mama is to address this disparity byoffering high quality maternity care that includes educating women and communities about health issues; and educating Tanzanians as midwives.

Boma la Mama will be a fully equipped maternal health clinic, a centre for public education, and a midwifery school. The centre will give women in the Arusha region access to safe and dignified care, and for those interested, the opportunity to be educated as a midwife.

We anticipate that there will be substantial start-up costs in developing a sustainable project (See attached budget). Our fund raising strategy includes donations of monetary funds or supplies and services, through fundraising and public and private grants and partnerships. The timeframe for the development of the project is 5 years. Maintaining the centre will rely on continuing contributions as well as sustainable sources such partnership with Tanzanian health authorities, developing a site for international students (tuition fees), and a non-profit tourism company.

This summary seeks to invite readers to become familiar with our project, and hopefully to encourage donors to contribute the funding we need to provide this important centre for Tanzanians. We are excited at the prospect of partnering with you. Thank you for considering this request.

Introduction

Boma la Mama was established in 2011 with the goal of opening a birth centre and preparing skilled Tanzanian midwives to provide the maternity care that meets global standards. Born of the intense need for safe maternity care in Tanzania, as witnessed by Boma la Mama’s founder, this project’s success is guaranteed by the absolute need for its services, and the expertise of its carefully selected board of directors and management team.

In Tanzania women birth at home or at health clinics and hospitals; most of which are starkly underfunded and understaffed. Boma la Mama will improve maternal and newborn outcomes by providing safe and dignified maternity care at little or no cost.

Board of Directors & Management Team

Boma la Mama’s founder and executive director, Leesha Mafuru, holds a degree in Health Sciences in Midwifery from Laurentian University, Canada. She has spent recent years volunteering in prenatal clinics and labour wards in the Arusha and Meru regions of Tanzania, as well as apprenticing and practising in Canada and spending a period at a birth centre in post- earthquake Haiti. Mrs. Mafuru co-founded Boma Africa Foundation with her husband, Lawrence Mafuru of Tanzania. Mrs. Mafuru’s education, fluency of the Swahili language and Tanzanian birth culture, business experience, and personal determination and belief in this project will assure its success. Mrs. Mafuru will work closely with Tanzanian health care workers and the Ministry of Health to develop an integrated, sensitive, and effective health care centre and educational model.

Lawrence Mafuru holds a diploma in Wildlife Management and Tourism. His business experience, intense desire to help his native Tanzania, as well as a deep consciousness of Tanzanian culture led him to find and accept the role of inaugural director of the Boma Africa Foundation, Tanzania’s first proclaimed socially responsible, Non-Profit Tour Company.

Boma Africa Foundation is partnered with Boma la Mama. This foundation uses the tourism industry in Tanzania as a direct and sustainable means of financing community projects. Boma Africa leads safaris, Kilimanjaro expeditions and coordinates volunteer placements in Tanzania. Monies generated have been used to fund projects such as microcredit small business loans, providing supplies and training to health centres, sponsoring students, promoting arts programs, and more. Boma Africa has a strong commitment to maternal health, and Boma la Mama is be their principal project. As a locally registered company, Boma Africa Foundation is a strong presence and influence in the local community, has a history of managing successful aid projects, and is the ideal organization to bring assistance and change to its own community.

Marie- Eve Lord, is a practising as registered midwife in Ontario, Canada, Marie-Eve is excited to part of Boma la Mama's Team. She has been to Tanzania twice, and volunteered on two different hospital wards, providing her with the insight required to make Boma la mama successful. Holding a degree in Health Sciences in Midwifery, Marie-Eve also teaches for a Canadian Midwifery Education Program, bringing knowledge and experience for the Midwifery School curriculum to Boma la Mama.

Dr. Jorge Virchezis an associate professor at Laurentian University, and he has been teaching since 1991 in the department of Geography. His main fields of research have been First Nations, Canadian Studies, Environmental Restoration and Sustainable Development. Dr. Virchez has published several scientific papers in peer reviewed journals and has published two books. He has been involved in various community projects locally, as well as internationally, and is extremely welltravelled.

Kerstin Gafvelsimmigrated to Canada in 1984 after travelling around the world for 3 years. She returned to Sweden to complete her midwifery degree in 1990 and has since then worked in different areas of maternity care including: community based midwifery, women’s health clinic for pregnant socially high risk and new immigrant women, and as a Maternal Newborn Health Services Consultant for the Government of Nunavut. Kerstin is a co-founderof the Lucina Birth and Family Wellness Centre in Edmonton. Kerstin visited Tanzania in March 2013and is looking forward to many more visits.

Beverley O’Brien is a Professor of Nursing at that University of Alberta, a Registered Midwife (now in-active) in Alberta and member of the American College of Nurse-Midwives. Her interests are to support and strengthen women who are experiencing challenges to their comfort, safety and well-being during pregnancy, birth and early motherhood with a particular focus on global heath (Ghana, Thailand, Brazil). A recent project with Ghanaian nurse-midwives was to examine the utility and acceptance of the WHO partograph by birth attendants in low income countries. Recent activities include: 1) Principal Investigator Integration of Midwifery Services Evaluation Project (IMSEP) in Alberta. 2) Acting Director to the Midwifery Education Program, Nunavut Arctic College: Responsibilities included developing proposal for a midwifery education program to insure graduates meet Canadian midwifery standards while incorporating Inuit values and practices. She wrote a book “Birth on the Land: Memories of Elders and Traditional Midwives”. 3) She was a member of a working group that developed a national survey for the Canadian Perinatal Surveillance Systems (CPSS), Public Health Agency of Canada and Statistics Canada. Activities included participation in survey development, analysis, and preparation of manuscripts/final report. This included analysis and writing of 8 of 38 subsections of the report, What Mothers Say: Canadian Maternity Experiences Survey (2008).

Situational Analysis

Tanzania is considered one of the poorest countries in the world. With an estimated average per capita income of less than 500 USD, the majority of the population lives well below the World Bank poverty line. Its 42 million inhabitants have a life expectancy of 58 and the access to healthcare depends greatly on financial status, transportation and rural vs. urban living. While Tanzania has benefitted from relative political stability compared to its neighbouring nations, drought, corruption, and HIV/AIDS are major challenges that have impeded progress.

The women of Tanzania are in desperate need of safe and quality maternity care. While the infant mortality rate is 95 per 1000, the maternal rate is a shocking 578 in 100 000, one of the highest in the world. To provide a statistical comparison, Canada’s infant mortality is less than 5 per 1000, and its maternal mortality is 12 in 100 000. Current initiatives to improve Tanzanian figures focus on encouraging all women to deliver in health centres, and to attend prenatal clinic no less than 4 times, with at least 1 visit in the first trimester. While this campaign has been successful, it has resulted in health centres that are habitually above capacity, under stocked, and/ or understaffed.

Why is pregnancy dangerous in Tanzania?

There are countless factors that obstruct quality health care in Tanzania. Of these is lack of well supplied health centres, shortage of adequately trained health care staff, costs of services, lack of transportation, demographic of uneducated women, young marriage, and lack of child spacing. The common obstetrical complications faced by women are haemorrhage, infection, fistula, high blood pressure, eclampsia (high blood pressure, neurological problems including seizures), obstructed labour, and mortality; all of which can be reduced by regular and thorough antenatal visits, antenatal education, and attendance at a health facility with referral system in place. According to the National Bureau of Statistics of Tanzania, only 43% of women attend 4 or more prenatal visits, with merely 15% attending a clinic in the first trimester, and only 31% of women and babies had one or more postnatal check-up. Approximately 50% of births are reported to have been attended by a skilled attendant.

Cost of Maternity Care

The government of Tanzania provides free reproductive health services. While clinic visits and birth services are free, there are many unofficial costs that limit women’s access to prenatal and intra-partum care. The average cost of a normal delivery in hospital is 11.60 USD, this does not include informal costs such as buying cotton, gloves, medication, suture material, khanga (fabric) and other supplies, transportation, and “tipping” of staff. Many women do not live close to a health centre and do not have enough money to pay the bus fare, motorbike or taxi fees. Patients that have extra to money to “tip” the staff are given preferred treatment. The inability to meet these costs is a great barrier to accessing care. Family decision makers (e.g., husbands, mothers-in-law) may restrict consent to attend clinic. Many women choose to stay home and deliver with traditional birth attendants (TBA); where the cost averages only 2USD.

Homebirth vs. Hospital

While the government of Tanzania encourages all women to deliver in health centres, only approximately 50% are attended by a skilled attendant- the remaining are conducted at home with relatives or traditional birth attendants (TBA) without formal maternity training. Interviewed women list many reasons for choosing to stay home including wanting to be with family (no support people are allowed in hospital). Tanzanian women have reported that TBAs are kind and respectful while hospital staff can be physically and emotionally abusive. Other factors that affect women’s choice of home or hospital are: lack of money and transportation, overcrowding of hospital wards, lack of food, and lack of privacy. In addition, many women are not aware of the risks and benefits of staying at home vs. going to a health centre. They also may not have an understanding that their mortality rates are high in that they have nothing to relate this to.

Infant Health

Seventy-nine percent of neonatal deaths are attributed birth asphyxia, infection, and preterm delivery. All of these can be reduced by attendance at prenatal appointments and the presence of a skilled attendant at delivery.

In Tanzania 69-83% of women and babies have no postnatal care. Often those who do deliver in health centres are discharged before 24h without any examination of mother or baby prior to departure.

Children of mothers who die during childbirth complications are 10 times more likely to die than other children. Ensuring their optimal health and educating mothers greatly increases the health and survival of their children.

Objectives

  • To provide and operate a clinic that will provide maternity care to pregnant women and infants.
  • To provide breastfeeding consultation to nursing mothers.
  • To provide postpartum counselling to new mothers and their families.
  • To provide education and information to expectant mothers relating to preparation for birth and care during early childhood.
  • To provide childbirth education classes that focus on issues of family- centered care, preparation for parenting and nutrition.
  • To educate and instruct medical professionals on prevention of, and curative measures for various health problems in developing countries.

Boma la Mama will be built on a large compound with lush trees, vegetable gardens, a school, a birth centre, a group education area, and housing for students and visitors. The birth centre will be carefully planned with antenatal, intrapartum and postpartum areas as well as a adequately equipped laboratory. Boma la Mama will partner with the community to make the highest possible level of maternity care available to birthing families. The facets of achieving this goal are four-fold; 1) insuring that all midwives at the clinic are well prepared in that they meet international maternity care/midwifery standards and 2) operating a well-supplied clinic staffed with skilled birth attendants (trained midwives)3) educating birthing women and their familie4) making maternity care available and little or no cost to the women.

The Prenatal Clinic

Women will attend the clinic for prenatal care at little or no cost. Their maternity experience will be enriched by developing a relationship with their caregivers and being informed about maternity choices. Important foci for maternal education will bewarning signs throughout pregnancy/birth/early parenthood, maternal/infant nutrition, and family planning. It is estimated that education and provision of family planning can reduce up to 1/3 of maternal deaths. Boma la Mama will also offer regular pre and post natal visits to surrounding rural communities.

The Birth Centre

We are committed to adhering to culturally safe and global maternity care standards e.g., Ministry of Health of Tanzania and the World Health Organization. Women who are not in active labour will stay on the antenatal ward, those in labour will be admitted to a private labour-delivery-recovery (LDR) room, and the postpartum ward will have semi-private rooms. A kitchen and garden will facilitate the preparation of nutritious meals. . Our goal is to build a facility where approximately 100 births per month can be accommodated. Boma la Mama will provide a women centered space that offers private labour and delivery suites, support people during labour, dignified care, nutritious meals, and a limit of one patient per bed. Only women who are registered at the prenatal clinic will deliver at Boma la Mama. Consultation with physicians will be available to ensure that women are appropriately referred/transferred in a timely way if needed.

Midwifery at Boma la Mama:

Education: Global midwifery education standards have been developed that reflect a country’s ability to prepare midwives with basic competencies.

A two-step approach based on global standards (see below) will be taken by Boma La Mama. 1) Women from the region will be sponsored to take existing Tanzania nurse-midwifery program. Additional education will be provided by global midwives on site to insure that all midwives have global “entry-to-practice” competencies. 2) A longer term goal will be the development of a direct-entry midwifery education program. ICM developed the Global Standards for Midwifery Education to assist primarily three groups of users: 1) countries who do not yet have basic midwifery education but are wanting to establish such programmes to meet country needs for qualified health personnel, 2) countries with basic midwifery education programmes that vary in content and quality who wish to improve and/or standardize the quality of their midwifery programme(s), and 3) countries with existing standards for midwifery education who may wish to compare the quality of their programme to these minimum standards. ICM expects that those countries whose current standards exceed these Document amended 2013 Due for review 2017 3 Global Standards

Boma la Mama’sMidwiferyenhancedprogram will insure that students practice within the acceptable global midwifery model of care, which consists of the following principles:

  • Provide Informed Choice
  • Respect for pregnancy and birth as normal and healthy events in a woman’s life
  • Care for the woman and her family’s emotional, physical, and social well-being throughout the childbearing cycle
  • Practice as autonomous care providers
  • Provide continuity of care
  • Use ”best available evidence” to inform practice
  • Provide pre and post natal education
  • Attendance at labour and delivery
  • Provide well-woman and well-baby care
  • Identifying high risk women and consulting or referring as necessary

Sustainability